The United States of Stress 2019

Originally Published: October 23, 2018

Foreword by Nan-Kirsten Forte, MS, Chief of The Well at Everyday Health

Our research shows that chronic stress is a national epidemic for all genders and ages, particularly those who are 25 to 35 years old. To unpack this problem is a matter partly of mental health and partly of physical health. Here’s the hard truth: The causes and solutions to chronic stress are a complex mixture of socioeconomic, environmental, genetic, physical, and spiritual factors.

Although there are different types of stress (some are even positive), the type we need to pay attention to, say experts, is chronic stress. This is the stress that makes it hard to sleep well, makes it nearly impossible to lose weight, and finds us fighting one cold after another. It’s the stress that can both cause medical conditions and trigger and exacerbate flare-ups from existing conditions. This kind of stress depresses the immune system, alters our moods, and damages our professional and personal relationships. Just as, on the positive side, yoga has been shown to lengthen the protective caps at the ends of our DNA strands called telomeres and keep us more youthful, ongoing stress can actually change our DNA for the worse.

As a country, we are struggling to address many mental health issues that, it turns out, are closely tied to chronic stress; there are not enough specialists or practicing healthcare professionals to address them. Is it any wonder people turn to social media to feel less isolated — only to find that social media itself can turn into a source of amped up, toxic stress?

Everyday Health is taking a stand on stress for everyone who wrestles with it daily, and especially for those who are most vulnerable to the negative effects of unmanaged stress: those already coping with health issues.

Our goal is to empower people with the knowledge and tools to manage their own stress; to help them recognize and identify the things that trigger their stress response; and to take action before it does them harm. Because we're not taking care of ourselves right now. Everyday Health's United States of Stress special report reveals that most of us care for others before we take care of ourselves, and we internalize stress rather than find healthy ways to relieve it. Women especially have this tendency, and among them, younger women in particular — the population segment revealed to be most burdened by stress and most likely to seek help for it.

Key takeaways:

• Almost one-third of those surveyed say they visited a doctor about something stress-related.
• 57 percent of the survey respondents say they are paralyzed by stress; 43 percent say they are invigorated by stress.
• 51 percent of the women surveyed say they don’t see friends at all in an average week.
• 59 percent of baby boomers have never been diagnosed with a mental health issue; 52 percent of Gen Zers already have been.
• Just over a third of all respondents say their job or career is a regular source of stress. Among millennials and Gen Zers, the chronically work-stressed rises to 44 percent.
• More than half of women (51 percent) say they feel bad about their appearance weekly, and 28 percent say their appearance regularly causes them stress. Only 34 percent of men say they feel bad about their appearance weekly.
• 52 percent of respondents say financial issues regularly stress them out, well above the 35 percent who cited jobs and careers as the next most common stressor.
• 47 percent of all respondents — with women and men almost evenly matched — say that their response to stress is to take it out on themselves.

Those thinkers, now members of Everyday Health’s Wellness Advisory Board, are:

