S t r e ss I n a m e r I c a ™ released february 4, 2015
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S T R E SS I N A M E R I C A ™ RELEASED FEBRUARY 4, 2015 Paying With Our Health Stress in America™: Paying With Our Health was developed, reviewed and produced by the following team of experts: AMERICAN PSYCHOLOGICAL ASSOCIATION Norman B. Anderson, PhD, Chief Executive Officer and Executive Vice President Cynthia D. Belar, PhD, Former Executive Director, Education Steven J. Breckler, PhD, Former Executive Director, Science Katherine C. Nordal, PhD, Executive Director for Professional Practice David W. Ballard, PsyD, MBA, Assistant Executive Director for Organizational Excellence Lynn F. Bufka, PhD, Assistant Executive Director, Practice Research and Policy, Practice Luana Bossolo, Assistant Executive Director, Public Relations, Practice Sophie Bethune, Director, Public Relations and Special Projects, Practice Angel Brownawell, Integrated Media Manager, Practice Katelynn Wiggins, Public Relations Associate, Practice CONSULTANTS Linda C. Gallo, PhD, San Diego State University HARRIS POLL Michele Salomon, Director, Project Development Aimee Vella Ripley, Manager, Project Development Nira Colonero, Senior Research Analyst VANGUARD COMMUNICATIONS Brenda Foster, Vice President of Account Services Crystal Borde, Senior Account Supervisor Brandi Horton, Associate Director of Innovation Kiran Bammarito, Assistant Account Executive Scott Rieder, Senior Account Executive About the Stress in America™ Survey Since 2007, the American Psychological Association has commissioned an annual nationwide survey as part of its Mind/Body Health campaign to examine the state of stress across the country and understand its impact. The Stress in America ™
and identifies leading sources of stress, common behaviors used to manage stress and the impact of stress on our lives. The results of the survey draw attention to the serious physical and emotional implications of stress and the inextricable link between the mind and body. For a Healthy Mind and Body, Talk to a Psychologist APA’s Mind/Body Health campaign educates the public about the connection between psychological and physical health and how lifestyle and behaviors can affect overall health and wellness. This multifaceted social marketing campaign addresses resilience and the mind-body connection through the Internet, social media, strategic partnerships and a nationwide grassroots network of psychologists offering free educational programs in local communities.
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA’s membership includes nearly 130,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people’s lives. METHODOLOGY 1 PAYING WITH OUR HEALTH 2 Feeling Financial Pressure 2 Struggling to Get By 3 A Stressful Reality for Parents and Younger Generations 5 Worrying More About Money 6 Seeking Emotional Support 7
Stress Trending Downward, But Health 9 and Wellness Still Out of Reach Stress Gap Widening Between Genders 11 Younger Generations Continue to Struggle 12 With Managing Stress Parents More Stressed Than Other Adults 13 Across the Country, Americans Report 14 Similar Stress Experiences APPENDIX: Guidelines for Reading Questions 15 and Interpreting Data RELEASED FEBRUARY 4, 2015 S T R E SS I N A M E R I C A ™ Paying With Our Health The Stress in America ™ survey was conducted online within the United States by Harris Poll on behalf of the American Psychological Association (APA) between August 4 and 29, 2014, among 3,068 adults ages 18+ who reside in the U.S. Results were weighted as needed for age, sex, race/ethnicity, education, region and household income. Propensity score weighting also was used to adjust for respondents’ propensity to be online. Throughout this report, different segments of adults are discussed. Adults’ (n=3068 total) demographic subgroups include gender (men: n=1204; women: n=1864); generation (Millennials [18 to 35 years old]: n=720; Gen Xers [36 to 49 years old]: n=548; Baby Boomers [50 to 68 years old]: n=1324; and Matures [69 years or older]: n=476); income (<$50K: n=1499; >$50K: n=1379); region (East: n=670; Midwest: n=776; West: n=637; South: n=984); and emotional support (yes: n=2042; no: n=649). In addition, the sample size of parents with a child under 18 in the household was 569. All sample surveys and polls, whether or not they use probability sampling, are subject to multiple sources of error, which are most often not possible to quantify or estimate, including sampling error, coverage error, error associated with nonresponse, error associated with question wording and response options, and post-survey weighting and adjustments. Therefore, Harris Poll avoids the words “margin of error,” as they are misleading. All that can be calculated are different possible sampling errors with different probabilities for pure, unweighted, random samples with 100 percent response rates. These are only theoretical because no published polls come close to this ideal. Respondents for this survey were selected from among those who have agreed to participate in Harris Poll surveys. The data have been weighted to reflect the composition of the U.S. population ages 18+. Because the sample is based on those who were invited and agreed to participate in the Harris Poll online research panel, no estimates of theoretical sampling error can be calculated. In order to determine whether there were statistically significant differences in how various subgroups changed in perceptions over time, Multiple Linear Regression was used to relate the following constructs to the overall stress rating (Q605): (1) time (eight waves over eight years); (2) main effect of the subgroup in question; and (3) interaction between subgroups and time. This analysis was conducted separately to make comparisons by gender, income and age. Significance of items (1), (2) and (3) above was determined by p-values smaller than .05. All values were smaller. All values but one (main effect for Gen Xers) were less than .01. METHODOLOGY page 1
