Approaches to measuring stress
A literature review
© Copyright 2007, Ed Mulligan
A literature review
© Copyright 2007, Ed Mulligan
Permission granted to reproduce for academic purposes.
This literature review is similar to one submitted as part of an MSc course in
Psychological Research Methods. Since the Open University prohibits posting
assignments on the Internet, this review has been altered and is different to
the one submitted to the Open University.
Approaches to measuring stress - A literature review
“Stress” has spawned a vast body of research in both the health and occupational literature. For example, Jones and Bright (2001) estimated over 1000 academic articles on stress were published each year in the decade prior to 2000. Jones and Kinman (2001) divide stress research into three areas: stressors (the environmental causes of stress), intervening variables and strains (the outcomes of stress). They add that these areas are interlinked and these categories are not mutually exclusive, which has led to much confusion in academic and popular writing on stress. Given the vast body of research, this review is necessarily selective so focuses mainly on differing ways of measuring stressors.
The Social Readjustment Rating Scale
An early attempt to provide a quantitative measure of stressors was Holmes and Rahe’s (1967) highly influential Social Readjustment Rating Scale (SRRS). Holmes and Rahe’s model of stress was a simple one: readjustment to change resulting from social events is significantly associated with onset time of illness. They used a survey to quantify the readjustment required for each of 43 major life events, selected on the basis of prior clinical experience. Participants (N=394) used their experience to estimate the relative readjustment required for each life event (regardless of its desirability) where “marriage” was given an arbitrary scale value of 500. The mean rating for each event was divided by 10 to determine its SRRS value. Holmes and Rahe reported correlations between ratings for discrete subgroups within the sample to justify the scale’s reliability.
In practise, the SRRS is used by adding together the weighted scores for the each event that a person has experienced in the past year. The total has been found in many studies to correlate with health outcomes as Holmes and Rahe intended (e.g. Dinis, Schor, & Blay, 2006; Masuda & Holmes, 1967b; Scully, Tosi, & Banning, 2000) and is used to identify those at risk of stress-related illness. The validity of the scale, however, has been questioned. The claim that the SRRS is a ratio level scale (made in Masuda & Holmes, 1967a) has been challenged by Hough, Fairbank and Garcia (1976). They argue that the scale ignores cultural variance in populations, suffers inconsistencies in the method of administration (Holmes and Rahe used different methods on different occasions, which Hough, et. al argue could lead to different weights being assigned to the items) and depends on the order of presentation of items
(which was not random and may have affected the scores given by participants). A different criticism comes from Lei and Skinner (1980) who suggest that the weights given to each life event in the SRRS are irrelevant. They found in a clinical sample (N=353) that using unweighted events (simply counting the number of events rather than using the SRRS weights) and randomised weights correlated as well with measures of strains as did the original SRRS score.
Daily Hassles and Uplifts
Lazarus (1980) proposed a transactional model of stress, the Daily Hassles and Uplifts (DHU) as an alternative to the major life events that underpin SRRS. Whereas a life event (such as the death of a spouse) is perceived to be of major importance and usually occurs infrequently, hassles and uplifts are “the relatively minor stresses and pleasures that characterise everyday life” (Kanner, Coyne, Schaefer, & Lazarus, 1981, p. 2). Kanner et al. compared the SRRS with DHU. Their methodology was a longitudinal survey (N=100) with monthly questionnaires completed for a year. The use of a longitudinal study is crucial, since the transactional model is a dynamic one, as Lazarus has argued (1990). Hassles and uplift scales were administered each month along side different strain measures and were found to be a better predictor of health outcomes than life events. The multiple measures allowed test-retest validity to be confirmed. They also found that hassles and uplifts were moderately correlated with positive and negative affect (see below).
As with the SRRS, lists of DHU are widely used in clinical practise and research. Kanner et al. (1981) provide normative data on the most frequent hassles and uplifts. The use of hassles and uplifts checklists has been validated by a number of researchers. Chamberlain and Zika (1990), for example, used four homogeneous samples (N=161,120,194,150) and reported that different groups reported different patterns of hassles which were stable over time. They concluded hassles were a valid and reliable stressor metric, which was significantly related to adaptional outcomes.
Subjective and perceived stress
Many theorists argue that it is the evaluation of stressors that is associated with positive or negative outcomes so what is needed is a measure of subjective stress. Of the many scales for this purpose, two will be reviewed here. Horowitz, Wilner and Alvarez (1979) devised the Impact of Event Scale (IES) as a scale of current subjective distress related to a specific event. Their method was a survey (N=66) asking participants to rate twenty items indicating intrusion and avoidance for their severity and frequency. Using cluster analysis they reduced the scale to 15 items, which they tested on a second sample (N=25) twice to evaluate the test-retest reliability.