• Christine Carter, PhD, a sociologist and a senior fellow at the University of California in Berkeley’s Greater Good Science Center
• R.D. Chin, a feng shui architect, interior designer, author, and owner of an architectural design consultant practice in New York City
• Frank H. Farley, PhD, the L.H. Carnell Professor at Temple University in Philadelphia and president of the Society for Experimental Psychology and Cognitive Science
• Arline T. Geronimus, doctor of science, a professor in the school of public health and a research professor at the Institute for Social Research at the University of Michigan in Ann Arbor
• Nikita Gupta, MPH, a registered yoga instructor, certified life coach, and program director of the GRIT Peer Coaching Program Director at UCLA
• Heidi Hanna, PhD, the founder and CEO of Synergy, a consulting company providing brain-based health and performance programs for organizations, and the executive director of the American Institute of Stress in Weatherford, Texas
• Kelley Holland, an award-winning business journalist and speaker and the founder of the money coaching firm Own Your Destiny in Montclair, New Jersey
• Janice Kiecolt-Glaser, PhD, the director of the Institute for Behavioral Medicine Research at the Ohio State University College of Medicine in Columbus
• David Livingstone Smith, PhD, a philosophy professor at the University of New England in Biddeford, Maine, and the author of Less Than Human: Why We Demean, Enslave, and Exterminate Others
• Bruce S. McEwen, PhD, the former Alfred E. Mirsky Professor and head of the neuroendocrinology laboratory at the Rockefeller University in New York City, and coauthor of The End of Stress as We Know It
• Bernadette Mazurek Melnyk, PhD, author and dean of nursing at Ohio State University, Columbus, where she also serves as the Chief Wellness Officer
• Darlene Mininni, PhD, MPH, a learning and development health psychologist at the University of California in Los Angeles and the author of The Emotional Toolkit: Seven Power-Skills to Nail Your Bad Feelings
• Stephen W. Porges, PhD, a Distinguished University Scientist at the Kinsey Institute at Indiana University in Bloomington, a professor of psychiatry at the University of North Carolina in Chapel Hill, and author of the polyvagal theory
• Rachel Simmons, the director of the Phoebe Lewis Leadership Program at Smith College in Northampton, Massachusetts, and the author of Enough as She Is: How to Help Girls Move Beyond Impossible Standards of Success to Live Healthy, Happy, and Fulfilling Lives
• Amit Sood, MD, the executive director of the Global Center for Resiliency and Well-Being, a former professor of medicine at the Mayo Clinic in Rochester, Minnesota, and the creator of Mayo Clinic Resilient Mind
  

Why are so many of us haunted by our finances? Kelley Holland, an award-winning business journalist and speaker and the founder of the money coaching firm Own Your Destiny in Montclair, New Jersey, says, “In speaking to researchers, it's clear that a lot of it comes down to how we relate emotionally to money. The more we see ourselves as relying on feelings in our decision-making, the more likely we are to feel that the 'unemotional, disciplined' world of finance is not for us."

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At the same time, she says, “Our financial lives have become more complicated — with debt, responsibility for our own retirement saving, and the like — but school-based financial education is often lacking, if it even exists.” The result: Many teens and young adults leave school with little or no financial knowledge, and stress soon follows.

Holland urges us to remember: “You don’t have to be wealthy to achieve financial well-being.”

That’s because cutting yourself off or minimizing social interactions outside of obligatory ones reduces opportunities for your nervous system to take a break from freaking out all the time, she says. Being fully present and “in person” with friends, your tribe, or a group whose members you trust allows for a whole experience that fires up the senses and communicates to your central nervous system — I’m alive, I feel good, I feel seen, I feel heard.

“We don’t need proximity and face-to-face interactions all the time, but we do need a daily dose,” says Stephen W. Porges, PhD, a Distinguished University Scientist at the Kinsey Institute at Indiana University in Bloomington, and a professor of psychiatry at the University of North Carolina at Chapel Hill, whose research on the vagus nerve points to our reflexive response to cues of safety or danger in others and in the environment. “Without it, our body shifts to a physiological state where we support defensive strategies, not pro-social ones.” These defensive strategies are the kind experienced with prolonged chronic stress.

The result, Dr. Porges says, is that we sacrifice not only our mental health, but also our physical health. “That doesn’t have to happen,” he says, “if we listen to our body and respect its needs.”

RELATED: Stephen W. Porges, PhD: Q&A About Freezing, Fainting, and the ‘Safe’ Sounds of Music Therapy

Assari’s research suggests that while white Americans, on average, are physically the “healthiest" group, they are also, on average, less “resilient” — that is, less able to “successfully adapt to life tasks in the face of highly adverse conditions” than black Americans.

