Life Stress Questionnaire

Based on studies of Dr. Thomas Holmes, University of Washington

Life Stress Questionnaire asks about sources of stress in the 2 years prior to the visit, and weights them for a total score, for instance assigning points to:
Change in social activities
Change in sleeping habits
Change in residence
Change in work hours
Change in church activities
Tension at work
Small children in the home
Change in living conditions
Outstanding personal achievement
Problem teenager(s) in the home
Trouble with in-laws
Difficulties with peer group
Son or daughter leaving home
Change in responsibilities at work
Taking over a major financial responsibility
Foreclosure of mortgage of loan
Change in relationship with spouse
Change to different line of work
Loss of a close friend
Gain of a new family member
Sex difficulties
Change in health of family member Retirement
Loss of job
Change in quality of religious faith
Personal injury or illness
Loss of self confidence
Death of a close family member
Injury to reputation
Trouble with the law
Marital separation
Death of spouse .
Other (invalid in family; drug or alcohol problem, etc):



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