Stress and Adversity Inventory (STRAIN)

The STRAIN, or Stress and Adversity Inventory, is a NIMH/RDoC-recommended instrument that efficiently and reliably assesses a person’s cumulative exposure to stress over the life course. The measure is entirely online and systematically inquires about a diverse array of acute life events (e.g., deaths of relatives, job losses, negative health events) and chronic difficulties (e.g., ongoing health problems, work problems, relationship problems, financial problems, etc.) that have implications for human health and well-being. Stressors occurring in early life (e.g., childhood maltreatment or neglect, parental loss/separation, etc.) are also queried in detail. Respondents are asked to rate the severity, frequency, timing, and duration of each stressor they endorse. Questions that are inappropriate (based on a participant’s demographic characteristics) are automatically omitted from the interview (e.g., female reproductive health questions for male participants, questions about children for persons without children). The instrument can be self-administered by users at a computer or can be administered by an interviewer who follows a series of simple on-screen prompts. Because the STRAIN is embedded in an automated, online interviewing environment, the interview can be completed almost anywhere, including in the clinic, research laboratory, or classroom. Presently, we have an adolescent version of the STRAIN (Adolescent STRAIN) that is available in English, and an adult version of the STRAIN (Adult STRAIN) that is available in English, Spanish, German, Swiss (High) German, Brazilian Portuguese, Croatian, and Italian (to begin using the STRAIN, complete the STRAIN Setup Form).

The average time needed to complete the STRAIN is 25 minutes, with a range of approximately 18-30 minutes based on the population being interviewed. Because there are multiple follow-up questions for each endorsed stressor (i.e., that assess severity, frequency, timing, and duration), there are approximately 220 questions that can be asked in all. Based on this information, the system produces 455 variables that are used to assess an individual’s cumulative exposure to stress over the life course. Using this raw data, we can presently create more than 115 different cumulative life stress summary variables and life charts that summarize a person’s lifetime stress exposure. Analyses can in turn be based on a number of factors, including stressor severity and/or the timing of stress exposure (e.g., Early Adversity vs. Distant vs. Recent Life Stress). More sophisticated analyses can be performed by focusing on stressors occurring in particular life domains (e.g., Housing, Education, Work, Health, Marital/Partner) or that have particular core characteristics (e.g., Interpersonal Loss, Physical Danger, Humiliation, Entrapment, Role Change).

Several other interview-based measures have been developed for assessing life stress over relatively short periods of time (e.g., a few months or years). The STRAIN is not a substitute for these systems, but rather is an alternative that can be used when the goal is to quickly and efficiently collect information about stressors occurring over the lifespan as opposed to over a few months or years. The STRAIN accomplishes this goal by combining the sophistication of an interview-based measure of life stress with the simplicity of a self-report instrument.

Stress Assessment Modules (SAMs)

The STRAIN’s 55 core questions cover a wide range of moderate-to-severe stressors that are typically experienced by most adolescent and adult populations. Questions that are tailored to particular populations (e.g., children, college students, older adults, caregivers, cancer survivors), or that assess specific life domains in a more nuanced way, are not included in the base STRAIN but can be added to the interview in the form of an additional 10 to 15-question Stress Assessment Module, or SAM. Presently, we have the following SAMs:

  • Transition to College, providing additional coverage of stressors that are relevant for college students.
  • Cancer, providing additional coverage of stressors that are relevant for cancer populations.

Use & Implementation

Ongoing development, maintenance, and administration of the STRAIN is supported in part by those who use the system. Additional details, cost estimates, and use consultation and instructions are gladly provided upon request.

The most recent version is Version 1.6, copyrighted and released by George Slavich on June 29, 2017. Unauthorized use is not permitted. For additional information or to get started using the STRAIN, complete the STRAIN Setup Form.