One reason, Assari says, is that white Americans are less prepared to cope with adversity because they have less experience with it. By contrast, minority groups in the United States have consistently lived under adverse economic and social conditions — exposed to a disproportionate share of adverse childhood experiences and the weathering effects of hardship, with chronic stressors such as racism leading to sustained, high-effort coping and, subsequently, internal wear and tear.

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These firsthand experiences may have taken a toll on the health of African-Americans, but they also may have engendered a belief in the ability to handle new stressors, Assari says.

Of course, the interplay between chronic stress and race-ethnicity is complicated. There has been research, for example, on the transmission of stress between generations and on depression as it may manifest differently in African-American men. Some research — and many personal testimonials — also suggest that black Americans are less likely to report symptoms of mental illness.

This tyranny of silence led the actress Taraji P. Henson to found the Boris Lawrence Henson Foundation. Named for her late father, a Vietnam veteran who suffered mental health challenges as a result of his wartime experience, the foundation has multiple related missions, including encouraging the training of African-American therapists, supporting mental health in urban schools, reducing prison recidivism, and encouraging black Americans with mental health issues to speak up and seek help.

At the same time, studies such as “The Geography of Desperation in America,” a 2017 report by the Brookings Institution, have found that while poor racial minorities often face worse poverty-related challenges than do poor non-Hispanic whites, they are significantly more optimistic about the future and commit suicide less.

What are some of the sources of this kind of resiliency among black Americans? Non-economic resources — such as connection to family, social support, and religion — are all key to maintaining a healthy physical and mental response to stress, according to McEwen.

“Tolerable stress, what I call allostatic load, can be an acute life event — the death of a loved one, the loss of a job, an accident, things that make a person feel a loss of a sense of control,” McEwen says. “The events may be severe, but if you have a good sense of internal support, good self-esteem, and external social and emotional support, you can weather the storm.”

Aspirations — or expectations — may also matter. As the Brookings report notes, “Poor blacks and Hispanics tend to report they are better off than their parents were, while many blue-collar whites are facing a reality of downward mobility” as jobs go extinct and family structures weaken.

Not all minority or marginalized groups possess supportive resources. In our survey, for instance, the lesbian, gay, bisexual, transgender, queer (LGBTQ) community appears to be highly stressed.

Arline T. Geronimus, doctor of science, a professor in the school of public health and a research professor at the Institute for Social Research at the University of Michigan in Ann Arbor, says this isn’t surprising. Dr. Geronimus’s “weathering” theory addresses both the corrosive and the strength-building aspects of adversity in marginalized groups.

LGBTQ people, unlike the black American population, are not generally raised from birth with a strong sense of LGBTQ identity or community, Geronimus says. Nor do they have generations of pooled adaptive responses passed on to them by their families to build resilience to homophobia, per se. “LGBTQ individuals have to find or build community on their own,” she says. “They also have to engage in the labor of constructing a positive identity and an alternative cultural framework to the dominant one in which they are marginalized.”

Unfortunately, Assari has found, marginalized communities — even those who have a culture of coping — are at risk of losing some of their resilience when some of their circumstances change for the better. In his study, as black Americans experience economic gains, they don’t retain as much resilience, says Assari. That may be because upwardly mobile blacks tend to move to white neighborhoods where resilience is often tempered by distance from family and social support, such as their church, as well as, often, a new stressor: more frequent exposure to racism.

To resolve these issues, Assari says, society must change how it treats minorities.

Says Geronimus: “When facing chronic, toxic stressors, resilience alone is not a panacea. Resilience requires physiological coping and comes at a disproportionate cost to health for individuals in marginalized communities. We should strengthen the institutions and societal elements that help us mentally and emotionally weather adversity, while eliminating those that weather, or eat away at, our health.”

The key results of the survey, Dr. Watson says, are that teenagers who are lesbian, gay, bisexual, transgender, or queer overwhelmingly feel unsafe in their own school classrooms and experience high levels of stress, anxiety, and rejection. Watson says we can better understand what LGBTQ teens are experiencing if we see them as a minority group whose members think of themselves as socially marginalized, or who are treated in socially marginalized ways.

