A. HEALTH
1. major personal illness or injury
2. major change in eating habits
3. major change in sleeping habits
4. major change in usual type and/or amount of recreation
5. major dental work
6. (female) pregnancy
7. (female) miscarriage or abortion
8. (female) started menopause
9. major difficulties with birth control pills or devices
B. WORK
10.difficulty finding a job
11.beginning work outside the home
12.changing to a new type of work
13.changing your work hours or conditions
14.change in your responsibilities at work
15.troubles at work with your employer or co-workers
16.major business readjustment
17.being fired or laid off from work
18.retirement from work
19.taking courses by mail or studying at home to help you in your work
C. SCHOOL
20.beginning or ceasing school‚ college‚ or training program
21.change of school‚ college‚ or training program
22.change in career goal or academic major
23.problem in school‚ college ‚ or training program
D. RESIDENCE
24.difficulty finding housing
25.changing residence within the same town or city
26.moving to a different town‚ city‚ state‚ or country
27.major change in your life conditions (home improvements or a decline in your home or neighborhood)
E. LOVE AND MARRIAGE
28.began a new‚ close‚ personal relationship
29.became engaged
30.girlfriend or boyfriend problems
31.breaking up with a girlfriend or boyfriend or breaking an engagement
32.(male) wife or girlfriend’s pregnancy
33.(male) wife or girlfriend having a miscarriage or abortion
34.getting married (or beginning to live with someone)
35.a change in closeness with your partner
36.infidelity
37.trouble with in-laws
38.separation from spouse or partner due to conflict
39.separation from spouse or partner due to work‚ travel‚ etc.
40.reconciliation with spouse or partner
41.divorce
42.change in your spouse or partner’s work outside the home (beginning work‚ ceasing work‚ changing jobs‚ retirement‚ etc.
F. FAMILY AND CLOSE FRIENDS
43.gain of a new family member (through birth‚ adoption‚ relative moving in‚ etc)
44.child or family member leaving home (due to marriage‚ to attend college‚ or for some other reason)
45.major change in the health or behavior of a family member or close friend (illness‚ accidents‚ drug or disciplinary problems‚ etc.)
46.death of spouse or partner
47.death of a child
48.death of family member or close friend
49.birth of a grandchild
50.change in marital status of your parents
G. PARENTING
51.change in child care arrangements
52.conflicts with spouse or partner about parenting
53.conflicts with child’s grandparents (or other important person) about parenting
54.taking on full responsibility for parenting as a single parent
55.custody battles with former spouse or partner
H. PERSONAL OR SOCIAL
56.major personal achievement
57.major decision regarding your immediate future
58.change in your personal habits (your dress‚ life-style‚ hobbies‚ etc.)
59.change in your religious beliefs
60.change in your political beliefs
61.loss or damage of personal property
62.took a vacation
63.took a trip other than a vacation
64.change in family get-togethers
65.change in your social activities (clubs‚ movies‚ visiting)
66.made new friends
67.broke up with a friend
68.acquired or lost a pet
I. FINANCIAL
69.major change in finances (increased or decreased income)
70.took on a moderate purchase‚ such as TV‚ car‚ freezer‚ etc.
71.took on a major purchase or a mortgage loan‚ such as a home‚ business‚ property‚ etc.
72.experienced a foreclosure on a mortgage or loan
73.credit rating difficulties
J. CRIME AND LEGAL MATTERS
74.being robbed or victim of identity theft
75.being a victim of a violent act (rape‚ assault‚ etc.)
76.involved in an accident
77.involved in a law suit
78.involved in a minor violation of the law (traffic tickets‚ disturbing the peace‚ etc)
79.legal troubles resulting in your being arrested or held in jail
K. OTHER- Other recent experiences which have had an impact on your life. List and rate.
80.______________________________
81.______________________________
82.______________________________
Good‚ Bad
0= No effect‚ 1= Some effect‚ 2= Moderate effect‚ 3= Great effect
Three scores are obtained from the questionnaire:
(a) negative events score – the sum of the impact ratings for all items designated as “bad” by the respondent;
(b) positive events score – the sum of the impact ratings for all items designated as “good” by the respondent;
(c) total events score – the sum of the impact ratings for both “bad” and “good” events.
Additional scoring clarification: When subjects write in additional life events (items 80-82)‚ these responses should be checked to see if they represent items already on the list (items 1-79). If so‚ the “other” response should be moved to the existing item and scored there. This prevents double scoring of the same event and allows for greater consistency in analyzing specific types or categories of events.
This instrument can be found at: http://nursing.ucsf.edu/sites/nursing.ucsf.edu/files/LifeEventsQues.pdf
Sarason‚ I.G.‚ Johnson‚ J.H.‚ & Siegel‚ J.M. (1978). Assessing the impact of life changes: Development of the life experiences survey. Journal of Consulting and Clinical Psychology‚ 46‚ 932-946.
Norbeck‚ J.S. (1984). Modification of recent life event questionnaires for use with female respondents. Research in Nursing and Health‚ 7‚ 61-71.
Norbeck‚ J.S.‚ Lindsey‚ A.M. and Carreiri‚ V.L. (1983). Further development of the Norbeck social support questionnaire: Normative data and validity testing. Nursing Research‚ 32‚ 4-9.
Norbeck‚ J.S. and Anderson‚ N.J. (1989). Life stress‚ social support‚ and anxiety in mid and late-pregnancy among low income women. Research in Nursing and Health‚ 12 (5)‚ 281-287.