WWW.STRESSINAMERICA.ORG Even though aspects of the U.S. economy continue to improve, some Americans are squeezed by sharp increases in health care costs and the cost of living. 1,2 This year’s Stress in America™ survey shows that stress about money and finances is prevalent nationwide. In fact, regardless of the economic climate, money has consistently topped Americans’ list of stressors since the first Stress in America™ survey in 2007. Overall, Americans seem to be doing fairly well — average stress levels are trending downward (4.9 in 2014 vs. 6.2 in 2007 on a 10-point scale, where 1 is “little or no stress” and 10 is “a great deal of stress”) and people generally say they are in good health (80 percent say their health is excellent, very good or good). But it seems that parents, younger generations and those living in lower-income households (making less than $50,000 per year) have a different experience — they report higher levels of stress than Americans overall, especially when it comes to money, and those who have particularly high stress about money are more likely to say they engage in unhealthy behaviors to manage their stress. 3,4 Women, who consistently report high levels of overall stress and unhealthy behaviors to manage stress, also report high levels of stress about money. What’s more, the gap between the percentage of those who appear to be doing well when it comes to managing their stress and the percentage of those who are not is growing. 5 These findings stand against a backdrop of research that shows the profound effects of stress on health status and longevity. 6 Research also shows that financial struggles strain individuals’ cognitive abilities, which could lead to poor decision-making and may perpetuate their unfavorable financial and health situations. 7 But there is good news. Survey findings show that those feeling the weight of money-related stress are able to cope and manage their stress in healthier ways when they say they have emotional support.
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Stress about money and finances appears to have a significant impact on Americans’ lives. Nearly three- quarters (72 percent) of adults report feeling stressed about money at least some of the time and nearly one- quarter say that they experience extreme stress about money (22 percent rate their stress about money during the past month as an 8, 9 or 10 on a 10-point scale). In some cases, people are even putting their health care needs on hold because of financial concerns. 1 Bureau of Economic Analysis, U.S. Department of Commerce. (2014, October 30). Gross domestic product: Third quarter 2014 (advance estimate) [Press release]. Retrieved from http://www.bea.gov/newsreleases/ national/gdp/2014/pdf/gdp3q14_adv.pdf 2 Knutson, R., & Francis, T. (2014, December 1). Basic costs squeeze families. The Wall Street Journal. Retrieved from http://www.wsj.com/articles/americans-reallocate-their-dollars-1417476499 3 Income <$50K n=1499; >=$50K n=1379. $51,939 is the median U.S. household income according to the 2013 Census. DeNavas-Walt, C., & Proctor, B. D. (September 2014). Income and poverty in the United States: 2013. Retrieved from http://www.census.gov/content/dam/Census/library/publications/2014/demo/p60-249.pdf 4 Adults with children under 18 living at home n=569; Adults without children under 18 living at home n=2499; Millennials 18 – 35 n=720; Gen Xers 36 – 49 n=548; Boomers 50 – 68 n=1324; Matures 69+ n=476. 5 Multiple Linear Regression was used in order to determine whether there were significant differences in how various subgroups changed in perceptions over time. Read the full Methodology here. 6 Schneiderman, N., Ironson, G., & Siegel, S. D. (April 2005). Stress and health: Psychological, behavioral, and biological determinants. Annual Review of Clinical Psychology, 1, 607–628. 7 Mani, A., Mullainathan, S., Shafir, E., & Zhao, J. (2013, August 30). Poverty impedes cognitive function. Science, 341(6149), 976–980. Retrieved from http://www.sciencemag.org/content/341/6149/976 8 Q702 Is there someone you can ask for emotional support if you need it, such as talking over problems or helping you make a difficult decision? PAYING WITH OUR HEALTH < TOP 4 SOURCES OF STRESS 40%
50% 60%
70% 80%
Money Work (if employed) Family responsibilities Health concerns *
lives. For each one, please indicate how significant a source of stress it is in your life. *In 2007, this option was presented to respondents as “personal health concerns.” Money tops charts of significant sources of stress
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page 3 WWW.STRESSINAMERICA.ORG NEARLY 1 in 5 AMERICANS SAY THAT THEY HAVE EITHER CONSIDERED SKIPPING OR SKIPPED GOING TO THE DOCTOR IN THE PAST YEAR WHEN THEY NEEDED HEALTH CARE BECAUSE OF FINANCIAL CONCERNS. More than one-quarter of adults (26 percent) report feeling stressed about money most or all of the time. More than half of adults (54 percent) say they have “just enough” or not enough money to make ends meet at the end of the month. Most adults say their level of stress about money has remained the same (59 percent) or increased (29 percent) in the past year. Significant sources of money-related stress reported by Americans include paying for unexpected expenses (54 percent said very or somewhat significant), paying for essentials (44 percent said very or somewhat significant) and saving for retirement (44 percent said very or somewhat