LGBTQ teens will have to use stress reducers more often and more concertedly than most other people, says Watson. Queer kids may have such high levels of stress, he says, that they may override coping mechanisms such as yoga or deep breathing or other known strategies for dealing with chronic stress, especially when it’s a challenge to simply get out of bed.

“We don’t just need an individual approach to reduce that stress,” Watson says. “We need a societal approach, and we hope our research findings will help inform policy and practice changes to improve the lives of these young people.”

“We need to tease apart whether these interactions and social connections are stress-generating,” says Robert Epstein, PhD, a senior research psychologist at the American Institute for Behavioral Research and Technology and the author of Teen 2.0: Saving Our Children and Families From the Torment of Adolescence. “The evidence suggests that they often are.”

Referring to his own research, Dr. Epstein says that the turmoil we see among America’s young people is caused by two factors: We artificially extend childhood well past puberty, treating all young people as if they are incompetent children no matter how competent or mature they might be; and we isolate young people from responsible adults, trapping them and their peers in the world of “teen culture.” That world is heavily influenced — Epstein says “controlled” — by specialized divisions of the media, entertainment, and fashion industries.

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As a result, he says, adolescence is characterized by a high degree of self-consciousness and by tendencies to judge and be judged, to conform, to wear certain clothes and shoes, and to see peers as competitors, even if you call them friends.

Says Epstein: “The result of our creating a teen culture — which doesn’t exist in more than a hundred contemporary cultures around the world — is that young people are socializing and communicating, but in trivial ways. They aren’t alone, but that doesn’t stop them from feeling stressed, inferior, lonely, or unprepared to face an uncertain future.”

The difference, Sood says, is that people with physical or mental health conditions may experience all these stressors more intensely, and for a variety of reasons. We all learn to value life’s basics, such as financial or job stability, in their absence. But even low-level chronic stress — meaning prolonged and unremitting stress, the kind you might experience with a chronic physical or mental health condition — damages the body and the brain in ways that leave us particularly sensitive to factors that can stress us out.

“It becomes an insidious feedback loop,” Sood says. “People with physical or mental health issues have a lower set point for reacting to the stressors in their lives. Because they’re already being challenged by their conditions, it’s easier for another stressor to push them into overload where they’re stressing out. Stressing out makes a chronic condition worse, which increases our experience of stress, which can worsen a chronic condition.”

Then, too, stressing out long enough or often enough can lead to chronic physical and mental health conditions, which may further aggravate the body’s stress response while adding stressors of their own to an already lethal brew.

That may be why, in the survey, this group was more likely to report panic attacks, and why for this group of respondents, stress is much more likely to be paralyzing than invigorating.

Whenever you develop a chronic condition and for whatever reason, including chronic stress, “I think of this as living in prey mode — your body and mind are being preyed upon, challenged, in all kinds of ways,” Sood says. “Now along comes some other stressor, and it’s like salt spread on sandpapered skin: The skin is already irritated. The salt sets it aflame and the feedback loop starts again.”

Exercise/sports fares considerably better, with 24 percent of all respondents saying they engage in some kind of concerted physical activity as one of their top three techniques to relieve or manage stress. (The breakdown is 27 percent of men, 21 percent of women, 25 percent of millennials, with Gen Zers and boomers tied at 24 percent, and Gen Xers at 22 percent.) That makes it the fourth most popular stress relief practice in our survey — after music, TV/videos, and sleep, but ahead of venting/talking to others, and eating.

About 22 percent overall say talking/venting is what they do when stressed (making it the fifth most popular choice), with 53 percent saying they feel better after talking to others who are experiencing stressful situations similar to theirs. Thirty-nine percent of men were significantly more likely to be irritated by those who talk to them about being stressed, while only 31 percent of women felt such irritation.

