43 common events from patients’ files and asked
samples of judges to rate the amount of behavioral
readjustment that each required. Death of a spouse
was rated as requiring the most behavioral readjustment,
100 “life change units” on a scale ranging
from 0 to 100; minor violations of the law had
the fewest life change units, 11. Holmes and Rahe
(1967) then showed that the more life change
units an individual accumulated during a year’s
time, the greater his or her likelihood of illness or
injury.
The Social Readjustment Rating Scale gave
behavioral researchers a simple, easily administered
way of assessing the amount of stress in
people’s lives in a survey format. Hundreds upon
hundreds of studies followed, examining the relationship
between stress exposure and various physical
and mental health outcomes. Findings in the
psychological, sociological, social work, nursing,
and medical literatures were unequivocal, especially
when dramatically expanded lists of events
were developed, events that happened to loved
ones were included, and issues of causal ordering
were addressed. First, socially undesirable or negative
events were more strongly associated with
poor physical and mental health than desirable,
positive events (Brown and Harris 1978; Hatch
and Dohrenwend 2007; Thoits 1983). Because of
this, the terms “life events” or “stressful events”
now refer to negative changes in people’s lives
(and from this point on, this is my meaning when I
mention life events). Second, the more negative
events that individuals experienced in a given
period of time (say, during six months or a year),
the higher the likelihood they would subsequently
suffer an injury, an illness, a disability, or death
(Cohen, Janicki-Deverts, and Miller 2007; Cooper
2005; Tennant 1999; Turner 2010). Pile-ups of
stressors also produced elevated levels of psychological
distress,2
and they also predicted onsets or
recurrences of psychiatric disorders, such as generalized
anxiety disorder, major depression, posttraumatic
stress disorder, and alcohol and substance
use disorders (Brown and Harris 1978; Dohrenwend
and Dohrenwend 1974; Mirowsky and Ross
2003b; Thoits 1983, 1995).
Investigators soon realized that, although significant
and consistent, the relationship between
events and outcomes was only weak to modest in
strength (Thoits 1983). Many people with high
numbers of events did not become ill or distressed,
while others with few events did. Correlations
between numbers of events and distress symptoms
ranged from .10 to .35 across studies, indicating