The Holmes And Rahe Stress Scale is often used by doctors to find this answer: Can the most stressful life events predict future illness? Two researchers in 1967 thought so. Combing through the medical records of over 5,000 patients with an eye to seeing if there was a connection between illness and the most stressful life events, Thomas Holmes and Richard Rahe found that a strong correlation did exist. This correlation was so strong that they ranked stressful situations on a scale from most stressful to least stressful. These could indicate which life stressors put people at higher risk for becoming ill as a result. Read on to calculate your own stress levels, and see how these stressful situations could be affecting your health.
The most stressful life events according to the Holmes And Rahe Stress Scale
These results were published as the Social Readjustment Rating Scale (SRRS), more commonly known as the Holmes and Rahe Stress Scale.
Rahe tested the reliability of the stress scale again in 1970. He gave the scale to 2,500 U.S. military members (sailors) and asked them to rank their most stressful life events. He then followed the sailors for six months, tracking their visits to the dispensary, to see if there was a correlation between their reported “life stress” and their visits to the doctor. The study once again proved the reliability of the scale. There was the exact same positive correlation between reported stress and illness as found in the original examination of medical record: 0.118.
The more stressful the event, the higher likelihood of illness. This result held true cross-culturally (looking at Japan and Malaysia in addition to the United States). It’s also true among different groups in the United States (African, Hispanic, and White Americans).
Top 10 most stressful life events
So what are the top ten most stressful life events on the Holmes and Rahe scale, and how are they used to predict the likelihood of illness?
Each event is assigned a “Life Change Unit” score. These are then added together over a year and used to predict your risk of illness. For adults, the top ten most stressful life events and their “Life Change Unit” scores are as follows:
- Death of a spouse (or child*): 100
- Divorce: 73
- Marital separation: 65
- Imprisonment: 63
- Death of a close family member: 63
- Personal injury or illness: 53
- Marriage: 50
- Dismissal from work: 47
- Marital reconciliation: 45
- Retirement: 45
*Note: Death of a child was not originally defined in the original Holmes and Rahe scale, but due to its catastrophic effects on an individual, we have since added it to our list on Pain Doctor.
To calculate your stress levels, add up each number for an event that has happened in the past year or is expected to happen in the future. If the event is expected to occur more than once, add those additional instances into your total. According to their scale, you have an:
- 80% likelihood of illness for scores over 300
- 50% likelihood of illness for scores between 150-299
- 30% likelihood of illness for scores less than 150
Other stressful life events
Just because you’re not experiencing a catastrophic event doesn’t mean you’re not suffering from cumulative stress. The stress test also includes these further categories (note that this list did come out in 1967, so some events are outdated in 2018, particularly mortgages that are less than $20,000!).
- Change in health of family member: 44
- Pregnancy: 40
- Sex difficulties: 39
- Gain of a new family member: 39
- Business readjustment: 39
- Change in financial state: 38
- Death of a close friend: 37
- Change to a different line of work: 36
- Change in number of arguments with spouse: 35
- Mortgage over $20,000 (updated for 2018 = ~$150,000): 31
- Foreclosure of mortgage or loan: 30
- Change in responsibilities at work: 29
- Son or daughter leaving home: 29
- Trouble with in laws: 29
- Outstanding personal achievement: 28
- Spouse begins or stop work: 26
- Begin or end school: 26
- Change in living conditions: 25
- Revisions of personal habits: 24
- Trouble with boss: 23
- Change in work hours or conditions: 20
- Change in residence: 20
- A school change: 20
- Change in recreational, social, or religious activities: 19
- Mortgage or loan less than $20,000 (updated for 2018 = ~$150,000): 17
- Changes in sleeping habits: 16
- Change in number of family get-togethers: 15
- Change in eating habits: 15
- Vacation: 13
- Christmas approaching: 12
- Minor violation of the law: 11
Again, a score of 300 or higher puts a person at risk of illness. 150-299 shows a moderate risk of illness and a score of less than 150 predicts only a slight risk of illness.
