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

 

survey measures attitudes and perceptions of stress among the general public 



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. 

About the American Psychological Association

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 SNAPSHOT 9

Stress Trending Downward, But Health 

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.


8

 

FEELING FINANCIAL PRESSURE 

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. 

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

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 



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

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.



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.

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. 



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

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 

*

2009

2008

2007

2010

2011

2012

2013

2014

BASE: ALL QUALIFIED RESPONDENTS 2007 (n=1848); 2008 

(n=1791); 2009 (n=1568); 2010 (n=1134); 2011 (n=1226); 

2012 (n=2020); 2013 (n=1950); 2014 (n=3068)

Q625  Below is a list of things people say cause stress in their 

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

72%

71%

76%

75%

69%

71%

64%

68%

69%

70%

70%

65%

69%

60%

58%

55%

58%

57%

57%

55%

47%

54%

47%

52%

53%

51%

52%

46%

REPORT FEELING STRESSED ABOUT 

MONEY AT LEAST SOME OF THE TIME 

72

%

 

(NEARLY 3/4) 

of Adults

73%

74%

60%

55%

page 2


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

 

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

BASE: ALL QUALIFIED RESPONDENTS 2007 (Under $50K n=709;  

≥$50K n=852); 2008 (Under $50K n=766 ; ≥$50K n=778); 2009  



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