The IES scale was devised for use in a specific clinical situation (treating post traumatic stress). Cohen, Kamarck and Mermelstein’s (1983) global measure of perceived stress (PSS) is a very widely used 14-item instrument designed to measure the degree to which life events are appraised as stressful. They provided evidence from three samples (N=332, 114, 64) on the reliability of the scale. They showed it correlated with both life events and various health outcomes. They argue that the PSS correlates better with health outcomes than “objective” scales of either life events or daily hassles. The PSS has been used in many subsequent studies as a simple measure of stress (e.g. Golden-Kreutz et al., 2005; Pbert, Doerfler, & DeCosimo, 1992)
The role of evaluation
Pbert et al. (1992) reported that perceived stress was correlated with negative affect, a conclusion reached by other researchers such as Watson and Pennebaker (1989). Their argument is that negative affect correlates highly with health complaints but not with measures of actual health. This, they claim, casts doubt on the use of self-reports in stress research. Lazarus has written extensively on the processes that underpin the evaluation of events as stressful, e.g. coping (Lazarus, 1993). He also argues that research needs to progress from viewing stress as a measurable cause or effect to a more integrated, field-based (Lewin, 1952) approach in which the meaning and emotional content of stressful experiences is emphasised (Lazarus, 1990). This view has met with considerable resistance from researchers with a quantitative approach to research (e.g. Breznitz, 1990; Brown, 1990).
Although much of the research covered in this review is old, the SRRS, DHU and PSS scales are still very much in current use, both in research environments and in clinical practise. For all their differences, the three scales are each based on survey and selfreport measures. Hurrell, Nelson and Bret (1998) in their review of methodologies note that self reports often confound stress and strain (the cause and the outcome) which can lead to spuriously high correlations. Their suggestion is to use methodological triangulation in research. While this is an admirable stance, it still requires a good understanding of the strengths and limitations of individual measures.
Breznitz, S. (1990). Theory-Based Stress Measurement? Not Yet. Psychological Inquiry, 1(1), 17-19.
Brown, G. W. (1990). What About the Real World? Hassles and Richard Lazarus. Psychological Inquiry, 1(1), 19-22.
Chamberlain, K., & Zika, S. (1990). The minor events approach to stress: Support for the use of daily hassles. British Journal of Psychology, 81, 469-481.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behaviour, 24, 386-396.
Dinis, D. H., Schor, N., & Blay, S. L. (2006). Stressful life events and painful
recurrent colic of renal lithasis. Journal of Urology, 6(1), 2483-2487.
Golden-Kreutz, D. M., Thornton, L. M., Well-Di Gregorio, S., Frierson, G. M., Jim, H. S., Carpenter, K. M., et al. (2005). Traumatic Stress, Perceived Global
Stress, and Life Events: Prospectively Predicting Quality of Life in Breast
Cancer Patients. Health Psychology, 24(3), 288-296.
Holmes, T. H., & Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research, 11(2), 213-218.
Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A Measure of Subjective Stress. Psychosomatic Medicine, 41(3), 209-218.
Hough, R. L., Fairbank, D. T., & Garcia, A. M. (1976). Problems in the Ratio
Measurement of Life Stress. Journal of Health and Social Behaviour, 17(1),
Hurrell, J. J. J., Nelson, D. L., & Simmons, B. L. (1998). Measuring Job Stressors and Strains: Where We Have Been, Where We Are, and Where We Need to Go. Journal of Occupational Health Psychology, 3(4), 368-389.
Jones, F., & Bright, J. (2001). Stress: the concept. In F. Jones & J. Bright (Eds.), Stress: Myth, Theory and Research. Harlow: Pearson Education.
Jones, F., & Kinman, G. (2001). Approaches to Studying Stress. In F. Jones & J. Bright (Eds.), Stress: Myth, Theory and Research. Harlow: Pearson Education.
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
event. Journal of Behavioural Medicine, 4(1), 1-39.
Lazarus, R. S. (1980). The stress and coping paradigm. In C. Eisdorfer, D. Cohen & A. Kleinman (Eds.), Conceptual Models for Psychopathology (pp. 173-203). New York: Spectrum.
Lazarus, R. S. (1990). Theory-Based Stress Measurement. Psychological Inquiry, 1(1), 3-13. Lazarus, R. S. (1993). Coping Theory and Research: Past Present and Future. Psychosomatic Medicine, 55, 234-247.
Lei, H., & Skinner, H. A. (1980). A Psychometric Study of Life Events and Social Readjustment. Journal of Psychosomatic Research, 24, 57-65.
Lewin, K. (1952). Field Theory in Social Science: Selected Theoretical Papers.
Masuda, M., & Holmes, T. H. (1967a). Magnitude estimations of social
readjustments. Journal of Psychosomatic Research, 11(2), 219-225.
Masuda, M., & Holmes, T. H. (1967b). The Social Readjustment Rating Scale: a cross-cultural study of Japanese and Americans. Journal of Psychosomatic
Research, 11(2), 227-237.
Pbert, L., Doerfler, L. A., & DeCosimo, D. (1992). An evaluation of the perceived stress scale in two clinical populations. Journal of Psychopathology and Behavioural Assessment, 14(4), 363-375.
Scully, J. A., Tosi, H., & Banning, K. (2000). Life Event Checklists: Revisiting the.Social Readjustment Rating Scale after 30 years. Educational and
Psychological Measurement, 60(6), 864-876.
Watson, D., & Pennebaker, J. W. (1989). Health Complaints, Stress, and Distress: Exploring the Central Role of Negative Affectivity. Psychological Review,96(2), 234-254.
Ed Mulligan has kindly given permission for his work to be republished here. His work will help students, those interested in the subject and those in need a very clear insight into how stress is measured along with a comprehensive list of references for those interested in further exploring this subject. My Sincere thanks goes out to ED for the oppurtunity to share his work.