Stress scale for non-adults
The scale was modified for “non-adults” and is scored in the same way:
- Death of a parent: 100
- Unplanned pregnancy/abortion: 100
- Getting married: 95
- Divorce of parents: 90
- Acquiring a visible deformity: 80
- Fathering a child: 70
- Jail sentence of a parent for over one year: 70
- Marital separation of parents: 69
- Death of a sibling: 68
- Change in acceptance by peers: 67
It is interesting to note that by number ten on the adult scale, the “Life Change Unit” score drops down to 45, but on the non-adult scale it is still relatively high at 67. This may indicate that non-adults are less able to cope with stressful events and need more assistance to navigate stressful times. For a more detailed analysis of each of these, check out HealthStatus’s website.
7 more of the most stressful life events
Here are seven more top stressors that are definitely worth considering. This list of stressors was submitted by readers in the comments.
1. Selling a home, buying a home, or moving
While major changes in living condition (25) is already listed on the Holmes and Rahe scale, the actual act of selling a home is not. And if selling a home wasn’t stressful enough, add a time crunch to that, and watch stress levels soar. One of our readers pointed out their experience, saying:
“I really think that selling your home and moving in a two day period should be on the list! My blood pressure is off the wall, I am exhausted and fretting……and worrying……”
2. High stakes testing
These days, students in school take anywhere from ten to 30 tests a year. Some of these tests are related to regular classroom instruction, but others are classified as “high-stakes.” These can influence everything from grade placement to eligibility for special programs (e.g., gifted programs). College entrance exams and other major tests like the Graduate Record Exam (GRE) and the Scholastic Aptitude Test (SAT) determine the course of a student’s future. And this all in the space of a few hours. With pressure like this, we agree it should be on the list!
3. Talking to someone you are interested in
Maybe you don’t remember the sweaty-palmed, nerve-wracking feeling of approaching someone that you like. One of our readers though believes this special type of anxiety deserves a place on the stress scale, saying:
“Talking to your crush for the very first time should be in the list. You come from home determined to talk and when you see him/her but when the moment of truth shows up you start sweating and become shy… Frustrating of course.”
4. Starting a new job
Changing responsibilities at work is listed as one of the most stressful life events on the Holmes and Rahe scale, but actually starting a new job is not. This can certainly be one of the top life stressors, especially if you are new to your field and unsure of what might be expected of you.
5. Becoming the victim of a crime
Noticeably absent from the original list is becoming a victim of a crime. This can include personal crimes, including any type of personal assault, or property crimes that include burglary of your home or vehicle. In the case of personal assault, the stress may be compounded by the manner in which the victim is treated. Without support and understanding, or if the victim is blamed in some way for the crime, this can exponentially increase the already-high level of stress that accompanies this type of life event.
6. Starting a business
Changes at work – losing employment, looking for a job, promotions, etc. – are covered by the stress scale, but starting a business specifically is not. This could be any type of business, from a brick and mortar shop to an online business. Along with the financial uncertainty of starting your own business comes the pressure put on the spouse and family of the new business owner. If a couple starts a business together, then double the stress and put it under the same roof.
7. Election years
We offer this stressful life event a bit tongue-in-cheek, but it is true that some election years can be more stressful than others. When there is a major shift in the political landscape, a war, or a transition from one party leading the country to another, politics can make the most even-tempered people feel stress.
How do the most stressful life events affect illness?
We often think of stress as being a largely mental state. After all, it seems like we can stress out about things we only imagine. But stress is more than just a thought in our minds. Stress is a physical response in our body to a perceived threat. Thousands of years ago, this stress kept us alive by flooding our bodies with cortisol and adrenaline in large enough amounts to escape attacking animals or tribes. In modern times, our most stressful life events are much different. Our bodies respond the same way, though, and sometimes that can lead to illness.
Richard S. Lazarus is credited with the creation of the modern definition of stress. This is the feelings we experience when “demands exceed the personal and social resources the individual is able to mobilize.” Stress, whether it is a minor event like dropping a glass or a major stressful life event such as a death in the family, triggers a physical response that allows us to react quickly and decisively.
