RELEASED FEBRUARY 7, 2013 Click on one of the sections or click here to read the full report Stress in America™ Missing STRESS BY CITY the Health Care Connection ATLANTA IMPACT OF stress CHICAGO 48–66 18–33 DENVER 67+ 34–47 STRESS BY STRESS BY DETROIT gender generation LOS ANGELES NEW YORK CITY STRESS BY region SEATTLE WASHINGTON, D.C. Stress in America™: Missing the Health Care Connection 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, Executive Director, Education Directorate Steven J. Breckler, PhD, Executive Director, Science Directorate Katherine C. Nordal, PhD, Executive Director for Professional Practice, Practice Directorate David W. Ballard, PsyD, MBA, Assistant Executive Director for Organizational Excellence Lynn F. Bufka, PhD, Assistant Executive Director, Practice Research and Policy, Practice Directorate Luana Bossolo, Assistant Executive Director, Public Relations, Practice Directorate Sophie Bethune, Director, Public Relations and Special Projects, Practice Directorate Angel Brownawell, Integrated Media Manager, Practice Directorate Kate Kelley, Public Relations Associate, Practice Directorate Harris Interactive, Inc. Michele Salomon, Vice President Aimee Vella Ripley, Senior Research Manager Negra Tutundzic, Research Associate Vanguard Communications Brandi Horton, Associate Director of Innovation Stephanie Dukes, Senior Account Manager Kirana Bammarito, Assistant 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 media, online communication and 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 and is the world’s largest association of psychologists. APA’s membership includes more than 137,000 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. Stress in America™ Missing the Health Care Connection Methodology 1 Missing the Health Care Connection 2 Impact of Stress 13 Stress by Gender 16 Stress by Generation 19 Stress by Region 22 Stress by City Atlanta 30 Chicago 34 Denver 38 Detroit 42 Los Angeles 46 New York City 50 Seattle 54 Washington, D.C. 58 The Stress in America™ survey was conducted online within the United States by METHODOLOGY Harris Interactive on behalf of the American Psychological Association between Aug. 3 and 31, 2012, among 2,020 adults ages 18+ who reside in the U.S. The four generations noted in this report are defined as the following: Millennials n=340 (18- to 33-year-olds), Generation X n=397 (34- to 47-year- olds), Boomers n=1040 (48- to 66-year-olds) and Matures n=243 (67 years and older). For the purposes of this report, Generation X will be referred to as “Gen Xers” in brief. Among the 2,020 adults surveyed, 1,424 report having been diagnosed with one or more of the following: Type 1 diabetes, Type 2 diabetes, cancer, heart disease or heart attack, high cholesterol, high blood pressure, overweight, stroke, asthma or other respiratory disease, chronic pain, depression, an anxiety disorder, arthritis or obesity. For the purposes of this report, this group will be referred to as “people with a chronic illness” or “chronic illness” in brief. For the purposes of this report, the phrase “describes” represents respondents who selected “describes completely.” In addition, health care providers are referenced throughout the report as “providers” and “HCPs.” Results were weighted to reflect the composition of the U.S. population ages 18+ as needed for age, sex, race/ethnicity, education, region and household income. For each of the city reports, results were weighted as needed for age, sex, race/ethnicity, education, region and household income among the entire population within the specific Metropolitan Statistical Area for each city as designated by the U.S. Office of Management and Budget. In addition to the national sample, oversamples in eight cities were collected resulting in a total of 1,715 interviews. Propensity score weighting was also used to adjust for respondents’ propensity to be online. 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 Interactive 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 Interactive surveys. Because the sample is based on those who were invited and agreed to participate in the Harris Interactive online research panel, no estimates of theoretical sampling error can be calculated. stressinamerica.org 1 Missing the Health Care Connection A Health Care System Falling Short There appears to be general agreement that persistent, high stress is unhealthy, yet Americans struggle to manage the relationship between stress and health in their lives. They consistently report stress levels that Stress in America™ are higher than what they believe to be healthy. Those who are already Missing managing the burden of either high stress or chronic illness report their stress is on the rise. And younger Americans are showing warning the Health Care signs for a future of poor health — higher-than-average stress levels, unhealthy strategies for managing stress and inadequate behavioral Connection health support. Overall, survey findings reveal a nation that is not getting what it wants or needs from the health care system to help manage stress and support healthy lifestyles. Lifestyle and behavior are at the root of many of the challenges Findings from the Stress in America™ survey draw important connections facing the health care system. Seven among patient-provider interactions, stress and wellness. A closer out of 10 deaths among Americans look reveals a system that is not meeting many specific patient each year are from chronic diseases. needs — especially those related to behavioral health that could Heart disease, cancer and stroke aid in the prevention and management of chronic illness. Few account for more than 50 percent Americans (19 percent) describe their health care as good quality; of all deaths each year.1 In 2005, 133 likewise, fewer describe their health care as focused on education million Americans — almost one out (12 percent), prevention (13 percent) or mental health needs (9 percent). of every two adults — had at least one chronic illness.2 While many of Only one in 10 would describe their health care as coordinated among these diseases and conditions can different providers. be prevented or controlled with a healthy lifestyle, the Stress in Despite the connection between behavior and disease prevention, only 10 America™ survey finds a population percent describe their health care as focused on behavior or lifestyle issues whose behavioral health and stress that can impact their health. management needs are not being adequately addressed by our health Vast majorities of adults do not make a connection between the health care system. care they receive and mental health. Only 9 percent say that “addressing their mental health needs” describes the health care they receive. 