1 Doutilar

Holmes And Rahe 1967 Evaluation Essay

Almost four decades ago, Holmes and Rahe (1967) published a checklist of 43 events, such as death of a spouse, divorce, fired at work, and sex difficulties, called the Schedule of Recent Experiences (SRE). Its purpose was to inventory “fundamentally important environmental incidents” (Meyer, 1951, p. 53) that were found (in analyses of patients’ charts) to frequently precede illness onsets. Stressful events were defined as occurrences that were likely to bring about readjustment-requiring changes in people’s usual activities. A magnitude estimation procedure was used by panels of judges to assign Life Change Unit (LCU) scores to each of the 43 events on the list (Holmes & Rahe, 1967). A summation of these scores on events occurring in a given, usually quite recent, period of time was taken as the indicator of amount of stress. The checklist can be answered in either a self-administered questionnaire or an interview.

Since the publication of this economical measurement procedure, the SRE, a tremendous increase has occurred in the construction of such measures and in quantitative research on relations between inventoried life events and health. For example, a search of the terms life events, life change, stressful life events, and life stress (or a combination of these terms) using PsycINFO (http://www.apa.org/psycinfo) shows an increasing rate of publications on these topics, from 292 in the decade of 1967 to 1976, to 2,126 in 1977 to 1986, to 4,269 in 1987 to 1996, to 3,341 in the truncated 1997 to 2005 portion of the present decade. This voluminous literature documents that life events are related to a wide variety of physical and psychological problems in both cross-sectional and longitudinal research (e.g., Breslau, 2002; Brown & Harris, 1989; Dohrenwend & Dohrenwend, 1974; Grant, Compas, Thurm, McMahon, & Gipson, 2004; Gunderson & Rahe, 1974; Paykel, 1974; Rahe & Arthur, 1978).

Most of the investigators in this research have used the Holmes and Rahe (1967) instrument, other, usually longer, inventories (e.g., Dohrenwend, Krasnoff, Askenasy, & Dohrenwend, 1978; Paykel, Prusoff, & Uhlenhuth, 1971; Sarason, Johnson, & Siegel, 1978), or unnamed admixtures of several instruments (e.g., Steele, Henderson, & Duncan-Jones, 1980) to investigate relations between stress and health outcomes. Special inventories have been developed for subgroups in the population. For example, at least 16 different checklists have been used in research with children and adolescents (Grant et al., 2004), and additions have been made to existing scales to take into account events in special circumstances, such as experiences with terrorism during the continuing hostilities in which Israel has been involved (Levav, Krasnoff, & Dohrenwend, 1981). Moreover, inventories have been developed specifically for the study of extreme situations, such as combat in the first Gulf War (Southwick, Morgan, Nicolau, & Charney, 1997) and the plight of Cambodian refugees (Mollica, Poole, & Tor, 1998). The common characteristic of these traditional checklists for research, whether focusing on usual situations or extreme situations, is that they consist of rather broad categories of events (e.g., divorce) rather than detailed descriptions of individual events (e.g., a divorce after a period of marital conflict over the infidelity of one’s spouse).

Although the emphasis has usually been on recent events in relatively brief intervals of time, such as 6 months to 1 year, a few studies have attempted to assess “traumatic” events (usually life-threatening or otherwise threatening to physical integrity), other major events (e.g., spousal bereavement), or both over the life course of the respondents (Breslau, Davis, Andreski, & Peterson, 1991; Breslau, Davis, Peterson, & Schultz, 1997; Breslau et al., 1998; Davidson, Hughes, Blazer, & George, 1991; Kessler, Davis, & Kendler, 1997; Kessler, Sonnega, Bromet, & Nelson, 1995; Norris, 1992; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993; Turner & Lloyd, 1995, 2004). These attempts at lifetime coverage of major events are consistent with Meyer’s conception of a life chart of fundamentally important environmental incidents and have the potential of providing more comprehensive information about (a) whether the events recur or persist over time to the extent of becoming ongoing difficulties (Brown & Harris, 1978) or chronic stressors (e.g., Lepore, 1997); (b) the role of the events singly and in relation to earlier stressful events in both onset and course of disorder; and (c) reciprocal relations between the occurrence of some types of events that are not completely independent of the behavior of the individual and the occurrence or recurrence of episodes of disorder (Grant et al., 2003, 2004; Hammen, 2005; Monroe & Harkness, 2005). When lifetime coverage involves long periods of recall, as it does in all of the previously mentioned retrospective studies, it is only feasible to focus on major events. Assessment of more easily forgotten minor events is not even remotely feasible unless recall periods are as short as possible. For example, longitudinal questioning at monthly intervals for 10 months has been found to elicit an average of 16.7 checklist events, most of them minor, compared with an average of 6.0 major and minor events reported retrospectively for the same 10-month period (Raphael, Cloitre, & Dohrenwend, 1991).

Although most attempts to inventory stressful life events have been conducted with traditional checklists of relatively broad life event categories such as those in the SRE, some more recent investigators have used checklists with more narrowly defined event categories to investigate both relatively large events (e.g., Paykel, 1997; Kubany et al., 2000) and small daily incidents or “hassles” (e.g., Kanner, Coyne, Schaefer, & Lazarus, 1981; Zautra, Guarnaccia, & Dohrenwend, 1986). The most radical methodological departure from traditional checklists, however, has been provided by much less economical procedures that involve intensive semistructured interview and rating procedures. The interviews are designed to elicit details of what actually happened to provide narratives of the events that can be rated by trained investigators for severity and other important characteristics. The best known and most widely used of these procedures was developed by George Brown and colleagues and is called the Life Events and Difficulties Schedule (LEDS; Brown & Harris, 1978). In contrast to traditional checklists of broad event categories and more recent checklists of more narrowly defined categories, LEDS and other similarly labor-intensive procedures (e.g., Dohrenwend, Raphael, Schwartz, Stueve, & Skodol, 1993; Hammen, 1991) will be referred to as narrative-rating approaches.

The emphasis in this paper is on stressful life events in relation to psychopathology. Much of the methodological analysis is also relevant for physical health outcomes. However, some problems, such as the confounding of the measurement of events and the measurement of health outcomes, are more serious when the outcomes involve psychiatric disorders for which no laboratory tests exist that are independent of self-reported symptoms. In addition, there may also be differences in the characteristics of events that are important for physical health outcomes versus outcomes involving psychopathology. Further investigation of these important differences is beyond the scope of this paper.

