What Is The Holmes And Rahe Stress Scale?

The Holmes and Rahe Stress Scale, also known as the Social Readjustment Rating Scale (SSRS), is a self-report questionnaire designed to measurea person’s probability of having a health breakdown based on the life events they experienced in the past year. It’s based on the premise that regardless of whether various life events are positive or negative, they can be stress-inducing by requiring a person to make significant changes to their daily routines. The SSRS can help assess human stress levels and predict the likelihood of potential health risks, such as a stress-related health breakdown, within the next two years. See below for a brief overview of the SSRS plus tips for coping with stress in a healthy way.

The Holmes and Rahe Stress Scale: A brief overview

The Holmes and Rahe Stress Scale is a self-report questionnaire that uses "objectively weighted life change units to index the relative level of adaptive demand associated with a particular life event." It lists potentially stressful life events that would require a person to make adjustments in such a way or to such an extent that is likely to induce stress. It’s often used by healthcare providers, such as doctors and therapists, to determine a person’s risk of future health challenges, but you can also take it yourself to get an idea of whether you might benefit from stress-reducing measures.

What life events are on the scale?

Some of the life events on the scale include the following:

• Death of a spouse (100 mean value)
• Major change in the health or behavior of a family member (44 mean value) 
• Divorce (73 mean value)
• Marital separation (65 mean value)
• Detention in jail or other institution (63 mean value)
• Major personal injury or illness (53 mean value)
• Marital reconciliation (45 mean value)
• Pregnancy (40 mean value)
• Sexual difficulties (39 mean value)
• Gaining a new family member (39 mean value)
• Major change in financial state or financial status (38 mean value)
• Changing to a different line of work (36 mean value)
• Foreclosure on a mortgage or loan (30 mean value)
• Trouble with in-laws (29 mean value)
• Son or daughter leaving home (29 mean value)
• Beginning or ceasing formal schooling (26 mean value)
• Outstanding personal achievement (28 mean value)
• Death of a close friend (37 mean value) 
• Death of a close family member (63 mean value) 
• Major change in working hours or conditions (20 mean value)
• Changing to a new school (20 mean value)
• Major change in usual type and/or amount of recreation (19 mean value)
• Major change in church activities (19 mean value)
• Major change in social activities (18 mean value)
• Major change in sleeping habits (16 mean value) 
• Major change in eating habits (15 mean value) 
• Revision of personal habits (24 mean value) 
• Taking on a mortgage (31 mean value) 
• Major change in the number of family get-togethers or family reunions (15 mean value)
• Minor violations of the law (traffic tickets, jaywalking, disturbing the peace, etc.) (11 mean value)

The idea is to add up the scores for any of the listed items that you experienced in the past year. An event that was experienced more than once can be counted twice. The total sum relates to your estimated stress levels, which can be used to predict your likelihood of having related health challenges within two years. 

What does the Holmes and Rahe Stress Scale measure?

The Holmes and Rahe Stress Scale measures the level of stress a person has experienced over the past year due to various life events. It uses this to predict the likelihood of potential health risks, particularly physical health problems, arising within the next two years. Stress can be seen as both a mental and physical phenomenon. It can significantly affect overall health and may contribute to a wide range of health issues, so it can be beneficial to be aware of the level of stress you’re experiencing. 

How the stress scale is scored

The stress scale is scored by adding up the values of the events a person has experienced within the past year, meaning the past 365 days, rather than the previous year of the calendar. A score of 150 or less indicates a low risk of a stress-induced health breakdown. Meanwhile, a score between 151 and 300 indicates an estimated 50% risk of a major health breakdown in the next two years. Finally, a score over 300 can imply an approximate 80% risk of experiencing a major health breakdown within the next two years.

Adult vs. non-adult versions

Non-adults can take an alternative version of the Holmes and Rahe Stress Scale. This version of the scale includes different life events than the adult version. For example, the most stressful event on the non-adult scale is the death of a parent rather than that of a spouse. An unplanned pregnancy or abortion is also listed at the top of the scale, as the prospect of being pregnant, giving birth, and child-rearing as a young person typically comes with significant stress. Below are a few other events that are included:

• Acquiring a visible deformity (80 mean value)
• Change in acceptance by peers (67 mean value)
• Discovery of being an adopted child (63 mean value)
• Having a visible congenital deformity (62 mean value)
• Not making an extracurricular activity (55 mean value)
• Beginning to date (51 mean value)
• Being accepted at new school/college of choice (43 mean value)
• Brother or sister leaving home (37 mean value)
• The addition of a third adult to the family (34 mean value)
• Becoming a full-fledged member of a church (31 mean value)
• Decrease in arguments between parents (26 mean value)

