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The Holmes–Rahe Stress Inventory

Article  in  Occupational Medicine · October 2017

DOI: 10.1093/occmed/kqx099

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QUESTIONNAIRE REVIEW
The Holmes–Rahe Stress Inventory
History
In 1967, psychiatrists Thomas Holmes and Richard
Rahe examined over 5000 patient’s medical records
to determine whether stressful events cause illnesses.
Patients ranked a list of 43 life events based on a relative
score. Each event, called a Life Change Unit (LCU), had
a different ‘weight’ for stress. More events mean a higher
score. The higher the score, and the larger the weight of
each event, the more likely the patient would become ill.
Their results were published as the Social Readjustment
Rating Scale (SRRS) [1], now commonly known as the
Holmes and Rahe Stress Scale. Subsequent validation
supported the links between stress and illness [2].
Description
The premise is that stressors can be ranked by the degree
of change or upheaval they typically cause in individuals’
lives. The scale lists common stressful events and arbi-
trarily assigns a value of 50 ‘LCUs’ to the stress caused
by marriage. Interpretation of the overall score is dif-
ficult because of the large interpersonal differences in
individual’s ability to cope and their particular reactions
to stress.
A total of ≤150 is good, suggesting a low level of stress
and a low probability of developing a stress-related dis-
order. If the score is ≥300, statistically there is an almost
80% chance of getting ill in the next 2 years. If the score
is ≥150 to ≥299, the chances are about 50%. At <150,
~30% chance of illness. This scale seems to suggest that
change in life requires an effort to adapt and then an
effort to regain stability.
Items
Although the scale was originally developed and vali-
dated on males, it provides useful results for both male
and female subjects. There is inherent variation because
stress caused by a particular stressor varies greatly from
one person to the next because of the variability in the
individual’s circumstances, interpretation, goals, per-
sonality, values coping strategy and resources. Although
the scale is well researched, the values are only a rough
approximation at best [1,3]. The 43  ‘life events’ and
the LCU score that was allocated to them after all the
subjects’ scores had been analysed are mean values,
standardized for age, sex, race, religion etc. Each loosely
worded category can have a wide range of possible inter-
pretations. The chosen ‘life changes’ reflect life, values
© The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
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Downloaded from https://academic.oup.com/occmed/article-abstract/67/7/581/4430935/The-Holmes-Rahe-Stress-Inventory
by Peter Noone
on 16 October 2017
Occupational Medicine 2017;67:581–582
doi:10.1093/occmed/kqx099
and the work and social environment as it existed for a
very different generation.
Validity
Rahe validated the scale in 1970 as a predictor of illness [4]
using 2500 US sailors rating scores of ‘life events’ over the
previous 6 months. Over the subsequent 6 months, detailed
records were kept of the sailors’ health. The +0.118 cor-
relation between stress scale scores and illness supported
a link between life events and illness [5], including visits
to medical clinics, or medical dropouts from underwater
demolitions training. The scale was also assessed against
different populations within the USA (African, Mexican
and white American groups) [6] and cross-culturally, com-
paring Japanese [7] and Malaysian [8] with American pop-
ulations. Malaysians exhibited different attitudes implying
different stress at the same score. This suggests weakness
of the SRRS in certain areas, with different cultural group
reactions to different life events. In 1978 Gerst tested SRRS
reliability and found that rank ordering remained extremely
consistent both for healthy adults (r  =  0.96–0.89) and
patients (r = 0.91–0.70) [9].
Conclusion
The SRRS is surprisingly consistent despite the cross-
cultural differences one would expect. Most people
experience major life events infrequently hence a better
measure might look at the stresses and strains of daily
life [10].
Source
The questionnaire is free to use and downloadable [1].
Peter A. Noone
e-mail: peter.noone@som.org.uk
References
1. Holmes TH, Rahe RH. The Social Readjustment Rating
Scale. J Psychosom Res 1967;11:213–218.
2. Rahe RH, Arthur RJ. Life change and illness studies: past
history and future directions. J Human Stress 1978;4:3–15.
3. Zimbardo PG, Weber AL, Johnson RL. Psychology. 5th edn.
Boston, MA: Allyn and Bacon, 2005.
4. Rahe RH, Mahan JL Jr, Arthur RJ. Prediction of near-
future health change from subjects’ preceding life changes.
J Psychosom Res 1970;14:401–406.
 582  OCCUPATIONAL MEDICINE

5. Rahe RH, Biersner RJ, Ryman DH, Arthur RJ. Psychosocial
predictors of illness behavior and failure in stressful train-
ing. J Health Soc Behav 1972;13:393–397.
6. Komaroff AL, Masuda M, Holmes TH. The Social
Readjustment Rating Scale: a comparative study of
Negro, Mexican and white Americans. J Psychosom Res
1968;12:121–128.
7. Masuda M, Holmes TH. The Social Readjustment Rating
Scale: a cross-cultural study of Japanese and Americans. J
Psychosom Res 1967;11:227–237.
8. Woon TH, Masuda M, Wagner NN, Holmes TH. The
Social Readjustment Rating Scale: a cross-cultural
study of Malaysians and Americans. J Cross-Cult
Psychol 1971;2:373–386.
9. Gerst MS, Grant I, Yager J, Sweetwood H. The reliability of
the Social Readjustment Rating Scale: moderate and long-
term stability. J Psychosom Res 1978;22:519–523.
10. Holm JE, Holroyd KA. The Daily Hassles Scale (Revised):
does it measure stress or symptoms? Behav Assessment
1992;14:465–482.

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by Peter Noone
on 16 October View
2017
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