In theory, once we remove the stressor, our bodies return to a neutral state. This perfect biological system is interrupted when we experience stressful life events that then become chronic stress. A state of heightened, chronic stress can lead to an increased risk of illness, many of which can be very serious. This correlation has been verified time and again in the research.
Types of illness caused by the most stressful life events
The types of illness that top stressors can cause are not particularly surprising. They include:
- Chronic pain, such as lower back pain and neck pain
- Obesity: While not an illness in and of itself, obesity is the root cause of many other serious and lethal conditions. Excess levels of cortisol, the stress hormone that floods our body during stress, causes fatty deposits around the midsection when stress becomes chronic.
- Diabetes: Stress raises the glucose levels of those with Type 2 diabetes directly. It also seems to increase unhealthy types of eating and lowered levels of physical activity.
- Depression and anxiety: Stress increases the chances of developing depression and anxiety by as much as 80%.
- Gastrointestinal disorders: Contrary to popular belief, stress doesn’t cause ulcers. It can, however, make gastrointestinal issues worse. It also contribute to the development of chronic heartburn (or gastroesophageal reflux disease, GERD) and irritable bowel syndrome (IBS).
- Accelerated aging: One study found that chronic stress can accelerate the pace of aging. This may be due to stress’s effect on telomeres, a structure at the end of each chromosome that protects against deterioration of that chromosome. Stress shortens telomeres, in effect offering less protection.
- Alzheimer’s disease: Stress causes the brain to form lesions more readily. This can accelerate the progression of Alzheimer’s disease.
Other illnesses caused by the most stressful life events
Other common stress-related illnesses include high blood pressure, heart disease, severe asthma, and increasing mental illness, including schizophrenia.
It is important to recognize that there are healthy levels of stress and that stress can be caused by happy events, such as marriage and the birth of a child. The issue is not with stress itself, but with stressful life events that turn into chronic stress.
What’s the difference between chronic stress versus episodic stress?
Episodic or acute stress is protective; chronic stress is degenerative. Here’s how to recognize the difference.
- Chronic stress makes it hard to unwind: People experiencing chronic stress may feel jumpy and unable to settle down. They may feel like they always need to be doing something, or they may feel always behind in their daily tasks.
- Chronic stress changes mood: Chronic stress’s major calling card may just be the snappy irritability that often accompanies it. Previously patient parents may find themselves snapping at their kids. Or they may find themselves overreacting to a situation. People with chronic stress may find themselves at the mercy of wild mood swings, elated one minute and furious the next.
- Chronic stress lasts well past the stressful life event: While a stressful life event may be challenging to process and let go of, stress becomes chronic when months (or years) later it seems as if the stressful event happened yesterday. It is common to have the features of chronic stress right as the stressful event is happening. These features should not last well past the event, though.
- Chronic stress brings various physical changes: Physical changes wrought by chronic stress are unique to each individual. They can include weight gain or loss, fatigue, dizziness, nausea, excitability or hyperactivity, heart palpitations, and nervousness. These symptoms can vary widely and are typically constant, not acute or episodic.
It is crucial to understand that chronic stress is a condition that you can reverse. It is also important to take the time to recognize when the most stressful life events become a threat to our well-being. In that way we can take steps to reduce our stressors in life. If you suffer from chronic pain, in particular, we encourage you to talk to one of our pain doctors. They can help you treat your pain, as well as find ways to cope with stressful situations.
How do you deal with a stressful situation?
First, take a moment to evaluate your level of stress on this stress scale.
Usually once a stressful event has passed, our bodies return to a regular state, but sometimes we find ourselves unable to settle back down. Sometimes the stressful life event is such that we find ourselves in an unbreakable cycle. For chronic pain patients, in particular, the most stressful life event may be the chronic pain itself. Battling a chronic condition takes a tremendous toll on both the pain patient and their family.