STRAIN Publications

22Smith, T., Johns-Wolfe, E., Shields, G. S., Malat, J., Jacquez, F., & Slavich, G. M. (in press). Associations between lifetime stress exposure and prenatal health behaviors. Stress and Health. doi: 10.1002/smi.2933
21Banica, I., Sandre, A., Shields, G. S., Slavich, G. M., & Weinberg, A. (2020). The error-related negativity (ERN) moderates the association between interpersonal stress and anxiety symptoms six months later. International Journal of Psychophysiology, 153, 27-36. doi: 10.1016/j.ijpsycho.2020.03.006
20Cazassa, M. J., Oliveira, MdS., Spahr, C. M., Shields, G. S., & Slavich, G. M. (2020). The Stress and Adversity Inventory for Adults (Adult STRAIN) in Brazilian Portuguese: Initial validation and links with executive function, sleep, and mental and physical health. Frontiers in Psychology, 10:3083. doi: 10.3389/fpsyg.2019.03083
19Slavich, G. M., Stewart, J. G., Esposito, E. C., Shields, G. S., & Auerbach, R. P. (2019). The Stress and Adversity Inventory for Adolescents (Adolescent STRAIN): associations with mental and physical health, risky behaviors, and psychiatric diagnoses in youth seeking treatment. Journal of Child Psychology and Psychiatry, 60, 998-1009. doi: 10.1111/jcpp.13038
18Schüssler-Fiorenza Rose, S. M., Contrepois, K., Moneghetti, K. J., Zhou, W., Mishra, T., Mataraso, S., Dagan-Rosenfeld, O., Ganz, A., Dunn., J., Hornburg, D., Rego, S., Perelman, D., Ahadi, S., Reza Sailani, M., Zhou, Y., Leopold, S., Chen, J., Ashland, M., Christle, J. W., Avina, M., Limcaoco, P., Ruiz, C., Tan, M., Butte, A. J., Weinstock, G. M., Slavich, G. M., Sodergren, E., McLaughlin, T. L., Haddad, F., & Snyder, M. P. (2019). A longitudinal big data approach for precision health. Nature Medicine, 25, 792-804. doi: 10.1038/s41591-019-0414-6
17Olvera Alvarez, H. A., Provencio-Vasquez, E., Slavich, G. M., Laurent, J. G. C., Browning, M., McKee-Lopez, G., Robbins, L., & Spengler, J. D. (2019). Stress and health in nursing students: The Nurse Engagement and Wellness Study. Nursing Research, 68, 453-463. doi: 10.1097/NNR.0000000000000383
16Pegg, S., Ethridge, P., Shields, G. S., Slavich, G. M., Weinberg, A., & Kujawa, A. (2019). Blunted social reward responsiveness moderates the effect of lifetime social stress exposure on depressive symptoms. Frontiers in Behavioral Neuroscience, 13:178. doi: 10.3389/fnbeh.2019.00178
15Lam, J. C. W., Shields, G. S., Trainor, B. C., Slavich, G. M., & Yonelinas, A. P. (2019). Greater lifetime stress exposure predicts blunted cortisol but heightened DHEA responses to acute stress. Stress and Health, 35, 15-26. doi: 10.1002/smi.2835
14Mayer, S. E., Prather, A. A., Puterman, E., Lin, J., Arenander, J., Coccia, M., Shields, G. S., Slavich, G. M., & Epel, E. S. (2019). Cumulative lifetime stress exposure and leukocyte telomere length attrition: The unique role of stressor duration and exposure timing. Psychoneuroendocrinology, 104, 210-218. doi: 10.1016/j.psyneuen.2019.03.002
13Shields, G. S., Ramey, M. M., Slavich, G. M., & Yonelinas, A. P. (2019). Determining the mechanisms through which recent life stress predicts working memory impairments: Precision or capacity? Stress, 22, 280-285. doi: 10.1080/10253890.2018.1556635
