Adaptation and validation of recent life changes questionnaire (RLCQ) to measure stress among urban adult population of Karachi, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Mental illnesses related to stress are increasing rapidly in our population. It is important to have reliable measures of stressful life events that are contextually relevant. The Recent Life Changes Questionnaire (RLCQ), developed by Richard Rahe in 1967, is one such tool that measures general stress with respect to life changing events but is not an accurate reflection of stressful life events in Pakistan since it has been developed for a first world setting. We aim to adapt RLCQ and validate the adapted RLCQ to allow accuracy in measurement of Stressful Life Events. Methods: The study was conducted in two phases: adaptation of the RLCQ and validation of the adapted RLCQ. In order to identify contextually relevant stressors in an open ended format, we used the qualitative method of in-depth interviews until saturation of reported events was received. These interviews were conducted from 20 purposefully selected residents of Karachi who visited general out-patient departments of Aga Khan University Hospital. Identified stressful events were included in the tool and those recognized as not stressful were removed. After identification of all relevant stressors, we performed the next phase of adaptation that required scaling of each item on the questionnaire so as to weigh each of these events in terms of severity of stress. This scaling exercise was performed on 200 random participants residing in four communities of Karachi namely Kharadar, Dhorajee, Gulshan and Garden. For analysis of the scaled tool, exploratory factor analysis was used to inform structuring. Content validity and face validity was also performed to complete the process of adaption by expert review, translation and back translation of the adapted RLCQ. In the second phase of the study, we performed validation of the resultant adapted RLCQ. 300 participants residing in the above four communities responded to the adapted RLCQ along with Mini International Neuropsychiatric Interview (MINI) which was our gold standard. ROC curves were generated and Sensitivities and Specificities of the adapted RLCQ for common mental disorders were reported. Cut offs were defined within the adapted and validated RLCQ for stressful life event measurements that were highly likely to correlate with the presence of neuropsychiatrically defined mental illness. Results: Stressful life events emerging from the qualitative phase of the study reflect daily life stressors arising from socio-political environment. Upon applying factor analysis, suggested categories were not meaningful; hence we kept the questionnaire in its original state and introduced a new category of 'Environmental Stressors'. In comparison of adapted RLCQ with MINI, AUC of ROC curve for serious mental disorders (SMD) and common mental disorders (CMD) came out to be 0.75 and 0.65 respectively. The sensitivity and specificity for SMD is 72% and 60% and that of CMD is 66% and 56% respectively. Conclusion: The adapted and validated RLCQ defines relevant events with cut offs that are able to predict the likelihood of common and serious mental illnesses which would develop as a result of experiencing high levels of chronic stress in urban population of Karachi with a reasonable sensitivity and specificity.

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