Checklists have continued to be dominant in research on the role of stressful life events in psychopathology, as well as other health outcomes. All of the previously discussed studies of potentially traumatic and other major negative events focused on various types of psychopathology and used traditional checklists with broad-event categories to inventory events over the life course. Checklists in the form of self-administered questionnaires or in the form of structured interviews consisting of closed questions with fixed alternative response categories have been relied on in other influential research on the role of life events in psychopathology conducted in recent years. The behavioral genetics study of depression by Kendler et al. (1995), the nationwide epidemiological research on the comorbidity of psychiatric disorders by Kessler et al. (1995), and, most recently, the study of gene-by-environment interaction for depression by Caspi et al. (2003). are examples.

The vast body of research on life events and psychopathology that has relied on checklist inventories has been subject to many critical reviews (see reviews in Brown, Sklair, Harris, & Birley, 1973; Cohen, Kessler, & Gordon, 1997a; Day, 1989; Dohrenwend, 2000; Gorman, 1993; Grant et al., 2003; Kessler, 1997; Lloyd, 1980; Mechanic, 1975; Monroe & Roberts, 1990; Norman & Malla, 1993; Paykel, 2001; Rabkin & Struening, 1976; Rutter, 1986; Tennant, Bebbington, & Hurry, 1981; Thoits, 1995; Turner & Wheaton, 1997). Although the reviewers have been impressed with the consistent relationships found between life events and psychological problems using such procedures, two broad themes of criticism can be found in these reviews. One theme emphasizes the small to modest amount of variance explained in relationships of the events to psychopathology and points to other variables, such social support, that may increase or decrease the impact of the events (e.g., Johnson & Bradlyn, 1988; Paykel, 2001; Rabkin & Struening, 1976; Sarason & Sarason, 1985). The other theme of criticism focuses more on problems of reliability and validity evident in the traditional checklist measures of stressful life events used in most of this research (e.g., Brown, Sklair, Harris & Birley, 1973; Creed, 1993; Dohrenwend, 1974, 2000). These two themes are not, of course, mutually exclusive. Focus here, however, is more on the latter, that is, on problems in the conceptualization and measurement of stressful life events that make the results of the research difficult to interpret.

The fundamental methodological puzzle in inventorying life events as risk factors for psychopathology is how to solve the problem of intracategory variability in traditional checklist measures—that is, the fact that a variety of types of experience are encompassed by each particular event category (Dohrenwend et al., 1993). Although various investigators have addressed one or another of the consequences of intracategory variability (e.g., Brown, 1974; Dohrenwend et al., 1993; Katschnig, 1986; McQuaid et al., 1992), they have done so piecemeal. No systematic review of the nature of the problem, its full range of sequelae, and the adequacy of various solutions has been conducted. The purposes here are, first, to examine the nature of the problem of intracategory variability and its full range of consequences; second, to describe how some of its consequences have been addressed within the tradition of economical checklist procedures and by narrative-rating procedures; and, third, to assess both the problems and prospects of the checklist procedures, on the one hand, and narrative-rating procedures, on the other, for reducing intracategory variability.

The problems with, and prospects of, checklist approaches are considered first, followed by a similar analysis of the more labor-intensive and time-consuming narrative-rating procedures. These analyses are followed by an examination of the handful of studies that have attempted to compare checklist and narrative-rating measures. Finally, ideas about future research that could resolve the problem of intracategory variability and result in the development of practical, as well as reliable and valid, procedures for inventorying stressful life events as risk factors for psychopathology are proposed.

Problem of Intracategory Variability

Traditional checklist approaches describe events at such a general level—for example, marriage, divorce, death of a spouse (Holmes & Rahe, 1967)—that they might more accurately be called lists of topics or categories of events than events per se. The core problem with traditional checklists, and the one to which all of the others are in some way and to some degree related, is that the actual experiences that lead a respondent to make a positive response to a given checklist category vary greatly. Findings from a study of 429 adult residents of the Washington Heights section of New York City illustrate this problem (Dohrenwend, Link, Kern, Shrout, & Markowitz, 1990). These respondents were interviewed about their responses to the 102 categories on a previously developed traditional checklist called the Psychiatric Epidemiology Research Interview (PERI) Life Events Scale (Dohrenwend et al., 1978).

When positive responses to event categories were probed for details of what actually occurred, it became evident, for example, that some deaths of close friends turned out to involve deaths of long absent, childhood friends to whom the respondents were no longer close; that serious illness and injury events ranged from episodes of flu and sprained arms to severe heart attacks; and that laid off, intended to encompass economic failure of the employer, was sometimes a euphemism for being fired for cause. Clearly, a positive response for the same item on the checklist could, and did, in fact, represent very different types of actual experience.

To investigate this matter further, the subsequent descriptions of what actually happened that led to a positive response to a checklist item by respondents were rated by the investigators on such characteristics as the likely magnitude of change in usual activities that the event would induce in most people who experience it.

As can be seen in Table 1, the anchoring examples used by the raters present experiences ranging from the catastrophic to the trivial.

Table 2 shows, for 10 checklist items, the ratings by the research team of likely magnitude of change based on respondents’ accounts of what actually happened. Each of the 10 items met the following criteria: were reported present by more than 20 respondents; were rated as likely to be negative or undesirable for most people who experience this type of event (Dohrenwend et al., 1978); and had one of the 10 largest a priori Life Change Unit (LCU) scores (Holmes & Rahe, 1967) among the checklist items meeting the preceding criteria. To arrive at the LCU scores for the PERI event categories, the magnitude estimation procedure used by Holmes and Rahe (1967) was followed. This involved asking judges to rate the magnitude of change for each item compared with marriage, which was given an arbitrary score of 500. The resulting LCU scores for the PERI event categories ranged from 1,036 for child died, which was ranked 1, to 163 for acquired a pet. Marriage, the modular event with 500, was ranked 22.

Table 2

Variability Within Event Categories on Rated Amount of Change Based on Narrative Details of What Actually Occurred

As can be seen in Table 2, a wide variability in narrative ratings exists within most of the event categories. Moreover, even when a majority or near majority of event descriptions in a particular category receive the same rating on amount of change, as in death of relative other than spouse or child and death of close friend, the findings are surprising. The modal ratings of the narratives describing the events in these categories were no change lasting a week or more, despite the fact that these items ranked in the top quarter of events on the PERI checklist in terms of the magnitude of their LCU scores. The actual descriptions of what happened for the events reported in these categories show why the discrepancy occurred. Most of the deaths were of biologically distant relatives who were living far away at the time and of acquaintances or long-absent friends with whom the respondents were no longer close.

