Racial dimensions of life stress and social support in the prediction of health changes



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The relationship between stressful life events and subsequent health changes has been the subject of increasing interest and controversy, particularly with respect to the methodology employed by Holmes and Rahe in their Social Readjustment Rating Scale (SRRS). There has been growing concern over whether the definitions of life stress as operationalized in the Holmes-Rahe inventory have been adequately validated for minority populations. These concerns center around a number of discreet issues: (1) the usefulness of the SRRS items when various ethnic groups are examined; (2) differences in the stress magnitudes or "weights" of various life events for diverse ethnic groups; and (3) differences between ethnic groups in the stressfulness attributed to the SRRS magnitude-estimation comparison event, "marriage." The role of the mediating factor, social support, in the occurrence of life events and degree of subsequently experienced pathology is also an issud of consequence: Differences in the types and availability of social support for various ethnic groups confound comparisons between ethnic groups of the usefulness of a stress inventory in predicting risk for health changes. Life event-subsequent health change studies antedating the present investigation have relied primarily on Anglo "samples of convenience"— typical middle socio-economic-status (SES) college students, hospital patients, and navy samples—to the general exclusion of minority group samples. The present study evaluated the stress changes for groups of Black and Anglo lower- to lower-middle SES Americans. Eighty life events, including Holmes and Rahe's 43 items, were evaluated by 153 subjects. The magnitude estimation method of scaling was employed; however, the comparison item was selected from a pilot study employing Thurstone’s paired-comparison method of scaling, and the item selected was one of equivalent stress value under that procedure for the two groups. Both raw score and logarithmic distributions of stress value were constructed for each event and evaluated for normality. The logarithmic distributions showed substantially more deviations from normality, and thus the arithmetic rather than geometric mean was employed as the measure of central tendancy for the stress value of each life event. Seventeen of Holmes and Rahe’s 43 SRRS items were not included in the top 43 ranks of expected stress either for the Black or for the Anglo groups, indicating that the events sampled in the SRRS may not be the most relevant stress events. For 18 of the life events, there was a significant difference in stress value obtained from the Black and Anglo samples, with the Black sample consistently indicating greater stress than the Anglo group. Eleven of those 18 events are not included on the Holmes and Rahe SRRS. Two revised scales were constructed reflecting high stress value and high base rates for the life event within the respective racial groups. Comparisons between the revised scales and the SRRS were made with respect to predicting subsequent health changes for a separate cross-validation sample of 292 Black and Anglo subjects. In addition, the mediating role in such prediction of social support was analyzed for Black and Anglo subjects. An analysis of variance indicated that the SRRS and revised scales were both powerful predictors of health changes. However, the revised scales were shown to be more sensitive predictors when useful primary prevention considerations are attended to. No effect for social support was evidenced. These results were considered with regard to the stressful life events-health change literature and epidemiologic health change prevention. Further, the unique socio-economic position of Black Americans was considered in terms of the results. Alternatives for future research were suggested and it was concluded that the present investigation has both practical and theoretical implications.



Stress (Psychology), African Americans--Mental health