1. 1 Stress, Coping, and Adaption February 25, 2008 Measuring Stress Curry College Eric Weiser

2. 2 Measuring Stress Stress can be measured three different ways Stress can be measured three different ways Paper-and-pencil scales Paper-and-pencil scales Interviews Interviews Physiological measurements Physiological measurements

3. 3 Measuring Stress: Paper and Pencil Scales Social Readjustment Rating Scale (SRRS) Social Readjustment Rating Scale (SRRS) Holmes & Rahe (1967) Holmes & Rahe (1967) Checklist of events, stressfulness ratings are fixed Checklist of events, stressfulness ratings are fixed Life Experiences Survey (LES) Life Experiences Survey (LES) Sarason, Johnson, & Siegel (1978) Sarason, Johnson, & Siegel (1978) Checklist of events, inquiry into desirability of each event Checklist of events, inquiry into desirability of each event Assessment of Daily Experiences (ADE) Assessment of Daily Experiences (ADE) Stone & Neale (1982) Stone & Neale (1982) Monitor and record thoughts and events Monitor and record thoughts and events Daily Hassles and Uplifts Scale (DHUS) Daily Hassles and Uplifts Scale (DHUS) Kanner, Coyne, Schaefer, & Lazarus (1981) Kanner, Coyne, Schaefer, & Lazarus (1981) Measure of minor stresses and pleasures of everyday life Measure of minor stresses and pleasures of everyday life

4. 4 Measuring Stress: Interviews Life Events and Difficulties Schedule (LEDS) Life Events and Difficulties Schedule (LEDS) Brown & Harris (1978) Brown & Harris (1978) A semi-structured interview technique, it attempts to evaluates life experiences within context of each person’s unique circumstances A semi-structured interview technique, it attempts to evaluates life experiences within context of each person’s unique circumstances e.g., “Birth of a child” would have a different meaning to an 20-year-old woman who is poor and unemployed than it would to a 35-year-old woman with a good job and no other stressors e.g., “Birth of a child” would have a different meaning to an 20-year-old woman who is poor and unemployed than it would to a 35-year-old woman with a good job and no other stressors

5. 5 Measuring Stress: Physiological Measures This involves taking blood, urine, or saliva assays (samples) to determine the presence of: This involves taking blood, urine, or saliva assays (samples) to determine the presence of: Catecholamines Catecholamines Epinephrine and norepinephrine Epinephrine and norepinephrine Cortisol Cortisol Usually measured via a cortisol metabolite often referred to as 17- OHCS (that is, 17-hydroxycorticosteriod) Usually measured via a cortisol metabolite often referred to as 17- OHCS (that is, 17-hydroxycorticosteriod) Normal ranges for urinary 17-OHCS are 2.5 to 12 mg/24 hours Normal ranges for urinary 17-OHCS are 2.5 to 12 mg/24 hours During extreme stress, urinary 17-OHCS exceeds 15 mg/24 hours During extreme stress, urinary 17-OHCS exceeds 15 mg/24 hours

6. 6 Social Readjustment Rating Scale (SRRS) The Social Readjustment Rating Scale (SRRS) was developed in 1967 by Thomas Holmes and Richard Rahe. The Social Readjustment Rating Scale (SRRS) was developed in 1967 by Thomas Holmes and Richard Rahe. In many ways, their work was influenced by earlier work by Adolph Meyer. In many ways, their work was influenced by earlier work by Adolph Meyer.

7. 7 Adolph Meyer (1866-1950) In the 1930s, Meyer proposed that life events were related to health In the 1930s, Meyer proposed that life events were related to health These events need not be negative, bizarre, or catastrophic; they must simply be interpreted as important life changes, requiring some degree of coping These events need not be negative, bizarre, or catastrophic; they must simply be interpreted as important life changes, requiring some degree of coping e.g., marriage, moving to new city, changing jobs, death in family e.g., marriage, moving to new city, changing jobs, death in family Life charts Life charts Although he noted the effects these life changes had on patients with diseases, he did not document his findings with empirical research Although he noted the effects these life changes had on patients with diseases, he did not document his findings with empirical research