significant). Over the past year, the majority of Americans have taken steps to live more economically by shopping during sales or using coupons (53 percent), cooking more at home (52 percent) and cutting back on non-essentials (51 percent). Nearly one-third of Americans (32 percent) say that their finances or lack of money prevent them from living a healthy lifestyle. One in five Americans say that they have either considered skipping (9 percent) or skipped (12 percent) going to the doctor in the past year when they needed health care because of financial concerns. Regardless of the role money plays in creating stress for the majority of Americans, people appear to have a positive attitude about finances: 80 percent say they have confidence in their ability to manage their money and 71 percent say they have a healthy relationship with money. At the same time, 71 percent say that having more money would make them happier and more than one-third say that money makes them tense (38 percent). These findings underscore the complexity of the relationship that many Americans have with money. STRUGGLING TO GET BY The United States is the world’s richest country, with a gross domestic product nearly double that of the runner- up, yet our economic inequality is among the highest in the world. 9,10
The Great Recession may have officially ended, but most American households face stagnant wages and increasing debt — many Americans are actually considered to be poorer than they were a decade ago. 11,12,13
9 International Monetary Fund. (October 2014). Report for Selected Countries and Subjects. Filtered for United States and China in U.S. dollars. Retrieved from http://www.imf.org/external/pubs/ft/weo/2014/02/ weodata/index.aspx 10
OECD. (n.d.). Income inequality. Retrieved from http://data.oecd.org/inequality/income-inequality.htm 11
Saez, E. (2013, September 3). Striking it richer:
The evolution of top incomes in the United States (updated with 2012 preliminary estimates). Retrieved from http://eml.berkeley.edu/~saez/saez-UStopincomes-2012.pdf 12 Federal Reserve Bank of New York. (February 2014). Household Debt and Credit Report. Retrieved from http://www.newyorkfed.org/microeconomics/hhdc.html#/2014/q3 13 Joint Center for Housing Studies of Harvard University. Tabulations of U.S. Census Bureau. Current Population Survey Data. Stayed the same 59% Decreased 12% Increased 29% < STRESS ABOUT MONEY BASE: ALL QUALIFIED RESPONDENTS (n=3068) Q6011 Thinking about the past year, would you say your level of stress about money has increased, decreased or has it stayed about the same? Stress about money is mostly staying the same or increasing PAYING WITH OUR HEALTH
page 4 WWW.STRESSINAMERICA.ORG PAYING WITH OUR HEALTH It also appears that the gap between the “haves” and the “have nots” is widening. In 2007, average reported stress levels were the same regardless of income, but now, those living in lower-income households report higher overall stress levels than those living in higher-income households (5.2 vs. 4.7 on a 10-point scale). For adults living in lower-income households, financial concerns are a common source of stress. Adults in lower-income households are twice as likely as those in higher-income households to say they feel stress about money all or most of the time (36 percent vs. 18 percent). Many lower-income Americans barely scrape by each month. Thirty percent of adults in lower-income households report that at the end of the month, they don’t have enough money to make ends meet, compared with 11 percent of adults in higher-income households. Forty-four percent of lower-income Americans say paying for out-of-pocket health care costs is a very or somewhat significant source of stress (compared with 34 percent of higher-income Americans). For those lower-income Americans who have out-of-pocket health care costs, 31 percent say they have difficulty paying for these costs (compared with 14 percent of higher-income Americans with out-of-pocket health care costs). Survey results suggest that for those living in lower- income households, both finances and stress about money stand in the way of a healthy lifestyle. Those living in lower-income households are almost twice as likely (45 percent) as those in higher-income households (24 percent) to say that their financial situation or lack of money prevents them from living a healthy lifestyle. Nearly three in 10 lower-income Americans have either considered skipping (9 percent) or actually skipped (20 percent) necessary doctors’ visits due to their finances. More people with lower reported income say that they have felt a sense of loneliness and isolation in the past month due to stress (29 percent vs. 21 percent of people with higher reported income). Those living in lower-income households who also say their stress about money is extreme (8, 9 or 10 on a 10-point scale) are more likely than those living in lower-income households reporting low stress about money (1, 2 or 3 on a 10-point scale) to say they engage in sedentary or unhealthy behaviors to manage their stress, such as watching television/movies for more than two hours per day (55 percent vs. 34 percent), surfing the Internet (58 percent vs. 27 percent), napping/sleeping (42 percent vs. 20 percent), eating (38 percent vs. 15 percent), drinking alcohol (20 percent vs. 7 percent) or smoking (25 percent vs. 6 percent). 2008 2007 2009 2010 2011 2012 2013 2014 Household income <$50K Household income ≥$50K 4 5 6 7 STRESS LEVEL 6.2 6.0 5.6 5.5 5.1 4.8 5.0 4.7 6.2 6.0 5.4 5.4 5.3 5.1 5.4 5.2 < STRESS LEVELS BETWEEN LOWER-INCOME AND HIGHER-INCOME HOUSEHOLDS Gap in stress levels between lower-income and higher-income households is growing
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