# Holmes and Rahe stress scale

The Holmes and Rahe stress scale (/reɪ/), also known as the Social Readjustment Rating Scale, is a list of 43 stressful life events that can contribute to illness. The test works via a point accumulation score which then gives an assessment of risk. The American Institute of Stress, for instance, regards a score of 300 or more as an "80% chance of health breakdown within the next 2 years". While there is good evidence that chronic stress can lead to ill health, there is not much evidence to support the ranking of stressful life events in this manner.

## Development

In 1967, psychiatrists Thomas Holmes and Richard Rahe examined the medical records of over 5,000 medical patients as a way to determine whether stressful events might cause illnesses. Patients were asked to tally a list of 43 life events based on a relative score. A positive correlation of 0.118 was found between their life events and their illnesses.
Their results were published as the Social Readjustment Rating Scale (SRRS), known more commonly as the Holmes and Rahe Stress Scale. Subsequent validation has supported the links between stress and illness.

## Supporting research

Rahe carried out a study in 1970 testing the validity of the stress scale as a predictor of illness. The scale was given to 2,500 US sailors and they were asked to rate scores of 'life events' over the previous six months. Over the next six months, detailed records were kept of the sailors' health. There was a +0.118 correlation between stress scale scores and illness, which was sufficient to support the hypothesis of a link between life events and illness.
In conjunction with the Cornell medical index assessing, the stress scale correlated with visits to medical dispensaries, and the H&R stress scale's scores also correlated independently with individuals dropping out of stressful underwater demolitions training due to medical problems. The scale was also assessed against different populations within the United States (with African, Mexican and White American groups). The scale was also tested cross-culturally, comparing Japanese and Malaysian groups with American populations.

## Criticism

The original scale, as well as its utility over time and differing circumstances, has faced scrutiny.
An article in Journal of Human Stress (Behavioral Medicine) noted several limitations, including:
* Lack of differentiation between favorable versus adverse life events
* Ambiguity of life events described
* Confounding dependent and independent variables
* Lack of specificity in items listed

## Adults

The sum of the life change units of the applicable events in the past year of an individual's life gives a rough estimate of how stress affects health.
| Life event | Life change units |
| Death of a spouse | 100 |
| Divorce | 73 |
| Marital separation | 65 |
| Imprisonment | 63 |
| Death of a close family member | 63 |
| Personal injury or illness | 53 |
| Marriage | 50 |
| Dismissal from work | 47 |
| Marital reconciliation | 45 |
| Retirement | 45 |
| Change in health of family member | 44 |
| Pregnancy | 40 |
| Sexual difficulties | 39 |
| Gain a new family member | 39 |
| Business readjustment | 39 |
| Change in financial state | 38 |
| Death of a close friend | 37 |
| Change to different line of work | 36 |
| Change in frequency of arguments | 35 |
| Major mortgage | 32 |
| Foreclosure of mortgage or loan | 30 |
| Change in responsibilities at work | 29 |
| Child leaving home | 29 |
| Trouble with in-laws | 29 |
| Outstanding personal achievement | 28 |
| Spouse starts or stops work | 26 |
| Beginning or end of school | 26 |
| Change in living conditions | 25 |
| Revision of personal habits | 24 |
| Trouble with boss | 23 |
| Change in working hours or conditions | 20 |
| Change in residence | 20 |
| Change in schools | 20 |
| Change in recreation | 19 |
| Change in church activities | 19 |
| Change in social activities | 18 |
| Minor mortgage or loan | 17 |
| Change in sleeping habits | 16 |
| Change in number of family reunions | 15 |
| Change in eating habits | 15 |
| Vacation | 13 |
| Major holiday | 12 |
| Minor violation of law | 11 |
Score of 300+: At risk of illness.
Score of 150-299: Risk of illness is moderate (reduced by 30% from the above risk).
Score < 150: Slight risk of illness.

## Non-adults

A modified scale has also been developed for non-adults. Similar to the adult scale, stress points for life events in the past year are added and compared to the rough estimate of how stress affects health.
| Life event | Life change Units |
| Death of parent | 100 |
| Unplanned pregnancy/abortion | 100 |
| Getting married | 95 |
| Divorce of parents | 90 |
| Acquiring a visible deformity | 80 |
| Fathering a child | 70 |
| Jail sentence of parent for over one year | 70 |
| Marital separation of parents | 69 |
| Death of a brother or sister | 68 |
| Change in acceptance by peers | 67 |
| Unplanned pregnancy of sister | 64 |
| Discovery of being an adopted child | 63 |
| Marriage of parent to stepparent | 63 |
| Death of a close friend | 63 |
| Having a visible congenital deformity | 62 |
| Serious illness requiring hospitalization | 58 |
| Failure of a grade in school | 56 |
| Not making an extracurricular activity | 55 |
| Hospitalization of a parent | 55 |
| Jail sentence of parent for over 30 days | 53 |
| Breaking up with boyfriend or girlfriend | 53 |
| Beginning to date | 51 |
| Suspension from school | 50 |
| Becoming involved with drugs or alcohol | 50 |
| Birth of a brother or sister | 50 |
| Increase in arguments between parents | 47 |
| Loss of job by parent | 46 |
| Outstanding personal achievement | 46 |
| Change in parent's financial status | 45 |
| Accepted at college of choice | 43 |
| Being a senior in high school | 42 |
| Hospitalization of a sibling | 41 |
| Increased absence of parent from home | 38 |
| Brother or sister leaving home | 37 |
| Addition of third adult to family | 34 |
| Becoming a full-fledged member of a church | 31 |
| Decrease in arguments between parents | 27 |
| Decrease in arguments with parents | 26 |
| Mother or father beginning work | 26 |
Score of 300+: At risk of illness.
Score of 150-299: Risk of illness is moderate. (reduced by 30% from the above risk)
Score < 150: Slight risk of illness.