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Most medical experts will recommend exercise — or at least moving your body, as in walking around — as an effective way to relieve stress. “And frankly, most everyone you talk to knows that exercise is a good thing,” says Epstein. “So why don’t more people exercise or play sports when they are stressing out or to prevent themselves from stressing out?”

Epstein says it’s because exercise is hard, especially when you haven’t really done it before. Even the steps involved to get to the exercise, like changing into sweats or traveling to the gym, can make exercise and sports “labor intensive,” he says.

Frank H. Farley, PhD, the L.H. Carnell Professor at Temple University in Philadelphia and the president of the Society for Experimental Psychology and Cognitive Science, says that to respond successfully to the stressors in our lives, he believes we need at least three things: “Self-knowledge — you need to know who you are, what energizes you and what enervates you. For example, are you risk-seeking or risk-averse? You need motivation — that is, you have to want to do something to change the situation. And you need the resources to take effective action.”

As most of our experts point out, the resources are what many individuals and communities don’t have — a green park, a community pool, a safe neighborhood for a late-night walk.

Here’s what concerns us: When asked, “What do you do in response to stress?” 47 percent of all our respondents (with women and men almost evenly matched) say they take it out on themselves.

Mininni, the health psychologist in learning and development at UCLA, asks: “What does that mean? Drinking? Overeating? Indulging in self-recrimination? I wonder about this because answering, ‘When I’m stressed I …,’ some 27 percent of respondents say they engage in none of the named actions. So, what do they do when they’re stressed?”

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Most men still don’t cry — certainly not as much as women do (0.4 percent versus 4 percent). For Mininni, “What that says is that as a society, we’re still not allowing men to show their emotions; it’s still not okay, even if this is a way to relieve stress. These kinds of gender limitations hurt everyone.”

There is no easy, quick fix; chronic stress is a bit too complicated for that.

In the course of researching and writing this special report, our experts made this clear — none more vividly than Janice Kiecolt-Glaser, PhD, the director of the Institute for Behavioral Medicine Research at the Ohio State University College of Medicine in Columbus.

“Stress is a little like an avalanche," Dr. Kiecolt-Glaser says. "It starts at the top of the mountain when something breaks off. Barreling down the mountain, it not only gains momentum, it also gains mass as it keeps destroying things in its path that become part of it, a monster feeding on itself.”

“So the broad solution,” she says, “is better recognition of the early signals,” what she considers red flag feelings — of being overloaded, out of control, unable to cope, and maybe even anxiety and the occasional panic. “That should prompt us to take stock and think about how to take care of ourselves,” she says.

So take time out to be with those you like and love or want to know. Spend time with people who make you feel seen and heard and safe.

We’re talking about taking a moment to exchange pleasantries with the person who makes your morning coffee. Or, instead of listening to your personal playlist, greet the person next to you on the elevator and wish them a great day. Take a break from Netflix to sit outside and actually chat with your neighbors. Grab some chalk and make a hopscotch board or a tic-tac-toe with your child or grandchild. Plant an herb garden with your partner — even if the garden is a small plastic tub. Invite a friend over for tea on a Saturday instead of running another errand. Stay for the socializing after religious services. Waiting outside a room for a meeting to start? Stop texting or tweeting or sending that last-minute email and make a human connection: Ask your colleague how his mom is doing after surgery, or what kind of dog she adopted and what she named it.

Put the phone down, step away from social media, and step into your life. Your mind, body, and soul — and everyone else you encounter — will be so very glad you did.

Additional Contributors: Dakila D. Divina, Maura Corrigan, Elizabeth DeVita Raeburn, Denise Maher, George Vernadakis, Ingrid Strauch, Melinda Carstensen, Sarah DiGiulio, Katie Robinson, Jamie Putman, Amy Kraft, Pharyl Knight, Beth Silvestri, Tiffany Szalay, Bethany Rouslin, Kristen Hom, Brianna Wesley-Majsiak, Larissa Green, Amanda Long, and Nicole Vegliando.