8. 8 Social Readjustment Rating Scale (SRRS) Holmes and Rahe (1967) Holmes and Rahe (1967)  Hypotheses: 1. The impact (slings and arrows) of life events build up over time. 2. Stress = social readjustment (amount of change in one’s normal pattern of life as a result of a life event), regardless of desirability 3. Stress varies in intensity, but the intensity is consistent among groups.  Death of spouse = MAJOR, MAJOR stress  Divorce = major stress  Lose job = very stress  Christmas = little “blast” of stress

9. 9 Social Readjustment Rating Scale (SRRS) Holmes & Rahe (1967) Holmes & Rahe (1967) A total of 394 respondents read a list of 43 life events A total of 394 respondents read a list of 43 life events Respondents asked to rate, in their opinion, how much average “readjustment” each life event entails Respondents asked to rate, in their opinion, how much average “readjustment” each life event entails Marriage given an arbitrary value of 500; all other items were then evaluated using this reference point. For example, an event requiring twice as much readjustment as marriage would be assigned a value of 1,000, whereas one requiring one-fifth as much readjustment as marriage would be assigned a value of 100 Marriage given an arbitrary value of 500; all other items were then evaluated using this reference point. For example, an event requiring twice as much readjustment as marriage would be assigned a value of 1,000, whereas one requiring one-fifth as much readjustment as marriage would be assigned a value of 100 The mean value for each event was later divided by 10 (Table 3); Ratings were highly correlated between groups of people (Table 2). The mean value for each event was later divided by 10 (Table 3); Ratings were highly correlated between groups of people (Table 2).

10. 10 Social Readjustment Rating Scale (SRRS) From this study the Social Readjustment Rating Scale (SRRS) emerged From this study the Social Readjustment Rating Scale (SRRS) emerged A respondent checks off each item that has happened in a certain period of time (e.g., one year) A respondent checks off each item that has happened in a certain period of time (e.g., one year) Ratings then totaled to produce a Life Change Unit (LCU) score Ratings then totaled to produce a Life Change Unit (LCU) score High LCU scores are hypothesized to be positively correlated to physical illness High LCU scores are hypothesized to be positively correlated to physical illness

11. 11 LCU Scores and Health Problems Holmes & Holmes (1970) Holmes & Holmes (1970) A total of 55 respondents (37 men, 18 women) given Schedule of Recent Events (SRE), which is a version of the SRRS adapted for daily use A total of 55 respondents (37 men, 18 women) given Schedule of Recent Events (SRE), which is a version of the SRRS adapted for daily use Respondents record which event happened to them on a particular day, each day for around two weeks Respondents record which event happened to them on a particular day, each day for around two weeks Respondents also record day to day health changes they may have experienced Respondents also record day to day health changes they may have experienced Would LCU scores be positively correlated with self-reported health problems during the study period? Would LCU scores be positively correlated with self-reported health problems during the study period?

12. 12 LCU Scores and Health Problems Results: Results: Events with relatively low magnitude of life change were the most frequently reported (Table 1) Events with relatively low magnitude of life change were the most frequently reported (Table 1) The most frequently reported health problems were: skin, eye, ear, nose, and throat problems (i.e., colds and fevers); gastro problems, and muscle problems (e.g., strain) The most frequently reported health problems were: skin, eye, ear, nose, and throat problems (i.e., colds and fevers); gastro problems, and muscle problems (e.g., strain) People with many symptoms tend to have them continuously, not all at once People with many symptoms tend to have them continuously, not all at once A positive relationship was found between LCU scores and symptoms (Table 3). A positive relationship was found between LCU scores and symptoms (Table 3).

13. 13 A BC Correlation of.45 (r =.45) between LCU score and average symptom frequency (A and B). This means that respondents with higher mean LCU scores tended to have more symptoms. Correlation of.48 (r =.48) between LCU score and proportion of days symptomatic (A and C). This means that respondents with higher mean LCU scores tended to have symptoms most of the times (chronically symptomatic).