1. Acknowledge the stress
You know the saying that the first step to solving a problem is to recognize that you have one? Start dealing with stress by acknowledging that you are currently experiencing it. This may seem oversimplified, but it is an important first step.
Especially for pain patients who are used to coping with the stress of pain every day, it can be difficult to admit when stress has become overwhelming. Because stress levels can predict future illness, it is important to admit where you are on the scale so that you can move forward.
2. Don’t do anything
While this advice may seem counter-intuitive, sometimes the best thing to do is…nothing. Mindfulness meditation is gaining widespread popularity as a complementary pain treatment, and with good reason.
Meditation reduces the perceived severity of stress and pain. It also helps with pain-related depression and anxiety, and may reverse aging. Sometimes doing nothing, especially at the beginning, is the best way to understand and handle the top stressors.
3. Practice self-care
The most stressful life events can consume our lives and daily routines until there is no time for anything else. Once we do get time, we may tend to collapse on the couch in front of the TV and call it “relaxation.”
A better way to spend that time would be in self-care. This can be as simple as a relaxing bath with Epsom salts and relaxing bath oils (think lavender) or as complex as going for a massage or other spa service. Self-care can even be indulging in a favorite hobby like gardening or painting. Regularly taking time out to do something you love can go a long way towards overall stress reduction.
4. Get support
Chronic pain can be a lonely, isolating condition. Too often even our loved ones don’t truly understand what we are going through. Support groups and online forums can make dealing with chronic pain easier, especially if stressful life events occur in addition to your daily pain. Other support groups for various life stressors (e.g., divorce, family illness, etc.) can also provide an empathetic ear. They can also provide some resources or local connections in the community. It may feel natural to withdraw when you are under stress, but reaching out can actually help you cope with it better.
5. Clear the clutter
The ancient Chinese art of feng shui deals with improving the energy flow of your space so that you feel calm and more harmonious. When stressors in life take over, our personal spaces may get cluttered and disorganized.
Taking a few moments at the end of each day to put things away can help you wake up with a clear space and a calm mind.
Adding different elements like flowing water, green plants, and specific types of metals in specific places in your home can also help manage stress.
We have said it so often that it may begin to sound routine, but it is absolutely true. One of the best ways to manage the most stressful life events is with exercise.
Level of intensity and duration don’t even matter. Just ten minutes of daily physical activity can be enough to reset your mental and emotional state. For those living with chronic pain, regular exercise is a crucial part of treatment. It keeps joints and muscles active and increases range of motion. On the most painful, stressful days, you can try slow and soothing exercise. Gentle, restorative yoga and flowing t’ai chi can help manage both stress and pain.
7. Go for a massage
We don’t all have the luxury of regular bodywork like massage. When possible, though, this complementary therapy is a great way to manage stress and treat pain at the same time.
8. Eat well
The most stressful life events can sometimes send us running to the kitchen for a snack.
The quality of these snacks may add to the stress and the pain that is already there. Choose wisely, and your “stress eating” can actually be good for stress busting and pain relief.
There are plenty of delicious, easy foods that are anti-inflammatory and help lower stress. You have to eat; you might as well take good care of yourself when you do.
9. Have a cup of tea
The simple act of stopping to sit and drink tea may be as effective a stress reliever as anything else on this list.
While teas can be medicinal, just taking time out from reacting to the most stressful life events, especially while in pain, may be the most powerful medicine.
10. Practice stress prevention
While certain amounts of stress are inevitable, it is possible to reduce stress in your life with a few simple steps. The most stressful events in life are often unpredictable and may occur all at once. Plan for the unknown as much as possible by putting systems into place that help you prevent what stress you can and cope better with what sneaks in.
The Holmes and Rahe Stress Scale can be a helpful predictor of the risk of illness. Have you experienced an increased risk of illness as a result of a stressful life event? (Hit the comments to see the most stressful life events for others and to share your own!)
If stressful life events are causing you pain, it may be time to talk to a pain specialist. They can help you find holistic methods for managing stress and treating your pain. Click the button below to find a pain doctor in your area or use the tips here to find one.