Note also the category laid off work. If being laid off was the consequence of an event like a plant shutdown, then it is difficult to see how that experience could lead to little or no change for almost a quarter of the respondents with such an experience. Again, the respondents’ descriptions showed what had happened. Some of those laid off, for example, had been employed as musicians, dancers, or actors who had come to the end of a contractual engagement. For them, this was hardly an event at all, because it was an expected and normal part of their occupational lives to be laid off several times a year. This heterogeneity with regard to the magnitude of events grouped into a particular checklist category is important because it obscures important differences, such as the paramount role of major negative events in first episodes of major depression and the paramount role of minor negative events in episodes that represent frequent recurrences of major depression (see updated review by Monroe & Harkness, 2005).

The problem of intracategory variability is evident in other critical characteristics of events as well—characteristics such as their valence and source (Dohrenwend, 2000). For example, being laid off on this checklist was meant to indicate the negative event of loss of a job because of the fateful, external environmental factor of economic failure by the respondent’s employer. When positive responses to this item were probed for details of what actually happened, it became clear that sometimes laid off was a euphemism for being fired for cause, an experience that cannot be categorized as fateful in the previously discussed sense (Dohrenwend, 1979). For 30.7% of the respondents who were laid off, the sequence leading to the event was rated as being equally or mostly determined by the respondents’ behavior, as opposed to external circumstances; for 43.3% of the respondents, this supposedly negative event was rated as mixed positive and negative; and for another 3.3% as mainly positive.

Summary of Problem of Intracategory Variability

The core problem with traditional checklist inventories is that the actual responses to the broad categories of events on the lists vary greatly. As a result, minor illnesses are included along with major events such as heart attacks in response to an item like serious physical illness or injury. Overinclusiveness with regard to magnitude is important because it is major events, not minor ones, which have proved to be substantial risk factors for some types of psychopathology, such as first episodes of major depression. The problem of intracategory variability is not limited to magnitude. It extends to other fundamentally important characteristics of events, for example, their valence (i.e., Are they mainly positive or negative? Do they involve gain rather than loss? Are they desirable rather than undesirable?) and their source (i.e., Is the origin of the events in environmental circumstances rather than a consequence of the actions of the individual?).

Impact of Intracategory Variability on Reliability and Validity of Traditional Checklist Approaches

Intracategory variability underlies more usually recognized problems of reliability and validity in traditional checklists: four sequelae of intracategory variability are unreliability of recall, susceptibility to recall bias, lack of criterion validity, and problems with construct validity.

Unreliability of Recall

Very few studies have been designed explicitly to test the reliability of traditional checklists. One of the best was conducted by Steele et al. (1980) with a checklist of items adapted from the work of Holmes and Rahe (1967) and Paykel (1974). The 52 respondents were recruited from diverse medical services. The Time 1 test consisted of a self-administered checklist questionnaire inquiring about events during the preceding 12 months; the questionnaire was followed immediately by an interview in which more detail was obtained about the Time 1 events reported. The retest 7 to 14 days later consisted of the same sequence of questionnaire followed by interview. The investigators report a test-retest correlation of .94 for total number of events. Even in this study with its very short test-retest interval, however, there was no more than 70% agreement for all of the events reported in the same category on either test. Steele et al. note that details obtained in the interviews showed that some of the discrepancies were the result of the same event being reported under different checklist categories; unfortunately the investigators do not provide information about how large a problem this was.

When the recall period is longer, reliability drops precipitously for both total scores and individual events. Reliability is particularly poor when the checklist is self-administered (see reviews by Neugebauer, 1983; Paykel, 1983; Rabkin & Struening, 1976; Thoits, 1983). For example, Neugebauer (1984) found test-retest correlations for total scores usually to be between .30 and .60. In the studies he reviewed, the investigation of reliability was sometimes a by-product of longitudinal research in which there was an overlap in reporting period covered in the first and second waves of data collection that provided two sets of reports for events occurring in the same period of time.

Problems of recall are particularly evident in comparisons of longitudinal and cross-sectional studies, which show that far more events are reported longitudinally than retrospectively. In such studies, retrospective reports are compared with longitudinal reports at shorter intervals either for the same period of time (Klein & Rubovits, 1987; Raphael et al., 1991) or a similar but nonoverlapping period of time (Monroe, 1982). In the study by Raphael et al. (1991), for example, there was longitudinal/retrospective agreement on only 25% of the events, with far more events reported in the monthly longitudinal assessment than in the retrospective assessment of the same 10-month period, as was noted earlier.

Susceptibility to Recall Bias

Checklists are rarely administered in daily diaries, and when they are, coverage tends to be limited to a few weeks or months in the life of the respondents (Eckenrode & Bolger, 1997). More usually, a substantial period of recall is involved between the occurrence of an event and the report of the respondent about the event, even when long-term coverage involves longitudinal research as, for example, in the investigations by Caspi et al. (2003). It has long been known that simple forgetting is not the only problem (e.g., Blaney, 1986). Rather, the reporting of events on traditional checklists is susceptible to recall biases (e.g., Cohen, Towbes, & Flocco, 1988; Raphael & Cloitre, 1994).

A methodological study by Southwick et al. (1997) suggested that even the most objective-seeming checklist descriptions of combat events are susceptible to such bias. These investigators examined responses by 59 United States Gulf War veterans of combat experiences to a 19-item “Desert Storm Trauma Questionnaire,” which was administered both at 1 month after the veteran’s return to the United States (Time 1) and 2 years later (Time 2). At Time 2 testing, the large majority of the veterans, 88%, changed their responses to at least one of the 19 checklist items; fully 61% changed two or more responses. Most important, those with more symptoms of posttraumatic stress disorder (PTSD) at Time 2 were more likely to report an increase in number of combat experiences from Time 1 to Time 2. A similar study with similar results was conducted by Roemer, Litz, Orsillo, Ehlich, and Friedman (1998) of 460 U.S. soldiers who had served in the peacekeeping mission in Somalia. Both sets of investigators note that the apparent dose/response relationship between exposure and PTSD symptoms was attributable in part to recall bias.

Two more recent studies focused on PTSD in war veterans have found less recall bias: one with Gulf War veterans (King et al., 2000), the other with Vietnam War veterans (Koenen, Stellman, Stellman, & Dohrenwend, 2000). A third study, with members of a Netherlands peacekeeping force in Cambodia, found almost none (Bramsen, van der Ploeg, Dirkzwager, & van Esch, 2001). How serious, then, is the problem of recall bias?