14. 14 There was a higher amount of life change on the day in which (as well as the day before and the day after) symptoms tended to be reported.

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19. 19 Social Readjustment Rating Scale (SRRS) The SRRS has had an enormous impact on the study of stress and illness The SRRS has had an enormous impact on the study of stress and illness Only a decade or so after it was first developed, it had been used in more than 1,000 studies. Only a decade or so after it was first developed, it had been used in more than 1,000 studies. Generally, people with LCU scores higher than 150 in any one year tend to have more physical and psychological ailments than do less stressed people. Generally, people with LCU scores higher than 150 in any one year tend to have more physical and psychological ailments than do less stressed people. These ailments include heart disease, diabetes, cancer, leukemia, various kinds of accidents, athletic injuries, fractures, colds and fever, major depression, and schizophrenia. These ailments include heart disease, diabetes, cancer, leukemia, various kinds of accidents, athletic injuries, fractures, colds and fever, major depression, and schizophrenia.

20. 20 Life Experiences Survey (LES) Sarason, Johnson, & Siegel (1978) Sarason, Johnson, & Siegel (1978) Similar to SRRS Similar to SRRS Respondent checks off items that they have experienced in the “recent past” (0-6 months or 7-12 months) Respondent checks off items that they have experienced in the “recent past” (0-6 months or 7-12 months) The difference between this and the SRRS is that the respondent also indicates how positive or negative of an impact each event has had on their life The difference between this and the SRRS is that the respondent also indicates how positive or negative of an impact each event has had on their life Scale ranges from -3 (extremely negative) to +3 (extremely positive) Scale ranges from -3 (extremely negative) to +3 (extremely positive) Includes: Includes: 47 core items 47 core items 3 items that the respondent includes 3 items that the respondent includes 10 “student only” items 10 “student only” items

21. 21 Life Experiences Survey (LES) Scoring Scoring Sum the impact ratings of items the respondent has designated as positive Sum the impact ratings of items the respondent has designated as positive Positive change score Positive change score Also, sum the impact ratings of items the respondent has designated as negative Also, sum the impact ratings of items the respondent has designated as negative Negative impact score Negative impact score By adding both scores, you get a total change score By adding both scores, you get a total change score An estimate of the total change the respondent has experienced (good and bad) An estimate of the total change the respondent has experienced (good and bad)

22. 22 Life Experiences Survey (LES)

23. 23 Problems with Checklist Approaches Studies finding a correlation between the experience of life events and illness does not mean that stress causes illness Studies finding a correlation between the experience of life events and illness does not mean that stress causes illness For example, poorer people (who tend to have poor health care) may lead lives in which more changes take place, due to financial problems; thus, stress may only be coincidental to health problems for this group, not the cause of it. For example, poorer people (who tend to have poor health care) may lead lives in which more changes take place, due to financial problems; thus, stress may only be coincidental to health problems for this group, not the cause of it. Studies using the SRRS and the LES use a retrospective design (i.e., respondents asked to recall illness and stressful life events at some point in time). Such reports are subject to considerable bias and distortion. Studies using the SRRS and the LES use a retrospective design (i.e., respondents asked to recall illness and stressful life events at some point in time). Such reports are subject to considerable bias and distortion.

24. 24 Assessment of Daily Experiences (ADE) Stone & Neale (1982) Stone & Neale (1982) Designed to address some of the inadequacies of the SRRS and LES (e.g., bias in retrospective reports) Designed to address some of the inadequacies of the SRRS and LES (e.g., bias in retrospective reports) Each day over a period of time (e.g., two weeks), respondents check which of 66 items happened to them on that day. If an event happened, they rate the event in terms of its desirability, meaningfulness, change, and control. Each day over a period of time (e.g., two weeks), respondents check which of 66 items happened to them on that day. If an event happened, they rate the event in terms of its desirability, meaningfulness, change, and control. Work-Related Activities Work-Related Activities Leisure Activities Leisure Activities Financial Activities Financial Activities Family and Friend Activities Family and Friend Activities Other Activities Other Activities

25. 25 Sample Section of Assessment of Daily Experience Scale (ADE) Sample Section of Assessment of Daily Experience Scale (ADE) Respondents indicate if an event occurred by circling arrow on left. If an event occurred, respondent rates in on dimensions of desirability, change, meaningfulness, and control using the geometric spaces on the right.