12Stewart, J. G., Shields, G. S., Esposito, E. C., Cosby, E. A., Allen, N. B., Slavich, G. M., & Auerbach, R. P. (2019). Life stress and suicide in adolescents. Journal of Abnormal Child Psychology, 47, 1707-1722. doi: 10.1007/s10802-019-00534-5
11Sturmbauer, S. C., Shields, G. S., Hetzel, E. L., Rohleder, N., & Slavich, G. M. (2019). The Stress and Adversity Inventory for Adults (Adult STRAIN) in German: An overview and initial validation. PLoS One, 14(5):e0216419. doi: 10.1371/journal.pone.0216419
10Slavich, G. M., & Shields, G. S. (2018). Assessing lifetime stress exposure using the Stress and Adversity Inventory for Adults (Adult STRAIN): An overview and initial validation. Psychosomatic Medicine, 80, 17-27. doi: 10.1097/PSY.0000000000000534
9Gillespie S. L., Christian, L. M., Alston, A. D., & Salsberry, P. J. (2017). Childhood stress and birth timing among African American women: Cortisol as biological mediator. Psychoneuroendocrinology, 84, 32-41. doi: 10.1016/j.psyneuen.2017.06.009
8Shields, G. S., Doty, D., Shields, R. H., Gower, G., Slavich, G. M., Yonelinas, A. P. (2017). Recent life stress exposure is associated with poorer long-term memory, working memory, and self-reported memory. Stress, 20, 598-607. doi: 10.1080/10253890.2017.1380620
7Cuneo, M. G., Schrepf, A., Slavich, G. M., Thaker, P. H., Goodheart, M., Bender, D., Cole, S. W., Sood, A. K., & Lutgendorf, S. K. (2017). Diurnal cortisol rhythms, fatigue and psychosocial factors in five-year survivors of ovarian cancer. Psychoneuroendocrinology, 84, 139-142. doi: 10.1016/j.psyneuen.2017.06.019
6Dooley, L. N., Slavich, G. M., Moreno, P. I., & Bower, J. E. (2017). Strength through adversity: Moderate lifetime stress exposure is associated with psychological resilience in breast cancer survivors. Stress and Health, 33, 549-557. doi: 10.1002/smi.2739
5Goldfarb, E. V., Shields, G. S., Daw, N. D., Slavich, G. M., & Phelps, E. A. (2017). Low lifetime stress exposure is associated with reduced stimulus-response memory. Learning and Memory, 24, 162-168. doi: 10.1101/lm.045179.117
4Shields, G. S., Moons, W. G., & Slavich, G. M. (2017). Better executive function under stress mitigates the effects of recent life stress exposure on health in young adults. Stress, 20, 75-85. doi: 10.1080/10253890.2017.1286322
3Toussaint, L., Shields, G. S., Dorn, G., & Slavich, G. M. (2016). Effects of lifetime stress exposure on mental and physical health in young adulthood: How stress degrades and forgiveness protects health. Journal of Health Psychology, 21, 1004-1014. doi: 10.1177/1359105314544132
2Bower, J. E., Crosswell, A. D., & Slavich, G. M. (2014). Childhood adversity and cumulative life stress: Risk factors for cancer-related fatigue. Clinical Psychological Science, 2, 108-115. doi: 10.1177/2167702613496243
1Slavich, G. M., & Toussaint, L. (2014). Using the Stress and Adversity Inventory as a teaching tool leads to significant learning gains in two courses on stress and health. Stress and Health, 30, 343-352. doi: 10.1002/smi.2523