It is likely that the size of the effect varies directly with the rate of clinically significant PTSD in the sample (very low in the study of Netherlands peacekeepers by Bramsen et al., 2001), the volatility of PTSD between the first and second recall measures, and changes in the climate of public opinion about the war or mission in which the exposure took place (Koenen et al., 2000; Morgan, 1997). The fact remains, however, that in none of these studies is there an independent, objective measure of what actually happened at the time of the exposure against which to test respondent recall at the time of first questioning. Therefore it is impossible to tell in absolute terms how large the bias is in subsequent recall at the Time 1 questioning.

With the size of the initial systematic bias between actual occurrence and respondent recall at Time 1 unknown, these results showing systematic recall bias between the Time 1 follow-up and the Time 2 follow-up reports by the respondent are cause for concern, whether this bias appears relatively large or relatively small as measured by changes of recall per se. The need for attention to the problem of recall bias is heightened when, as is the case here, the bias can produce misleading results on an issue as important as the presence and strength of a dose/response relationship between exposure and PTSD. That systematic recall bias of this kind occurs at all between successive measures of postexposure recall indicates that state-dependent or mood-congruent recall processes (e.g., Kihlstrom, Eich, Sandbrand, & Tobias, 2000) are operating. Reliance on measures of exposure susceptible to such processes compromises tests of the dose/response relationship between exposure and PTSD.

These recall bias studies provide clues as to where this susceptibility may lie, and these clues lead back to the problem of intracategory variability. The categories on the checklists used in the research on recall bias were thought to be objective and to measure highly traumatic events. Table 3 contains examples of items that showed substantial amounts of change between Time 1 and Time 2 in the study by Southwick et al. (1997).

Table 3

Examples of Checklist Events on Desert Storm Trauma Questionnaire

Morgan (1997) reinterviewed 36 of the Gulf War veterans in this study and confronted them with the discrepancies. He found that the veterans were surprised and could supply no coherent explanation of why they changed their responses. Morgan con cluded that the veterans were reinterpreting the meaning of terms in the checklist items in the context of contemporary situations, including respondents having obtained, from the media and from discussions with other veterans, additional and often different information about the war during the 2-year interval. This reinterpretation may be because different sources of information are discounted in memory while the information itself is retained, resulting in reconstructions of events that bear little resemblance to actual experience at the time of the events (Tourangeau, 2000). If so, then the more symptomatic individuals are the ones who are most likely to select information that increases their reports of negative events.

The results from investigations of recall bias suggest that traditional checklists of events have problems not only of intracategory variability between individual respondents, as was shown earlier, but also problems of intracategory variability for the same individual over time. The breadth of their categories, which leave traditional checklists open to differing interpretations by respondents of the types of experiences a category can include, may make traditional inventories particularly susceptible to systematic recall biases. If this is the case, then procedures for reducing intracategory variability should also reduce recall biases.

Problems With Criterion Validity

It is sometimes possible to develop indicators of the occurrence of events and their characteristics that are independent of self reports and that can, at least partially, verify the accuracy of the reports. For example, the availability of military and historical records can be used to indicate the probable severity of exposure of U.S. veterans to war zone stressors in Vietnam (Dohrenwend et al., 2004); court records can document childhood victimization (Widom, 1998); and medical records can substantiate events such as abortion (Schaeffer, 2000). For most events on checklist inventories, however, no independent, self-evident, and readily available gold standards exist to establish, independently of self-report, whether a reported event actually occurred, much less its important characteristics. Perhaps the nearest so far to a check on the accuracy of checklist reports in general are studies comparing respondent reports to reports about the respondent by significant others, such as spouses, other relatives, or friends.

Coinformant reports are not, however, ideal checks on the accuracy of respondent reports. An informant may lack first-hand information about some of the events the respondent experienced because the coinformant was not present when the events occurred. The coinformant may either have no hint that such events occurred or may be relying on the respondent’s account of the events rather than on the coinformant’s own independent observations. However, choice of appropriate coinformants can reduce these problems; for example, peers for some types of events experienced by adolescents and parents for others, depending on the sphere of activity in which the event occurs (Williams & Uchiyama, 1989). Nevertheless, if the respondent and the coinformant are thinking of different actual events when they see a particular broad event category, then they are not going to agree on whether it happened. For example, if the respondent uses the euphemism laid off for a job loss and the informant recalls that the respondent was fired for cause, then only the respondent will check the item laid off on the checklist; reports of serious physical illness would also differ if a respondent’s health problem was viewed as serious by one but not the other.

In view of these possibilities for different interpretations, it is not surprising that reports of coinformants, in samples of psychiatric patients (for reviews, see Neugebauer, 1983; Tennant et al., 1981) and in a sample of nonpatients and patients (Yager, Grant, Sweetwood, & Gerst, 1981), show poor correspondence with respondent reports on traditional checklists. For example, in a study of 18 outpatients with diagnoses of schizophrenia, Neugebauer (1983) reported a mean intrapair agreement for all events on the PERI checklist (Dohrenwend et al., 1978) of .22, with a range from 0 to .42. For their sample of 102 nonpatient men (Department of Veterans Affairs and university employees), Yager et al. (1981) reported agreement for only a third of the events that were reported by either the respondent or significant other on the Holmes and Rahe SRE.

Problems With Construct Validity

Investigators who study environmental influences on health disagree on how to define stress (e.g., review by Cohen, Kessler, & Gordon, 1997b). Nevertheless, as Cohen and colleagues point out, all investigators “share an interest in a process in which environmental demands tax or exceed the capacity of the organism, resulting in psychological and biological changes that may put the person at risk . . . [for adverse health outcomes]” (p. 3). Within this general framework of agreement, life events are important representations of environmental demands.

It is generally recognized that the events occur in the situations in which people live their everyday lives (e.g., Dohrenwend, 2000). These situations can vary from the regular activities involved in domestic relationships, education, work, and play that are, by and large, satisfying for most people in most communities in times of peace, on the one hand, to extreme situations of persistent threat, on the other hand. The latter include combat during wartime, prolonged human-made or natural disasters, longstanding domestic violence and child abuse, severe chronic physical illness, and poverty. Note that various demographic factors can be associated with extreme situations but do not, in and of themselves, constitute such situations. For example, low socioeconomic status (SES), which is defined by low education, occupation, and income, is associated with poverty; however, low SES is not synonymous with poverty, which is defined by having inadequate resources to meet the demand of daily living (e.g., O’Hare, 1989). By contrast with the indicators of poverty, the indicators of low SES do not, in and of themselves, define an unusually threatening ongoing situation.

