Holmes and Rahe stress scale

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The Holmes and Rahe stress scale (/r/)[1] 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".[2] 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.[3]


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),[4] known more commonly as the Holmes and Rahe Stress Scale. Subsequent validation has supported the links between stress and illness.[5]

Supporting research[edit]

Rahe carried out a study in 1970 testing the validity of the stress scale as a predictor of illness.[6] 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.[7]

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.[7] The scale was also assessed against different populations within the United States (with African, Mexican and White American groups).[8] The scale was also tested cross-culturally, comparing Japanese[9] and Malaysian[10] groups with American populations.


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: Only have a slight risk of illness.


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.[11][12]

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.

See also[edit]



  1. ^ Maris, Ronald W. (2019). Suicidology: A Comprehensive Biopsychosocial Perspective. New York: Guilford. p. 125. ISBN 978-1-4625-3698-6.
  2. ^ Marksberry, Kellie. "Holmes- Rahe Stress Inventory". The American Institute of Stress. Retrieved 2021-07-25.
  3. ^ Salleh, Mohd. Razali (October 2008). "Life Event, Stress and Illness". The Malaysian Journal of Medical Sciences. 15 (4): 9–18. ISSN 1394-195X. PMC 3341916. PMID 22589633.
  4. ^ Holmes TH, Rahe RH (1967). "The Social Readjustment Rating Scale". J Psychosom Res. 11 (2): 213–8. doi:10.1016/0022-3999(67)90010-4. PMID 6059863.
  5. ^ Rahe RH, Arthur RJ (1978). "Life change and illness studies: past history and future directions". J Hum Stress. 4 (1): 3–15. doi:10.1080/0097840X.1978.9934972. PMID 346993.
  6. ^ Rahe RH, Mahan JL, Arthur RJ (1970). "Prediction of near-future health change from subjects' preceding life changes". J Psychosom Res. 14 (4): 401–6. doi:10.1016/0022-3999(70)90008-5. PMID 5495261.
  7. ^ a b Rahe RH, Biersner RJ, Ryman DH, Arthur RJ (1972). "Psychosocial predictors of illness behavior and failure in stressful training". J Health Soc Behav. 13 (4): 393–7. doi:10.2307/2136831. JSTOR 2136831. PMID 4648894.
  8. ^ Komaroff AL, Masuda M, Holmes TH (1968). "The social readjustment rating scale: a comparative study of Negro, Mexican and white Americans". J Psychosom Res. 12 (2): 121–8. doi:10.1016/0022-3999(68)90018-4. PMID 5685294.
  9. ^ Masuda M, Holmes TH (1967). "The Social Readjustment Rating Scale: a cross-cultural study of Japanese and Americans". J Psychosom Res. 11 (2): 227–37. doi:10.1016/0022-3999(67)90012-8. PMID 6059865.
  10. ^ Woon, T.H.; Masuda, M.; Wagner, N.N.; Holmes, T.H. (1971). "The Social Readjustment Rating Scale: A Cross-Cultural Study of Malaysians and Americans". Journal of Cross-Cultural Psychology. 2 (4): 373–386. doi:10.1177/002202217100200407. S2CID 145729382.
  11. ^ "Archived copy" (PDF). Archived from the original (PDF) on 2014-08-01. Retrieved 2014-06-30.{{cite web}}: CS1 maint: archived copy as title (link)
  12. ^ "Holmes and Rahe Stress Scale". prezi.com.

Further reading[edit]