The history of the scale

This scale was created by psychiatrists Thomas Holmes and Richard Rahe in 1967 to examine the correlation between stressful events and illness. To do this, they had over 5,000 patients rank 43 events based on a relative score, giving each one a different weight according to its impact. They then examined the medical records of these individuals to help them properly quantify the impact of the listed events. They posited that a higher total score would correlate with a greater likelihood of a person experiencing illness. Their theory and findings were published as the Social Readjustment Rating Scale. 

In the following years, various studies were conducted to test the scale. For example, in 1970, one study involving American sailors assessed how many stressful life events they had experienced within the last six months. The total scores experienced by each participant were recorded, and their health was tracked over the next six months. Findings suggested that the sailors' life change units correlated with their illness scores, though the study noted that life events are not the sole predictors of the onset of an illness. For example, other aspects of an individual’s life, such as their general living conditions, can impact their health.

Other subsequent studies suggested potential limitations of the SRRS, such as the possibility of cultural factors impacting one's reaction to certain life events. Nevertheless, it’s been noted that results seem to be largely consistent despite cultural differences. 

The American Institute of Stress has many other tools that can also be used to assess a person’s stress level and negative items that could be impacting their physical and mental health. 

Limitations of the scale

While the scale may evaluate the potential of an event to be stress-inducing, it does not necessarily evaluate each event's impact on an individual level. For example, experiencing the death of a partner—the highest score on the scale—may affect individuals differently depending on the circumstances and a person’s existing coping strategies.

Other potential limitations of the scale include:

• No accounting for the infrequency of major events in one's life
• A lack of inclusion of other potential stressors, such as smaller daily stressors, awareness of global conflicts, and experiences of racism
• Some ambiguous or outdated listed items 
• The role of individual responses to stress
• The role of individual coping mechanisms for stress

What to do after taking the scale

After taking the scale, it may be helpful to employ stress management skills to decrease the odds of experiencing a health breakdown. A few simple strategies to decrease stress include getting plenty of quality sleep, eating nutritious food, staying hydrated, and exercising regularly. 

Finding healthy coping skills, such as engaging with hobbies, spending time with loved ones, and connecting with nature, can also be beneficial. If your experience of stress has become overwhelming or you’re not sure how to handle it on your own, consider working with a mental health professional like a licensed therapist.

About stress and coping mechanisms

The American Psychological Association (APA) defines stress as "the physiological or psychological response to internal or external stressors." This response typically involves changes affecting the entire body, mind, and emotions, and these changes may contribute to mental and physical illnesses when acute or prolonged. 

According to the latest findings from the APA's annual survey, Stress in America, "the COVID-19 pandemic, global conflicts, racism and racial injustice, inflation, and climate-related disasters are all weighing on the collective consciousness of Americans." In other words, there are many factors today that could be contributing to high stress levels among individuals and communities.

There are many helpful ways to manage stress, however, which may reduce its potentially negative impact on individual health. Below are several examples:

• Engaging in relaxation techniques, deep breathing exercises, and mindfulness
• Exercising regularly
• Taking the time to do activities you enjoy
• Journaling to express your thoughts and emotions
• Spending time in nature
• Volunteering for causes you believe in
• Prioritizing your tasks to limit overload
• Maintaining a social support network
• Adopting healthy sleep habits
• Limiting exposure to social media and the news
• Avoiding unhealthy habits, such as smoking and drinking heavily
• Seeking therapy for additional support

Therapy for stress-related concerns

Therapy may help you find healthy ways to navigate changes in your life so you can minimize stress and reduce your chances of negative health outcomes. If the prospect of finding a therapist near you and regularly commuting to and from in-person appointments seems like it would add to your stress, you might consider online therapy as a more convenient alternative.

With an online therapy platform like BetterHelp, you can get matched with a licensed mental health professional based on your needs and preferences as reflected in your answers to a brief questionnaire. Then, you can connect with your therapist remotely via phone, video, or live chat, all from the comfort of home or anywhere you have an internet connection. 

A growing body of research supports the effectiveness of online therapy in treating a variety of mental health concerns. Some studies have also indicated its value in helping individuals learn stress management skills and improve overall health.