The extreme situation end of the continuum of usual activities is characterized far more by chronic stressors or ongoing difficulties that make severe and continuing demands on individuals. Events in such extreme situations need to be assessed not only for their impact on usual activities of the extreme situations but also on the activities in the more usual situations to which the individuals may return—as, for example, the return of a veteran to civilian life after service in a war zone.

In addition, inventorying approaches share the assumption that diverse types of events have characteristics in common that determine their impact. Investigators differ, however, in the characteristics of events they emphasize as making them more or less stressful, severe, or demanding. As noted earlier, for Meyer (1951), as translated by Holmes and Rahe (1967), events are stressful to the extent that they bring about changes in the life of the individual that require his or her readjustment. In accord with this focus on change per se, Holmes and Rahe include positive and negative incidents in their list of stressful events. However, it has become evident that negative events (but not positive events) are positively associated with psychological distress and disorder (e.g., Grant, Sweetwood, Yager, & Gerst, 1981; Lewinsohn, Rohde, & Gau, 2003; Paykel, 1974; Vinokur & Selzer, 1975; Zautra & Reich, 1983). Therefore it is not surprising that investigators, focusing on adverse outcomes involving psychopathology especially, have developed a variety of alternative definitions of the severity of stressful life events that tend to emphasize their negative characteristics. Examples of these characteristics are undesirability (Sarason et al., 1978), objective negative impact (Paykel, 1997), the extent to which the events involve loss of resources (Hobfoll, 1989), their degree of contextual threat (Brown & Harris, 1978), and the extent to which the events are likely to contribute to uncontrollable negative changes in the usual activities of most individuals who experience them (Dohrenwend, 1998, 2000).

Dohrenwend (2000) has posited that at least six general characteristics of events are likely to contribute to the nature and extent of their contribution to uncontrollable negative changes in the usual activities of most individuals who experience them. In addition to valence (positive or negative, desirable or undesirable, involving gain or loss), these are source (occurrence caused by factors in the external environment in contrast with occurrence resulting from actions of the individual); unpredictability (the extent to which the occurrence of event would not be foreseen by most people who experience it); centrality (from life threat, to threat to physical integrity, to threat to basic needs, to threat to other goals); magnitude (in terms of likely change in the usual activities of most people who experience the event); and potential to exhaust the individual physically.

Unlike the other five characteristics, source is more likely to be associated with differences in the processes that contribute to uncontrollable negative changes than with the magnitude of such changes. When the source of the event is mainly external (e.g., as in death of a loved one), factors in the environment are more likely to be implicated, and the event can be described as fateful (Dohrenwend, 1979); when the actions of the individual contribute strongly to the occurrence of the event (e.g., being fired for cause), prior disorder and other personal predispositions, including genetic liability to the occurrence of nonfateful negative events (Kendler, 1998), are more likely to be implicated. Other things equal, no self-evident way comes to mind in which fateful, compared with nonfateful, negative events would contribute more to uncontrollable negative changes in the life of the individual. Much needs to be learned about the conditions under which one or the other type of source is more important in determining the impact of events in relation to various disorder outcomes.

Regardless of the problems in dealing with the complexities of the characteristics of events and the situations in which they occur that will be considered later, a more immediate challenge exists to the construct validity of traditional life event inventories as indicators of environmental demands. The challenge resides in the types of broad event categories the inventories include. As Hudgens (1974) pointed out many years ago, the list of 43 event categories covered in the Schedule of Recent Experience (SRE) contains a substantial number of items that, rather than being fundamentally important environmental incidents, could include manifestations of psychiatric disorder; for example, the categories of major change in eating habits, major change in sleeping habits, marital separation from mate, and being fired from work. Depending on the circumstances in which they occur, the first two items could be outright symptoms of psychiatric disorder; the second two could be indicators of problems in social functioning related to the presence of psychiatric disorder.

Therefore it is not surprising that such events correlate highly with psychopathology (e.g., Brett, Brief, Burke, George, & Webster, 1990), although they do not appear to account for the correlation between the total checklist events and such outcomes (Zimmerman, O’Hara, & Corenthal, 1984). To the extent that a checklist contains categories that can include symptoms of psychological disorder or disabilities related to such disorder, the measurement of stressful events as a putative antecedent risk factor will be confounded with the measurement of the putative psychiatric outcome—and the potential for such confounding appears considerable in the SRE (Dohrenwend, Dohrenwend, Dodson, & Shrout, 1984). Without more information about the actual events in these categories, it is impossible to tell whether they are fundamentally important environmental incidents or symptoms of psychiatric disorder.

Summary of Impact

The consequences of intracategory variability in traditional checklists include unreliability of recall and, even more serious, susceptibility to recall bias. The latter problem, previously illustrated by the studies of the relation of checklists of exposure to stressful war zone events and PTSD, is especially serious because the susceptibility of checklists of events to recall bias can inflate the supposed dose/response relationship between exposure and a psychopathological outcome. An additional source of confounding of the measurement of exposure occurs when a category such as marital separation or divorce includes events that may be brought about by disorder-related functioning of the respondent, as well as by events with occurrences that are unaffected by the respondent’s behavior. This type of intracategory variability undermines the construct validity of the traditional checklist as a measure of environmentally induced stress. Problems of criterion validity exist as well. It is unlikely, for example, that coinformants will confirm that a respondent has experienced an event on a checklist if the respondent and the informant are thinking of different types of events within the same broad checklist category.

Approaches to Reducing Intracategory Variability in Checklists

Three procedures have been developed to reduce the intracategory variability in traditional checklist approaches. One involves subjective appraisals of stressfulness by the respondent. A second supplies definitions to the respondent, to the interviewer, or to both regarding what is and what is not to be included in an event category. The third involves intensive interviews with the respondent to elicit details of the actual event reported under the various event topics and ratings by the investigators of the characteristics the researchers believe are important.

This third approach is far more labor intensive. Although its purpose, similar to the previous two, is to improve procedures for inventorying stressful life events, the change from relatively economical modifications of traditional checklists on the SRE model to a time-consuming and labor-intensive procedure is of sufficient magnitude to suggest that it be described as something other than a checklist approach. It is referred to here as a narrative-rating methodology.

Respondent Appraisals of Stressfulness

Obviously, intracategory variability has resulted in the inclusion of objectively small events and objectively large events in the same-event categories. Some investigators have attempted to reduce this variability economically, by having the respondents provide ex post facto subjective judgments of the severity of negative impact of the events they experienced (e.g., Grant, Gerst, & Yager, 1976; Sarason et al., 1978). This scoring procedure leads to a stronger relationship between events reported and adverse psychological outcomes (e.g., Tennant & Andrews, 1978; Zuckerman, Oliver, Hollingsworth, & Austrin, 1986).

