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The involvement of stress in the incidence of disorders such as peptic ulcer, hypertension, and heart disease has been demonstrated. 1 2 It is estimated that emotional stress plays an important part in more than 50% of diseases 3 and many patients associate recurrences of uveitis with stressful life events. Duke-Elder recognised a relation between uveitis and psychological factors, 4 and a connection with menstruation has also been described. 5
Some physical and emotional disorders tend to cluster around periods of major change in individuals' lives (such as divorce or moving house), and an attempt has been made to evaluate the degree of stress associated with various life events, with the Holmes and Rahe social readjustment rating scale. 3 6 This scale has been developed over many years and quantitates various life events and the amount of coping required to deal with them. It takes the form of a list of events (see Table 1 ) which the patient is asked to look at and indicate if any have happened to them in the time before this presentation. 7 For example, in a study where the role of life events in suicide attempts was examined using this rating scale, the mean social readjustment index was 255.2 (SD 137.01), which is a much higher score than that observed in other medical inpatients (180.69 (72.03)). 8 The Spielberger state-trait anxiety inventory has been used extensively in research and clinical practice and has specifically been designed to measure the anxiety component of stress. 9 It comprises separate self report scales for measuring state (S-anxiety) and trait (T-anxiety) anxiety. The S-anxiety scale consists of 20 statements that evaluate how respondents feel "right now at this moment" and evaluates feelings of apprehension, tension, nervousness, and worry. It has been used extensively to assess the levels of anxiety induced by unavoidable real life stressors such as interviews, exams, hospital visits, etc. 10
Rank | Life event | Mean value |
1 | Death of spouse | 100 |
2 | Divorce | 73 |
4 | Jail term | 63 |
5 | Death of close family member | 63 |
7 | Marriage | 50 |
8 | Fired at work | 47 |
10 | Retirement | 45 |
12 | Pregnancy | 40 |
17 | Death of a close friend | 37 |
23 | Son or daughter leaving home | 29 |
30 | Trouble with boss | 23 |
31 | ... |