What is the Holmes and Rahe Stress Scale?

Introduction

The Holmes and Rahe stress 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.

Brief History

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.

Scale

  • 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.

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 EventLife Change Units
Death of a Spouse100
Divorce73
Marital Separation65
Imprisonment63
Death of a Close Family Member63
Personal Injury or Illness53
Marriage50
Dismissal from Work47
Marital Reconciliation45
Retirement45
Change in Health of Family Member44
Pregnancy40
Sexual Difficulties39
Gain a New Family Member39
Business Readjustment39
Change in Financial State38
Death of a Close Friend37
Change to Different Line of Work36
Change in Frequency of Arguments35
Major Mortgage32
Foreclosure of Mortgage/Loan30
Change in Responsibilities at Work29
Child Leaving Home29
Trouble with In-Laws29
Outstanding Personal Achievement28
Spouse Starts or Stops Work26
Beginning or End of School26
Change in Living Conditions25
Revision of Personal Habits24
Trouble with Boss23
Change in Working Hours or Conditions20
Change in Residence20
Change in Schools20
Change in Recreation19
Change in Church Activities19
Change in Social Activities18
Minor Mortgage/Loan17
Change in Sleeping Habits16
Change in Number of Family Reunions15
Change in Eating Habits15
Vacation13
Major Holiday12
Minor Violation of Law11

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 EventLife Change Units
Death of a Parent100
Unplanned Pregnancy/Abortion100
Getting Married95
Divorce of Parents90
Acquiring a Visible Deformity80
Fathering a Child70
Jail Sentence of Parent of Over One Year70
Marital Separation of Parents69
Death of a Brother or Sister68
Change in Acceptance by Peers67
Unplanned Pregnancy of Sister64
Discovery of Being an Adopted Child63
Marriage of Parent to Step-Parent63
Death of a Close Friend63
Having a Visible Congenital Deformity62
Serious Illness Requiring Hospitalisation58
Failure of a Grade in School56
Not Making an Extracurricular Activity55
Hospitalisation of a Parent55
Jail Sentence of Parent for over 30 Days53
Breaking Up with Boyfriend or Girlfriend53
Beginning to Date51
Suspension from School50
Becoming Involved with Drugs/Alcohol50
Birth of a Brother or Sister50
Increase in Arguments between Parents47
Loss of Job by Parent46
Outstanding Personal Achievement46
Change in Parent’s Financial Status45
Accepted at College of Choice43
Being a Senior in High School42
Hospitalisation of a Sibling41
Increased Absence of Parent from Home38
Brother or Sister Leaving Home37
Addition of Third Adult to Family34
Becoming a Full-Fledged Member of a Church31
Decrease in Arguments between Parents27
Decrease in Arguments with Parents26
Mother or Father Beginning Work26

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Why Mental Health First Aid?

There are many reasons for people to train in mental health first aid (MHFA).

Mental health problems are very common. As many as 1 in 4 people will experience mental health problems in any year. This means that most people know someone who has personal experience of mental health problems.

Currently, 1 in 20 people have depression. Around 80% of mental health problems are anxiety and depression. General practitioners (GP’s) are likely to diagnose 60% of mental health problems, and 90% of those will be treated by their GP’s. Almost 40% of absences from work are caused by mental health problems. Of all GP appointments, 70% will be patients with depression and anxiety.

Mental illness and distress has been a taboo subject in our society. This taboo is due to the stigma that surrounds mental health issues. In Western countries, people with mental health problems have been ridiculed or treated differently. For this reason, there is often a fear of speaking about such experiences.

Most people know very little about mental health. Good information and understanding about where to get effective help and treatment for mental health problems is invaluable when a crisis occurs, regardless of the setting. Receiving help or treatment early gives people the best possible chance of recovery.

Having people in the community who are comfortable talking about mental health issues, and who offer kindness, support and appropriate information, helps to reduce distress and promote recovery.

Many people are fearful of a diagnosis of a mental health problem, believing that receiving such a diagnosis will ruin their lives. This fear may cause people to hold back from asking for help when they most need it. Fears are kept alive by ignorance and a lack of understanding. Gaining more knowledge about mental health helps to ease fears and encourage recovery.

People from other countries and cultures who live and work in the United Kingdom (UK) may have very different ideas about mental health and find the National Health Service (NHS) and system confusing or difficult to access. For instance, Chinese medicine does not recognise the division between the mind and the body that is common in Western medicine. Therefore, a system that has separate care for mental and physical health may be difficult for a Chinese person to accept or feel confident using. Support that recognises and respects difference can help to bridge cultural differences and encourage understanding.

Professional help is not always immediately available. A ‘mental health first-aider’ can offer comfort and support in a crisis until help arrives.

In some instances, the person experiencing a mental health problem is not aware of the problem. Some illnesses cause the person’s thinking to be affected. In other cases, the person is so distressed that they do not know how to ask for help. Others may be aware that something is wrong, but may feel afraid of judgement or rejection. A mental health first-aider is trained to approach the person, offer assistance and to listen without judgement, enabling the person to say how they feel. The first-aider can then encourage the person to get appropriate help.

Knowing how to respond in a crisis is a key part of MHFA. It gives the first-aider confidence to know that they are offering effective help and not making things worse. MHFA is based on a five-step action plan that can be applied in any situation in which a person is experiencing mental health problems or distress.

What is Mental Health First Aid?

Mental health first aid (MHFA), like any other type of first aid, is the help given to a person before appropriate professional help or treatment can be obtained.

First aid of any type has the following aims:

  • To preserve life;
  • To prevent deterioration of any injury or illness;
  • To promote healing; and
  • To provide comfort to the person who is ill, injured, or distressed.

MHFA is the help given to someone experiencing a mental health problem before other help can be accessed.

The aims of MHFA are:

  • To preserve life;
  • To provide help to prevent the worsening of an existing condition;
  • To promote the recovery of good mental health;
  • To provide comfort to a person experiencing distress; and
  • To promote understanding of mental health issues.

MHFA does not teach people to be therapists. However, it does train people in:

  • How to ask about suicide;
  • How to recognise the signs of mental health problems or distress;
  • How to provide initial help; and
  • How to guide a person towards appropriate professional help.