It has long been known, however, that such judgments are influenced by the nature of the outcome in retrospective case/control studies or by antecedent psychological risk factors, such as prior disorder or coping history, in prospective research (cf. Brown & Harris, 1978; Grant et al., 1976; Lennon, Dohrenwend, Zautra, & Marbach, 1990; Raphael & Cloitre, 1994; Schless, Schwartz, Goetz, & Mendels, 1974; Theorell, 1974). For example, Theorell investigated two sets of ratings—by samples of patients with neurotic diagnoses, patients who had myocardial infarctions (MI) and controls—of items on a revised version of the SRE. One rating was of the amount of adjustment the event would require; the other was of the amount of “upsettingness” that the event would cause. Patients with neurotic diagnoses rated both more upsettingness and more adjustment than the controls; the patients with MIs rated more upsettingness than the controls. Information about the events actually experienced in the 12 months before the MI had been obtained from both the patients with MIs and the controls, for a corresponding 12-month period. The ratings of patients who actually experienced the events did not differ from the ratings from patients who did not experience the events; by contrast, controls who experienced the events tended to rate them as less upsetting and requiring less adjustment than the controls who did not experience the events. These results show that the tendency of the patients to appraise the same checklist events as more upsetting than did the controls occurred whether or not the events had been experienced.

It could be argued that use of appraisals that are antecedent to psychiatric outcomes and independent of prior disorder and other personal predispositions might be a viable and economical way to reduce intracategory variability. These are not easy conditions to satisfy. Moreover, even under these conditions of temporal priority and independence from personal predispositions, accurate objective measurement of the events is needed to assess the extent to which the appraisals are commensurate with the objective characteristics of the events or, rather, vary with other factors such as gender, ethnic/racial background, and SES. Appraisal processes are important in life stress processes (Lazarus & Folkman, 1984). However, it makes more sense to consider appraisals as one of a variety other relevant variables in life stress processes rather than as economical means of reducing intracategory variability in traditional checklists (e.g., Dohrenwend, 1998, 2000). By doing so, it becomes possible to investigate how appraisals are related to objectively measured events and other important variables in life stress processes.

Specification of Inclusion and Exclusion Criteria for Event Categories

A few investigators have departed from traditional checklists by defining for the interviewer, the respondent, or both what events are to be included in an event category. For example, interviewers using Paykel’s (1983) checklist of 61 events are given detailed instructions on administration, including definitions of what is and what is not to be included in each category; they are instructed to probe for enough details to be able to decide whether or not the event should be included in the category. Other examples are life events interviews developed by Wittchen, Essau, Hecht, Teder, and Pfister (1989) and screening questionnaires for potentially traumatic events developed by Goodman, Corcoran, Turner, Yuan, and Green (1998) and Kubany et al., (2000). Zimmerman, Pfohl, and Stangl (1986) have referred to such attempts to increase item specificity as leading to a “second generation” of checklist inventories.

As with traditional checklists, these instruments have good test-retest reliability for total scores over brief periods of time. In addition, however, they tend to have far better test-retest agreement for individual events (e.g., Goodman et al., 1998; Wittchen et al., 1989). An indication also exists of much less fall off of event reporting over time. For example, Wittchen et al. report an average falloff rate of only .36% per month in recall of events measured by a detailed interview and use of memory aids over an 8-year period of recall, which compares favorably with rates such as the 4 to 5% per month over 8 to 9 months for traditional checklists reported by Jenkins, Hurst, and Rose (1979) and Monroe (1982). As would be expected, falloff is least for major negative events (e.g., Raphael et al., 1991; Wittchen et al., 1989).

The checklists developed by Goodman et al. (1998) and by Kubany et al. (2000) to screen for the occurrence over the life course of traumatic events illustrate the kinds of procedures that can be used to specify detail. For example, in their measure to screen for potentially traumatic events, the Stressful Life Events Screening Questionnaire (SLESQ), Goodman et al. (1998) follow positive responses to the broad question, “Has an immediate family member, romantic partner, or very close friend died as a result of accident, homicide, or suicide?” with probes for the respondent’s age at the time, how the person died, the respondent’s relation to the person lost, and how often the respondent saw or otherwise had contact with the deceased in the year before the death.

The procedure developed by Kubany et al. (2000) is called the Traumatic Life Events Questionnaire (TLEQ). It reduces intracategory variability in magnitude by providing more detailed definitions than most second-generation measures of what is to be included in its categories. It differs from the procedure used by Goodman et al. (1998) in that, instead of using follow-up of positive responses to rather broad questions with probes consisting mainly of the closed questions, the Kubany et al. procedure includes the details of the events in the questions themselves. Examples of these TLEQ items are, “Were you involved in a motor vehicle accident for which you received medical attention or that badly injured or killed someone?” and “While you were growing up, were you physically punished in a way that resulted in bruises, cuts, or broken bones?” These details clearly reduce intracategory variability in the checklist items, and Kubany et al. report much better test-retest reliability, not only for total scores but also for individual events than has been found with traditional checklists.

What is less clear, however, is whether the events included in response to further specification by the types of procedures illustrated by either the SLESQ or the TLEQ will be exhaustive of the major events in each event category. The danger in providing explicit inclusion and exclusion criteria is that such detail may make the definition of events to be reported too narrow. Major events that do not clearly meet such criteria or are construed by the respondent not to meet such criteria may be missed altogether (Goodman et al., 1998). Some evidence suggests that the greater the detailed definition provided for the events in each checklist category, the greater will be the test-retest reliability of the instrument for individual, as well as total, events over brief intervals, the less the falloff in event reporting with length of the recall period, and the greater the agreement between respondent and coinformant (e.g., Paykel, 1987). A price for these improvements, however, may be failure to elicit major events that do not fit neatly into the detailed definitions of what should be included in the checklist category.

Narrative-Rating Methodology

The dominant alternative approach in life event measurement, unlike the checklist approach, is labor intensive and involves the collection and analysis of detailed information about the events reported. It is this narrative information about the event that makes it possible to reduce intracategory variability. For example, if one knows the details of what actually happened, then he or she can distinguish between major events (e.g., those with magnitude ratings of more than a moderate amount of change as illustrated in Table 1) and minor events within a particular category and obtain evidence of the sources of an event that, if identified only by a positive response to a checklist category, may otherwise be ambiguous (as with the category divorce that may elicit events precipitated to a greater or lesser extent by the individual) or misleading (as when laid off is a euphemism for being fired). Ratings by trained judges can be made of the event characteristics—such as valence, source, and magnitude—that are of interest.

