The Holmes and Rahe Stress Scale was developed by psychiatrists Thomas Holmes and Richard Rahe in 1967. The pair wanted to know if the most stressful life events could predict future illness. The Holmes and Rahe stress scale is a list of 43 stressful situations an individual can experience that can lead to illness.

Understanding the Holmes and Rahe stress scale

After examining the medical records of 5,000 patients, Holmes and Rahe discovered a strong correlation between illness and the most stressful life events. These situations were then ranked on a scale from most stressful to least stressful, providing clarity on the sort of life situations deleterious to human health.

The reliability of the scale was then tested in 1970 with a study involving 2,500 U.S. Navy personnel. Rahe asked each sailor to rank their most stressful life events and then monitored them for six months to see if any event correlated with visits to the doctor. Once again, Rahe found that the more stressful an event, the higher likelihood of illness.

The top ten most stressful events on the Holmes and Rahe scale

Holmes and Rahe found a total of 43 events contributing to illness. Each event was assigned a specific life change unit score according to how traumatic it was felt across a large sample of study participants. 

For the sake of brevity, we will take a look at the top twenty events and their associated score below:

1. Death of a spouse or child – 100 units.
2. Divorce – 73 units.
3. Marital separation – 65 units.
4. Detention in jail or related institution – 63 units.
5. Death of a close family member – 63 units.
6. Major personal injury or illness – 53 units.
7. Marriage – 50 units.
8. Being fired from employment – 47 units.
9. Marital reconciliation – 45 units.
10. Retirement from work – 45 units.
11. Major change in the health or behavior of a family member – 44 units.
12. Pregnancy – 40 units.
13. Sexual difficulties – 39 units.
14. Gaining a new family member through birth, adoption, etc. – 39 units.
15. Major business readjustment – 39 units.
16. Major change in financial state, such as a windfall or bankruptcy – 38 units.
17. Death of a close friend – 37 units.
18. Changing to a different line of work – 36 units.
19. Major change in the number of spousal arguments regarding child-rearing, personal habits, and so forth – 35 units.
20. Taking on a home or business loan – 31 units.

Calculating stress levels and the risk of illness

To calculate stress levels and the associated risk of illness, the individual must run through the list of events and determine how many they’ve been subject to in the last twelve months. If the same event occurred twice, then it should be counted twice.

Then, the life change unit score for each should be added together to form a total score.

• For scores over 300, there is an 80% chance of illness.
• For scores between 150-299, there is a 50% chance of illness.
• For scores of less than 150, there is a 30% chance of illness.

The types of illnesses stress can cause are not overly surprising. They may include chronic back and neck pain, obesity, depression, diabetes, anxiety, and gastrointestinal disorders. Chronic stress can also accelerate the aging process and the progression of Alzheimer’s disease.

Key takeaways:

• The Holmes and Rahe stress scale describes a list of 43 stressful situations an individual can experience that can lead to illness. It was developed by psychiatrists Thomas Holmes and Richard Rahe in 1967.
• The Holmes and Rahe stress scale is backed by several studies which resulted in a list of 43 stressful life events. The top five most stressful situations are the death of a spouse or child, marital divorce, marital separation, jail, and the death of a close family member.
• The Holmes and Rahe stress scale estimates the likelihood of becoming ill based on the total life change unit score for events experienced in a twelve-month period. 

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