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 measure the extent of adjustments to one’s life caused by a given event. It’s based on the premise that regardless of whether an event is positive or negative, it can be stress-inducing by requiring a person to make significant changes to their daily routines. The SSRS can help assess a person’s stress levels and predict the likelihood of 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 or 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.

Some of the life events on the scale include:

• 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)
• Pregnancy (40 mean value)
• Sexual difficulties (39 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 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) 

The idea is to add up the scores for any of the listed items that you experienced in a 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. 

Having a score of 150 points or less indicates a "relatively low amount of life change and a low susceptibility to stress-induced health breakdown." A score of 150–300 suggests a "50% chance of a major health breakdown" within the next two years, and 300 points or more increases the odds of a breakdown to around 80%, according to the test's statistical prediction model. 

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 each of the 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 correlated 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 suggest that the sailors' life change units correlated with their illness scores, though the study notes that life events are not the sole predictors of the onset of an illness. 

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. 

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

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, which 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 are contributing to high stress levels among individuals and communities.

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

• 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 a sense of overload
• Maintaining a network of social support
• 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

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Looking to reduce stress?

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Therapy for stress-related concerns

Therapy may help you find ways to navigate changes in your life in a healthy way 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 therapist based on your needs and preferences as reflected in your answers to a brief questionnaire. Then, you can connect with them remotely via phone, video, and/or in-app messaging, all from the comfort of home or anywhere you have an internet connection. A growing body of research suggests the effectiveness of online therapy for addressing a variety of mental health concerns. Some studies have also indicated its value in helping individuals reduce stress-related symptoms in particular and improving mental well-being overall.