As noted earlier, the best-known example of a narrative-rating method is the Life Events and Difficulties Schedule (LEDS) developed by Brown and colleagues (e.g., Brown & Harris, 1978). LEDS has been used more frequently abroad than in the United States (e.g., Brown & Harris, 1989), but it, or variations of it, have been adopted by a number of U.S. investigators in recent years (Duggal et al., 2000; Frank, Anderson, Reynolds, Ritenour, & Kupfer, 1994; Garber, Keiley, & Martin, 2002; Goodyer & Altman, 1991a, 1991b; Hammen, 1991; Kendler, Hettema, Butera, Gardner, & Prescott, 2003; McQuaid, Monroe, Roberts, Kupfer, & Frank, 2000; Monroe, Kupfer, & Frank, 1992; Rudolph & Hammen, 1999).

Starting with its introduction over 25 years ago (Brown & Harris, 1978), the focus of LEDS has usually been on relatively recent events, that is, those occurring within the past year or less. LEDS requires intensive interviewing about the details of each event that occurred. This instrument was designed to deal with both the problem of intracategory variability in objective scoring of checklist categories and the problem of confounding involved in subjective scoring of the severity or stressfulness of the event by the respondent. Trained raters evaluate the likely “contextual threat” of the event for the individual by assessing its place within the respondent’s “biographically determined circumstances” (Brown & Harris, 1978, p. 90).

Another approach to eliciting detailed information about recent major stressful events is called the Structured Events Probe and Narrative Rating Method (SEPRATE; Dohrenwend et al., 1993). Preliminary versions of this instrument have been used in several studies (Lennon et al., 1990; Mazure, Bruce, Maciejewski, & Jacobs, 2000; Shrout et al., 1989; Stueve, Dohrenwend, & Skodol, 1998). As with LEDS, detailed descriptions or narratives of the event are elicited and rated, not by the respondent, but by trained raters. What is meant by a narrative in this approach is not dissimilar to eliciting a record of the facts through testimony in a court of law, with the aim of developing a “readily digestible account of what happened, how it happened and, if possible, why it happened” (Weitz, 1987, p. 202).

The theoretical framework served by this approach, however, requires that life events measures be distinct from measures of other components of life stress processes (e.g., SES, personal predispositions, and social network supports) so that their interrelations can be investigated and their separate and joint contributions assessed (Dohrenwend, 1998). This requirement leads to a difference with the Brown and Harris LEDS procedure. LEDS combines situational and personal variables that may be important risk factors into the single life event measure of contextual threat. As a result, LEDS provides no way to tell which of the components of life stress processes encompassed in the global threat rating account for a particular association (Kessler, 1997; Tennant et al., 1981; Wethington, Brown, & Kessler, 1997). In the SEPRATE approach, what gets left in a narrative and what is taken out before the ratings depends on the theory underlying the hypotheses to be investigated in a particular study; for example, when the roles of ethnic/racial background and SES are of theoretical interest, information about these variables is removed from event narratives so that their independent contribution can be assessed (Stueve et al., 1998). With SEPRATE, more generally, the emphasis in the narrative material given to the raters is more on the here and now of what happened than on the biographically determined circumstances of the individual.

Narrative-rating procedures have proved far superior to traditional checklist approaches in test-retest reliability for individual events (cf. Gorman, 1993; Paykel, 1983). Moreover, in contrast to the poor agreement with coinformants for traditional checklists noted previously, intrapair agreement with LEDS has been found to range between 78% and 91% (the latter for LEDS events rated as carrying severe contextual threat) in samples with diagnoses of depression and schizophrenia (Brown et al., 1973). A particularly valuable example is the use of narratives from adult sisters to measure childhood abuse and neglect (Bifulco, Brown, Lillie, & Jarvis, 1997). In this study, sisters of similar age provided narratives of their own experiences and the experiences of their sisters. The investigators were able to show that, although there was marked difference in the amount of abuse and neglect experienced by each member of the sister pairs (concordance of about 0.4 as measured by kappa), there was good agreement between the sisters about the abuse and neglect that each experienced (kappa of about 0.7). Such agreement between the sisters increases confidence in the accuracy of the adult sisters’ retrospective reports about their childhood that could otherwise be highly suspect.

With regard to construct validity, evidence suggests that narrative-rating procedures provide more interpretable and sometimes (but not always as will be seen later) stronger associations with adverse psychological outcomes than traditional checklist measures (Bebbington, Tennant, Stuart & Hurry, 1984; Duggal et al., 2000; McQuaid et al., 2000; Shrout et al., 1989). When effect sizes are measured by odds ratios or attributable risks, moreover, it is evident that these effect sizes are substantial (Cooke & Hole, 1983). Consider by way of examples some results from two case/control studies that used narrative-rating procedures to measure stressful events in the 3 months before the onset of episodes of major depression. The first study by Ormel, Oldehinkel, and Brilman (2001), with LEDS as the measure of stressful life events, found an odds ratio of 25.9 for one or more severe events in a comparison of case and control groups of older adults from the general population. The second study by Stueve et al. (1998) used SEPRATE to measure stressful events and was particularly concerned with major negative events that were fateful, that is, negative events that occurred independently of the behavior or actions of the individual. The odds ratio was 13.8 for one or more such recent events in a comparison of a sample of psychiatric outpatients with recent episodes compared with controls sampled from the community.

Because the customary procedure with checklists is to sum events rather than dichotomize the measures as in the previously discussed case and control studies using narrative-rating procedures, making a direct comparison of the effect sizes obtained with the two procedures is usually impossible. The second of the two case/control studies, however, does provide an opportunity for this comparison. This study was conducted in an Upper Manhattan section of New York City and involved a comparison of 404 adults sampled from the general population from whom persons with recent (in the preceding year) episodes of major depression had been removed, and 96 outpatients diagnosed as having recent episodes of major depression. As a result of a concerted effort to oversample them, half of the patients were in their first episode of major depression. Focus is on the following 12 checklist events that had been judged to be negative and likely to be fateful in previous research with the PERI checklist (Dohrenwend, Shrout, Link, Martin, & Skodol, 1986): spouse died; child died; close friend died; miscarriage or stillbirth; found out cannot have children; family member other than spouse or child died; lost home through fire, flood, or other disaster; physically assaulted or attacked; cut in wage or salary without demotion; did not get expected wage or salary increase; laid off; and unable to get treatment for illness or injury. The controls were asked to report events on the checklist that occurred in the year before the interview; the cases were asked to report on events in the year before the onset of the episode of depression.