26. 26 Assessment of Daily Experiences (ADE) Stone, Reed, & Neale (1987) Stone, Reed, & Neale (1987) Using the ADE, studied the relationship between desirable and undesirable life events and the onset of episodes of respiratory illness. Using the ADE, studied the relationship between desirable and undesirable life events and the onset of episodes of respiratory illness. Of 30 subjects who experienced episodes of respiratory infection, the daily frequency of desirable and undesirable life events that occurred from one to ten days prior was examined. Of 30 subjects who experienced episodes of respiratory infection, the daily frequency of desirable and undesirable life events that occurred from one to ten days prior was examined. Also, the daily frequency of desirable and undesirable life events was determined for one to ten days before a control day (i.e., a day in which no respiratory infection occurred. Also, the daily frequency of desirable and undesirable life events was determined for one to ten days before a control day (i.e., a day in which no respiratory infection occurred.

27. 27 Mean Number of Desirable Events Preceding Illness (Stone et al., 1987)

28. 28 Mean Number of Undesirable Events Preceding Illness (Stone et al., 1987)

29. 29 Daily Hassles and Uplifts Scale (DHUS) Kanner, Coyne, Schaefer, & Lazarus (1981) Kanner, Coyne, Schaefer, & Lazarus (1981) Assumes that the minor stressors and pleasures of everyday life have a bigger effect on health than the big, traumatic events assessed by SRRS Assumes that the minor stressors and pleasures of everyday life have a bigger effect on health than the big, traumatic events assessed by SRRS Checklist scale Checklist scale Originally given to 100 adults once a month for 10 months Originally given to 100 adults once a month for 10 months Subjects rate how much of a hassle (or uplift) numerous items were in a particular month Subjects rate how much of a hassle (or uplift) numerous items were in a particular month Ratings were on a 4-point scale ranging from 0 (none or not applicable) to 3 (a great deal) Ratings were on a 4-point scale ranging from 0 (none or not applicable) to 3 (a great deal)

30. 30 Daily Hassles and Uplifts Scale (DHUS) HasslesUplifts 1. Concerns about weight 2. Health of a family member 3. Rising prices of common goods 4. Home maintenance 5. Too many things to do 6. Misplacing or losing things 7. Outside home maintenance 8. Property, investment of taxes 9. Crime 10. Physical appearance 1. Relating well to spouse or lover 2. Relating well with friends 3. Completing a task 4. Feeling healthy 5. Getting enough sleep 6. Eating out 7. Meeting your responsibilities 8. Visiting, phoning or writing to someone 9. Spending time with the family 10. Home pleasing to you The Hassles scale was found to be a better predictor of psychological problems than life event scores, both at the time and later.

31. 31 Life Events and Difficulties Schedule (LEDS) Brown & Harris (1978) Brown & Harris (1978) Includes a semistructured interview, covering over 200 kinds of stressors (death, illness, role changes, etc) Includes a semistructured interview, covering over 200 kinds of stressors (death, illness, role changes, etc) The interviewer and the respondent work together to establish a timeline of each of the major life events within a given period of time The interviewer and the respondent work together to establish a timeline of each of the major life events within a given period of time After the interview, raters evaluate the event in terms of severity, short-term threat, long-term threat, and other dimensions After the interview, raters evaluate the event in terms of severity, short-term threat, long-term threat, and other dimensions The LEDS was designed to evaluate the importance of an event in terms of a person’s unique life circumstances The LEDS was designed to evaluate the importance of an event in terms of a person’s unique life circumstances e.g., pregnancy would have quite a different meaning for an indigent 19-year-old woman than it would for a 35-year-old woman who had been trying to conceive for a long time e.g., pregnancy would have quite a different meaning for an indigent 19-year-old woman than it would for a 35-year-old woman who had been trying to conceive for a long time

32. 32 Example of a Life Events Timeline