What is the Holmes and Rahe Stress Scale?


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.


  • 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.


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
Marital Separation65
Death of a Close Family Member63
Personal Injury or Illness53
Dismissal from Work47
Marital Reconciliation45
Change in Health of Family Member44
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
Major Holiday12
Minor Violation of Law11


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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