After filling out the PERI checklist, the respondents were questioned about details of the events. The research team rated the resulting narratives for actual fatefulness and hypothetical amount of negative change. The anchors for the ratings of magnitude are those shown earlier in Table 1. The ratings of source, from which fatefulness was estimated, were made in two parts: the prelude leading up to the event and the immediate occurrence of the event. For example, in an event involving loss of a job, the prelude might consist of repeatedly being late for work and not getting one’s job done; the immediate occurrence might be being told by your boss that you are fired. The ratings for this event would be as shown in Table 4.

Table 4

Ratings of Source as a Basis for Determining Fatefulness

To be considered fateful, both the prelude to the event and its actual occurrence had to be rated as mostly or completely determined by external circumstances. In making these magnitude and fatefulness ratings, the raters were blind as to whether the event narratives being rated came from patients or nonpatient controls to avoid possible rater bias in favor of the stress hypothesis. Data on ethnic/racial background and educational level were also removed, because these were variables of interest in the research that needed to be assessed for their independent contribution.

Table 5 compares three measures of the 12 negative events as they differentiate cases from controls: one or more unmodified “fateful” checklist events; one or more events verified to be fateful; and one or more events verified to be fateful and likely to entail more than a little change (Shrout et al., 1989). As Table 5 shows, the odds ratios are much larger for the measure revised for both fatefulness and magnitude on the basis of detailed interview data—even after scores on a scale of nonspecific distress or demoralization were entered to control for mood-congruent recall bias.

Table 5

Comparison of Three Fateful-Loss Exposure Variables in Patient Cases with Major Depression and Community Controls

By contrast with traditional checklists, labor-intensive procedures have also led to important findings suggesting, as noted earlier, that among inventories of recent events, it is major negative events of substantial magnitude that are most strongly related to important types of psychiatric disorders, especially first onsets of major depression, and that these relationships are substantial (e.g., Brown & Birley, 1968; Brown & Harris, 1978; Ormel et al., 2001; Stueve et al., 1998). These findings on the importance of major negative events are consistent with the results of case studies of individual events, such as spousal bereavement (Clayton, 1998), divorce (Bruce, 1998), rape (Kilpatrick, Resnick, Saunders, & Best, 1998), child abuse and neglect (Widom, 1998), and serious physical illness (Dew, 1998). Moreover, it has been possible to show that these major events are much more likely to be fateful for depression than for schizophrenia (Stueve at al., 1998).

Stress and Life Events

Saul McLeod published 2010

Holmes and Rahe (1967) developed a questionnaire called the Social Readjustment Rating Scale (SRRS) for identifying major stressful life events.

Each one of the 43 stressful life events was awarded a Life Change Unit depending on how traumatic it was felt to be by a large sample of participants.

A total value for stressful life events can be worked out by adding up the scores for each event experienced over a 12 month period.

If a person has less the 150 life change units they have a 30% chance of suffering from stress.

150 - 299 life change units equates to a 50% chance of suffering from stress.

Over 300 life units means a person has an 80% chance of developing a stress related illness.

Social Readjustment Rating Scale (SRRS)

Empirical Research (Rahe, 1970)

The aim of this study was to investigate whether scores on the Holmes and Rahe Social Readjustment Rating Scale (SRRS) were correlated with the subsequent onset of illness.

Procedure: 2,500 male American sailors were given the SRRS to assess how many life events they had experienced in the previous 6 months. The total score on the SRRS was recorded for each participant.

Then over the following six-month tour of duty, detailed records were kept of each sailor’s health status. The recorded number of Life Change Units were correlated with the sailors’ illness scores.

Results: There was a positive correlation of +0.0118 between Life Change scores and illness scores. Although the positive correlation was small (a perfect positive correlation would be +1.00), it did indicate that there was a meaningful relationship between Life Change Units and health (this is often referred to as a statistically significant correlation). As Life Change Units increased, so did the frequency of illness.

The researchers concluded that as Life Change Units were positively correlated with illness scores, experiencing life events increased the chances of stress-related health breakdown. As the correlation was not perfect, life events cannot be the only factor in contributing to illness.

Evaluation: The SRRS does not take individual difference into consideration. The scale assumes that each stressor affects people the same way. Not necessarily true e.g. for some people divorce is extremely stressful while for others it can be amicable or even a relief.

Most people experience major life events very infrequently. Therefore a better measure of stress might look at the stresses and strains of daily life. These are called “daily hassles”, e.g. such as losing your keys.

Source of Stress: Daily Hassles & Uplifts

Most 43 life changes in the SRRS aren’t everyday events.  Kanner et al (1981) has designed a Hassles Scale which consists of 117 items, including concerns about losing things, traffic jams, arguments, disappointments, weight and physical appearance.

Daily hassles are ‘irritating, frustrating, distressing demands that to some degree characterise everyday transactions with the environment’ (Kanner 1981) – i.e. the straw that broke the camel’s back!

Kanner et al (1981) Empirical Study

Aim: Kanner et al (1981) were interested in investigating whether it is daily hassles, rather than major life events that are the most stressful. They developed a 117 item hassles scale and a 135 uplifts scale to examine the relationship between hassles and health.

Procedure: An opportunity sample of 100 American participants, including 52 women and 48 men, all white, well-educated and middle class were asked to circle the events on both scales that they had experienced the previous month and rate each according to severity (for the hassles) and frequency (for the uplifts).

Each participant was tested once a month for ten consecutive months using the two stress measures together with another two psychometric tests for psychological well-being.

117 Daily hassles

135 Daily uplifts

about weight


rising prices

relations with friends

home maintenance

good weather

losing things

job promotion

physical appearance

eating out


Getting enough sleep

Results: They found the hassles scale tended to be a more accurate predictor of stress related problems, such as anxiety and depression, than the SRRS. Uplifts had a positive effect on the stress levels of women, but not men.

Further Information

Biology of Stress


Holmes, T. H., & Rahe, R. H. (1967). The social readjustment rating scale. Journal of psychosomatic research, 11, 213..

Kanner, A. D., Coyne, J. C., Schaefer, C., & Lazarus, R. S. (1981). Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. Journal of behavioral medicine, 4(1), 1-39.

Rahe, R. H., Mahan, J. L., & Arthur, R. J. (1970). Prediction of near-future health change from subjects' preceding life changes. Journal of Psychosomatic Research, 14(4), 401-406.

How to reference this article:

McLeod, S. A. (2010). SRRS - stress of life events. Retrieved from www.simplypsychology.org/SRRS.html

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