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
| Number | Publication | Download |
|---|---|---|
| 21 | Smith, 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. | |
| 20 | Cazassa, 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 |  |
| 19 | Slavich, 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 | |
| 18 | Schüssler-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 | |
| 17 | Olvera 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 | |
| 16 | Pegg, 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 | |
| 15 | Lam, 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. | |
| 14 | Mayer, 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. | |
| 13 | Shields, 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. | |
| 12 | Stewart, 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 | |
| 11 | Sturmbauer, 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 | |
| 10 | Slavich, 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. | |
| 9 | Gillespie 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. | |
| 8 | Shields, 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. | |
| 7 | Cuneo, 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. | |
| 6 | Dooley, 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. | |
| 5 | Goldfarb, 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. | |
| 4 | Shields, 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. | |
| 3 | Toussaint, 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. | |
| 2 | Bower, 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. | |
| 1 | Slavich, 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. | |
STRAIN Superusers
 University of California, Los Angeles |  University of California, Los Angeles |  University of California, San Francisco |
 University of Texas at El Paso |  University of California, Davis |  University of Iowa |
 Brandeis University |  Clinic Barmelweid, Switzerland |  Columbia University |
 Luther College |  Pontifical Catholic University of Rio Grande do Sul |  University of Washington |
 University of California, Los Angeles |  Florida State University |
STRAIN Users
 Massachusetts Institute of Technology |  University of California, Los Angeles |  University of California, Los Angeles |
 New York University |  University of Pittsburgh |  Stanford University |
 University of Cincinnati |  Rhodes College |  University of Maryland |
 University of Pittsburgh |  Australian Catholic University |  Northwestern University |
 University of California, Los Angeles |  Simon Fraser University |  University of North Carolina at Chapel Hill |
 University of California, Los Angeles |  Wake Forest School of Medicine |  University of Southern California |
 University of Louisville |  University of Missouri |  New York University |
 New York University |  Tufts University |  Bournemouth University |
 University of Nebraska Medical Center |  University of California, San Francisco |  Roosevelt University |
 Vanderbilt University |  Stony Brook University |  Trinity College |
 University of Colorado, Boulder |  University of Toronto, Scarborough |  State University of New York at Binghamton |
 University of California, Los Angeles |  Columbia University Medical Center |  University of California, Los Angeles |
 West Virginia University School of Medicine |  Washington University School of Medicine |  University of California, Los Angeles |
 University of Oregon |  McGill University |  Medical College of Georgia |
 Loyola University Chicago |  MD Anderson Cancer Center |  Pennsylvania State University |
 Vanderbilt University Medical Center |  The Pennsylvania State University |  Virginia Commonwealth University School of Medicine |
 Rochester Institute of Technology |  Wayne State University |  University of Rochester |
 Emory University |  University of Vermont |  University of Arizona |
 Stanford University |  University of Tehran |  Stanford University |
 Boston University School of Medicine |  University of Maryland School of Medicine |  University of Massachusetts Lowell |
 University of Oregon |  Asheville Integrated Behavioral Health |  Saint Louis University |
 City of Hope Medical Center |  Boise State University |  Northwestern University |
 UC Davis MIND Institute |  Columbia University |  Mind Body Performance |
 University of Colorado |  University of Illinois at Chicago |  Brigham Young University |
 University of Houston |  Stony Brook University |  Yale University |
 New York University |  Icahn School of Medicine at Mount Sinai |  Moffitt Cancer Center |
 Northwestern University |  Northwestern University |  Washington University in St. Louis |
 University of Maine |  George Washington University |  Rutgers University |
 University of Denver |  University of Cincinnati |  Yale University |
 University of Cincinnati |  Massachusetts General Hospital |  Cincinnati Children's Hospital Medical Center |
 University of Louisville |  University of Wisconsin–Madison |  Georgetown University |
 Georgetown University |  University of Southern California |  Furman University |
 Ohio State University |  University of Pittsburgh |  University of Rhode Island |
 Children's Hospital Los Angeles |  Pacific Neuroscience Institute |  Harvard Medical School, Massachusetts General Hospital |
 Stony Brook University |  McLean Hospital/Harvard Medical School |  Yale University |
 Colorado State University |  University of Michigan |  University of Michigan |
 Brigham Young University |  Washington University School of Medicine |  Children's Hospital Los Angeles |
 Harvard University |  University of Maryland |  University of Connecticut |
 University of Pittsburgh |  Columbia University |  Princess Margaret Cancer Centre |
 Princess Margaret Cancer Centre |  University of Minnesota |  University of Haifa |
STRAIN in the World
 Milton J. CazassaPontifical Catholic University of Rio Grande do Sul Brazilian Portuguese | Hector A. Olvera, Ph.D. University of Texas Spanish |  Alberto Collazzoni, Ph.D.University of L' Aquila Italian |
 Francisco MS Cardoso, Ph.D.University of Trás-os-Montes and Alto Douro European Portuguese |  Rosangela BertelliUniversity of Trás-os-Montes and Alto Douro European Portuguese |  Svitlana Avramchenko, Ph.D.Cherkasy National University, Bogdan Khmelnitskiy Ukrainian |
 Cornelia Rada, Ph.D. Francisc I. Rainer Institute of Anthropology Romanian |  Stefania RoscaLucian Blaga University of Sibiu Romanian |  Rimovecz Cristina KlariWest University in Timisoara Romanian |
 Ibrahim Yiğit, Ph.D.Baskent University Turkish |  Melike GuzeyAnkara University Turkish |  Koç University School of Medicine Turkish |
 Dora Kirigin M.S.Clinical Hospital Centre Split Croatian |  Dolores Britvic, M.D.University of Split Croatian |  Pål Kraft,Ph.D.University of Oslo Norwegian |
 Zahir Vally, Ph.DUnited Arab Emirates University Arabic |  Akershus University Hospital Norwegian |  Federal University of Rio de Janeiro Brazilian Portuguese |
 Universidad Autónoma de Bucaramanga Spanish |  Nicolas Rohleder,Ph.D.Friedrich-Alexander-University of Erlangen-Nürnberg German |  University of Wollongong Australia |
 Loughborough University United Kingdom |  University of Manchester United Kingdom |  Bournemouth University United Kingdom |