STRAIN Superusers

Julienne E. Bower, Ph.D.
University of California, Los Angeles
George M. Slavich, Ph.D.
University of California, Los Angeles
Ellissa S. Epel, Ph.D.
University of California, San Francisco
Hector A. Olvera, Ph.D.
University of Texas at El Paso
Grant S. Shields, M.A.
University of California, Davis
Susan K. Lutgendorf, Ph.D.
University of Iowa
Nicolas Rohleder, Ph.D.
Brandeis University
Roland von Känel, M.D.
Clinic Barmelweid, Switzerland
Randy P. Auerbach, Ph.D.
Columbia University
Loren L. Toussaint, Ph.D. 
Luther College
Margareth da Silva Oliveira Ph.D.
Pontifical Catholic University of Rio Grande do Sul
Maria E. Bleil, Ph.D.
University of Washington
Carrie E. Bearden, Ph.D.
University of California, Los Angeles
Greg Hajcak, Ph.D.
Florida State University


Satrajit S. Ghosh, Ph.D.
Massachusetts Institute of Technology
Naomi I. Eisenberger, Ph.D.
University of California, Los Angeles
April D. Thames, Ph.D.
University of California, Los Angeles
Elizabeth A. Phelps, Ph.D.
New York University
Aidan G.C. Wright, Ph.D.
University of Pittsburgh
Michael P. Snyder, Ph.D.
Stanford University
Jennifer Malat, Ph.D.
University of Cincinnati
Rebecca Klatzkin, Ph.D.
Rhodes College
Andres De Los Reyes, Ph.D.
University of Maryland
Stephen B. Manuck, Ph.D.
University of Pittsburgh
Joshua F. Wiley, Ph.D.
Australian Catholic University
Stewart A. Shankman, Ph.D
Northwestern University
Theodore F. Robles, Ph.D.
University of California, Los Angeles
Pablo A. Nepomnaschy, Ph.D.
Simon Fraser University
Mitchell J. Prinstein, Ph.D.
University of North Carolina at Chapel Hill
Michelle G. Craske, Ph.D.
University of California, Los Angeles
Donald W. Bowden, Ph.D.
Wake Forest School of Medicine
Tara L. Gruenewald, Ph.D.
University of Southern California
Sandra E. Sephton, Ph.D.
University of Louisville
Allison Halt
University of Missouri
Candace M. Raio, Ph.D.
New York University
Paul W. Glimcher, Ph.D.
New York University
Heather L. Urry, Ph.D.
Tufts University
Rachel L. Moseley, Ph.D.
Bournemouth University
Crystal M. Epstein
University of Nebraska Medical Center
Owen M. Wolkowitz, M.D.
University of California, San Francisco
Susan R. Torres-Harding, Ph.D.
Roosevelt University
Bruce E. Compas, Ph.D.
Vanderbilt University
Stacey B. Scott, Ph.D.
Stony Brook University
Nicole Desrosier
Trinity College
Tor D. Weger, Ph.D.
University of Colorado, Boulder
Anthony C. Ruocco, Ph.D.
University of Toronto, Scarborough
Mark F. Lenzenweger, Ph.D.
State University of New York at Binghamton
David Farabee, Ph.D.
University of California, Los Angeles
Jennifer J. Manly, Ph.D.
Columbia University Medical Center
Michael R. Irwin, Ph.D.
University of California, Los Angeles
Cristian Sirbu, Ph.D.
West Virginia University School of Medicine
Jean E. Schaffer, M.D.
Washington University School of Medicine
Robert M. Bilder, Ph.D.
University of California, Los Angeles
Michelle L. Byrne, Ph.D.
University of Oregon
Anna E.F. Weinberg, Ph.D.
McGill University
John C. Morgan, M.D., Ph.D.
Medical College of Georgia
Linda W. Janusek, Ph.D., RN
Loyola University Chicago
Eileen H. Shinn, Ph.D.
MD Anderson Cancer Center
Hannah M.C. Schreier, Ph.D.
Pennsylvania State University
Steven M. Brunwasser, Ph.D.
Vanderbilt University Medical Center
Jennifer E. Graham-Engeland, Ph.D.
The Pennsylvania State University
Roxann Roberson-Nay, Ph.D.
Virginia Commonwealth University School of Medicine
Sarah Nowalis, M.A.
Rochester Institute of Technology
Samuele Zilioli, Ph.D.
Wayne State University

Catherine R. Glenn, Ph.D.
University of Rochester
Michael T. Treadway, Ph.D.
Emory University
Julie A. Dumas, Ph.D.
University of Vermont
Johnny Vanuk
University of Arizona
Ian H. Gotlib, Ph.D.
Stanford University

