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Life Changes & Stress

Richard Rahe, J L Mahan & R J Arthur 1970



AIMS: During the 1950s many studies indicated a relationship between stress and poor health. One of the most important of these was the 1958 study by Ray Rosenman & Meyer Friedman which found a link between the kind of stress experienced by ‘Type A’ personalities and coronary heart disease  - see Stress & Vulnerability.

Rahe, Mahan & Arthur were more interested in environmental factors which caused stress to the point of illness, rather than temperament.

The idea of ‘life events’ causing stress to the point of illness had begun in 1919 with the ‘life chart’ work of Adolph Meyer. His work became the foundation for the Schedule of Recent Events (SRE) developed by David Hawkins, R Davies & Thomas Holmes (1957); this looked at the cumulative effect of life events in causing stress. In 1967 Holmes & Rahe added the idea of the magnitude of different life events - measured in ‘life change units’ (LCUs) - to get a more precise understanding of the cumulative effect. They 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 0.3 was found between their life events and their illnesses. And thus, the SRE became the Social Readjustment Rating Scale (SRRS).

Most studies into the relationship between stress and illness in the 1950s and 1960s - eg: William Greene (1954), Greene, Lawrence Young & Scott Swisher (1956), Rahe, M Meyer, M Smith, G Kjaer & Holmes - were carried out retrospectively - ie: the participants were already hospitalised with illness. So the participants’ memory of stress factors which might have contributed to their illness may have been coloured by the very fact that they were now ill.

Rahe, Mahan & Arthur wanted to conduct a prospective study - ie: to predict illness as a result of stress factors.

Thus, the researchers’ aim was to test whether participants who scored highly on the SRRS would become ill - in which illness through stress could be deemed predictable.


PROCEDURE (METHOD): 2,684 American naval men of varying ranks were asked to complete an SRRS specially customised for navy personnel The questionnaire was used to assess the stressful life events each man had experienced over 4 consecutive 6-month periods in the lead-up to their deployment on one of 3 navy cruisers. Each stressful factor was assigned an LCU weighting that indicated the severity of the source of stress. A total LCU score was calculated for each of the 4 6-month periods prior to embarkation.

The sample represented 90-97% of each ship’s crew and fell to a total of (less than 10%) due to transfer off the ships. The average age of the men was 22.3 years; approximately 2/3 of them were high school graduates; and they ranged in experience from apprentice seamen to high-ranking officers with 30 years’ naval experience.

The ships were on 6 months active duty and 2 of them were on military missions off the coast of Vietnam.

On board any illness, no matter how trivial, had to be recorded by the ship’s medical facility. When the data on health was analysed, any sickness believed to be motivated by a desire to avoid work was discarded - as were any reports of pre-existing conditions. The remaining information on the number, type and severity of new health problems was used to produce an illness criterion.

Neither the participants themselves nor the ship’s medical facilities knew their health records were going to be used in this way.


FINDINGS (RESULTS): The only significant correlation found - r = 0.118 - was between the LCU total for the 6 months prior to departure and the illness score. Consequently only the data relating to the final pre-departure 6 months was used in subsequent analyses.

Overall totals were calculated by putting participants in order of highest to lowest LCU and dividing the list into 10 bands (each 1/10 of the ship’s crew). When divided up in this way, 2 of the ships showed large differences but one was not so great. So the data for all 3 vessels were combined which obscured the variations between the third ship and the others. The only big differences then were at each end of the scale. To overcome this, the grouping was changed, combining some of the 10 bands to make 4 bigger groups.

The final stage of analysis was to re-group the men’s LCU scores into bands 0-99, 100-199, 200-299, 300-399, 400-499, 500-599, 600-600+ and plot these against mean illness rates. This produced a linear


Event


Points

1

Death of spouse

100

2

Divorce

73

3

Marital separation

65

4

Prison term

63

5

Death of close family member

63

6

Personal injury or illness

53

7

Marriage

50

8

Fired at work

47

9

Martial reconciliation

45

10

Retirement

45

11

Change in health of family member

44

12

Pregnancy

40

13

Sex difficulties

39

14

Gain of new family member

39

15

Business readjustment

39

16

Change in financial state

38

17

Death of close friend

37

18

Change to different line of work

36

19

Change in number of arguments with spouse

35

20

A large mortgage or loan

30

21

Foreclosure of mortgage or loan

30

22

Change in responsibilites at work

29

23

Son or daughter leaving home

29

24

Trouble with in-laws

29

25

Outstanding personal achievement

28

26

Spouse begins or stops work

26

27

Begin or end school or college

26

28

Change in living conditions

25

29

Change in personal habits

24

30

Trouble with the boss

23

31

Change in work hours or conditions

20

32

Change in residence

20

33

Change in school or college

20

34

Change in recreation

19

35

Change in church activities

19

36

Change in social activities

18

37

A moderate mortgage or loan

17

38

Change in sleeping habits

16

39

Change in number of family get-togethers

15

40

Change in eating habits

15

41

Holiday

13

42

Christmas

12

43

Mionor violations of the law

11

The standard Social Readjustment Rating Scale

LCU band

Mean illness

rate

1

1.434

2

1.377

3

1.583

4

1.543

5

1.498

6

1.685

7

1.651

8

1.693

9

2.083

10

2.049

LCU bands grouped

Mean illness

rate

1 & 2

1.405

3, 4 & 5

1.541

6, 7 & 8

1.676

9 & 10

2.066

relationship between exposure to life events and ill health.

The 2 ships judged to have the easiest missions showed the strongest relationships between LCU totals and mean illness rates. It was considered possible that the current stress levels on the third ship may have nullified the effects of pre-embarkation stress factors.


CONCLUSIONS: Rahe et al concluded that there was a link between the higher LCUs from the 6 months prior to departure and higher illness rates on board ship. When the  pre-departure life changes were low, so where the onboard illness rates. However, the study indicated this relationship could be masked by onboard stressful experiences which increased the illness rate for the entire crew.

Additionally, the link was stronger for older men (over 21s) and married men.


CRITICISMS (EVALUATION): The study had a number of strengths:-

However, the study also has a number of weaknesses:-