Mohammadali Amini-Tehrani
University of Tehran
Tiffany Cheing Ho, Ph.D.
Stanford University
Jori A. Berger-Greenstein, Ph.D.
Boston University School of Medicine
L. Elliot Hong, M.D.
University of Maryland School of Medicine
Jill Portnoy, Ph.D.
University of Massachusetts Lowell
Melynda D. Casement, Ph.D.
University of Oregon
Will Hamilton, Ph.D.
Asheville Integrated Behavioral Health
Tony W. Buchanan, Ph.D.
Saint Louis University
Sunita K. Patel, Ph.D.
City of Hope Medical Center
Dr. Kelly R. Rossetto
Boise State University
Greg Miller, Ph.D.
Northwestern University
Clifford D. Saron, Ph.D.
UC Davis MIND Institute
Martin Picard, Ph.D.
Columbia University
Dr. Yashar Khosroshahi, ND, ACC
Mind Body Performance
Josiane L. Broussard, Ph.D.
University of Colorado
Tory A. Eisenlohr-Moul, Ph.D.
University of Illinois at Chicago
Patrick R. Steffen, Ph.D., BCB
Brigham Young University
Michael J. Zvolensky, Ph.D.
University of Houston
Brady D. Nelson, Ph.D.
Stony Brook University
Jutta Joormann, Ph.D.
Yale University
Javiera P. Oyarzun, Ph.D.
New York University
Melanie Brown, Ph.D.
Icahn School of Medicine at Mount Sinai
Jennifer B. Permuth, PhD, MS
Moffitt Cancer Center
Mercedes Carnethon, Ph.D., FAHA
Northwestern University
Kristen L. Knutson, PhD
Northwestern University
Joan Luby, M.D.
Washington University in St. Louis
Emily A.P. Haigh, Ph.D.
University of Maine
James L. Griffith, M.D.
George Washington University
Anna Konova, Ph.D.
Rutgers University
Erika Manczak, Ph.D.
University of Denver
Teresa Smith
University of Cincinnati
Kunmi Sobowale, MD
Yale University
Fabiano Nery, MD, Ph.D.
University of Cincinnati
Yakeel T. Quiroz-Gaviria, Ph.D.
Massachusetts General Hospital
Katherine A. Bowers, Ph.D., MPH
Cincinnati Children's Hospital Medical Center
Tamara Newton, Ph.D.
University of Louisville
Richard J. Davidson, Ph.D.
University of Wisconsin–Madison
Lindsay Kobayashi, Ph.D.
Georgetown University
Jeanne Mandelblatt, MD, MPH
Georgetown University
Daniel A. Hackman, Ph.D.
University of Southern California
Cinnamon Stetler, Ph.D.
Furman University
Janice Kiecolt-Glaser, Ph.D.
Ohio State University
Mary L. Woody, Ph.D.
University of Pittsburgh
Mary C. Sullivan, Ph.D., RN, FAAN
University of Rhode Island
Michele D. Kipke, Ph.D.
Children's Hospital Los Angeles
Sarah C. McEwen, Ph.D., NSCA-CPT
Pacific Neuroscience Institute
Lindsay Fourman-Nissim, MD
Harvard Medical School, Massachusetts General Hospital
Kristin Bernard, Ph.D.
Stony Brook University
Diego A. Pizzagalli, Ph.D.
McLean Hospital/Harvard Medical School
Avram J. Holmes, Ph.D.
Yale University
Kaigang Li, Ph.D.
Colorado State University
Nestor Lopez-Duran, Ph.D
University of Michigan
Luke W. Hyde, Ph.D.
University of Michigan
Patrick Steffen, Ph.D.
Brigham Young University
Cynthia Rogers, M.D.
Washington University School of Medicine
Michele D. Kipke, Ph.D.
Children's Hospital Los Angeles
Hayley Dorfman, Ph.D.
Harvard University
Patti E. Gravitt, Ph.D.
University of Maryland
Diane M. Quinn, Ph.D.
University of Connecticut
Lori N. Scott, Ph.D.
University of Pittsburgh
Lauren Houghton, Ph.D., MSc
Columbia University
Madeline Li, MD, Ph.D.
Princess Margaret Cancer Centre
Gary M. Rodin, MD, FRCPC
Princess Margaret Cancer Centre
Sarah M. Lofgren, MD
University of Minnesota
Anna Reebs, MA, MSc
University of Haifa
Giulio M. Pasinetti, MD, Ph.D.
Icahn School of Medicine at Mount Sinai
Carri Shaw, BSN RN CEN
University of Michigan

STRAIN in the World

Milton J. Cazassa
Pontifical Catholic University of Rio Grande do Sul
Brazilian Portuguese
Hector A. Olvera, Ph.D.
University of Texas
Alberto Collazzoni, Ph.D.
University of L' Aquila
Francisco MS Cardoso, Ph.D.
University of Trás-os-Montes and Alto Douro
European Portuguese
Rosangela Bertelli
University of Trás-os-Montes and Alto Douro
European Portuguese
Svitlana Avramchenko, Ph.D.
Cherkasy National University, Bogdan Khmelnitskiy
Cornelia Rada, Ph.D.
Francisc I. Rainer Institute of Anthropology
Stefania Rosca
Lucian Blaga University of Sibiu
Rimovecz Cristina Klari
West University in Timisoara
Ibrahim Yiğit, Ph.D.
Baskent University
Melike Guzey
Ankara University
Hale Yapıcı Eser, M.D., Ph.D.
Koç University School of Medicine
Dora Kirigin M.S.
Clinical Hospital Centre Split

Dolores Britvic, M.D.
University of Split
Pål Kraft,Ph.D.
University of Oslo
Zahir Vally, Ph.D
United Arab Emirates University
Tone Gretland Valderhaug, M.D., Ph.D.
Akershus University Hospital
Laiana Quagliato, M.D.
Federal University of Rio de Janeiro
Brazilian Portuguese
Mario A. Rosero P, Ph.D.
Universidad Autónoma de Bucaramanga
Nicolas Rohleder,Ph.D.
Friedrich-Alexander-University of Erlangen-Nürnberg
Lisa-Marie Greenwood, Ph.D.
University of Wollongong
David Fletcher, Ph.D.
Loughborough University
United Kingdom
Kimberly Dienes, Ph.D.
University of Manchester
United Kingdom
Julie M. Turner-Cobb, Ph.D.
Bournemouth University
United Kingdom
Hannah L. Graham
Loughborough University
United Kingdom
Darren Hedley, Ph.D.
La Trobe University

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