19 Thirty-one percent of adults say that “addressing their mental health needs” % does not describe their health care at all. OF AMERICANS DESCRIBE THEIR HEALTH CARE AS good quality 1 Kung, H. C., Hoyert, D. L., Xu, J. Q., & Murphy, S. L. (2008). Deaths: final data for 2005. National Vital Statistics Reports, 56(10). Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf 2 Wu, S. Y., & Green, A. (2000). Projection of chronic illness prevalence and cost inflation. Santa Monica, CA: RAND Health. stressinamerica.org 2 MMiissssiinngg tthhee HHeeaalltthh CCaarree CCoonnnneeccttiioonn 22 % While Americans consistently report living with a level of stress that is higher than what they believe is healthy and as many as one in five (20 percent) say their stress is extreme or high (an 8, 9 or 10 on a 10-point OF AMERICANS SAY THAT THEIR scale where 1 is “little or no stress” and 10 is “a great deal of stress”), they HEALTH CARE PROVIDER SUPPORTS them in managing their stress do not believe the health care they receive provides support that could help them manage their stress and make lifestyle and behavior changes. On average, more than half of Americans (53 percent) say that their PEOPLE WHO GET STRESS OR health care provider offers little or no support to help them manage BEHAVIOR MANAGEMENT SUPPORT their stress — even among those living with high stress (52 percent). FROM A HEALTH CARE PROVIDER Yet, when individuals report that they do receive a great deal or a lot of DO BETTER AT REACHING support from their health care provider for managing stress or making HEALTHY LIVING GOALS. lifestyle or behavior changes, they appear to be doing better. Percentage Reporting Doing an Excellent or Very Good Job Americans reported their mean stress level as a 4.9 on a 10-point scale, A great deal/A lot of Little/No support support from HCP from HCP for stress or while they define a healthy level of stress as a 3.6 on the same scale. for stress or behavior behavior management management Twenty percent of Americans reported stress levels that are extreme (an 8, Having a good 9 or 10 on a 10-point scale). relationship 71% Little/No Support from HCP for Stress Management (B) with my family 50% Having good relationships 63% OAn lolty/G 2re2at dpeael orcf Seupnpto rot frfo mA HmCPe forri cStarenss sM asnaagye mthenat t(A )their health care provider supports with my friends 39% them in managing their stress. Doing well 61% in my career/studies 39% Twenty-nine percent say their health care provider supports them in 47% Managing stress 29% making lifestyle or behavior changes that can improve their health. 47% Eating healthy 29% People who do not receive support from their health care provider for Getting 44% enough sleep 25% managing stress or making lifestyle or behavior changes are more likely to say their stress increased in the past year than those who do get support Being physically 40% active or fit 28% (38 percent with little or no support vs. 29 percent with a great deal or a lot BASE: A Great deal/A lot of support for either stress or behavior management of support). (n=658); Little/No support for neither stress nor behavior management (n=706) Q7010 How well are you doing at achieving each of these? stressinamerica.org 3 Missing the Health Care Connection People appear to value discussions with health care professionals about stress management and lifestyle and behavior changes that could improve their health. When asked about the importance people place on having specific conversations with their health care provider about their health and wellness, discrepancies appear between what people think is important and the frequency with which they are discussing these issues, regardless of who starts the conversation. For many adults, conversations with their health care provider about stress, lifestyle and behavior are not happening at all. Twenty-one percent report that they never talk with their provider about lifestyle or behavior changes that could improve their health, 27 percent never discuss progress they are making toward their lifestyle and behavior goals, 33 percent never discuss CONVERSATIONS ABOUT STRESS ways to manage stress and 38 percent never discuss their mental health. AND BEHAVIOR WITH HEALTH CARE PROVIDERS DO NOT OCCUR AT RATES Forty-six percent of adults think it is extremely or very important to discuss IN LINE WITH WHAT PEOPLE VALUE. barriers they may face as they follow treatment recommendations, while Importance vs. Frequency only 25 percent of adults report that these conversations are happening Extremely/Very important Often/Always often or always. to discuss with HCP discuss with HCP Lifestyle or behavior 42% FoHarptpeyn-intgw oftoen /aplweayrscent of adults think it is extremely or very important to changes that would improve my health 28% discuss lifestyle or behavior changes that could improve their health, while Extremely/Very important only 28 percent of adults report that these conversations are happening My progress toward 37% making desired lifestyle often or always. and behavior changes 25% 32% Thirty-seven percent think it is extremely or very important to discuss How to manage stress 17% progress made toward lifestyle and behavior change goals, while only 25 percent report that these conversations are happening often or always. 32% My mental health 17% Thirty-two percent think it is extremely or very important to discuss BASE: All respondents (n=2020) managing stress, as well as to discuss their mental health, while only 17 Q6035 How important do you think it is that your HCP(s) discuss the following with you? Q6030 How often do you and your HCP(s) discuss the following? percent report that these conversations are happening often or always. stressinamerica.org 4 Missing the Health Care Connection At the Tipping Point Many living with high stress are at a tipping point, faced with potential physical and emotional health challenges if they are not able to get the support they need to manage their stress well. If untreated, consistently high stress could become a chronic condition, which can result in serious health problems including anxiety, insomnia, muscle pain, high blood pressure and a weakened immune system.3 Research shows that stress can even contribute to the development of major illnesses, such as heart disease, depression and obesity, or exacerbate existing illnesses.4 Rather than helping those at the tipping point — or preventing others from reaching it — the health care system is not providing people with the care needed to manage stress, prevent disease and live well. People who say their stress is high (an 8, 9 or 10 on a 10-point scale) also report increasing stress levels and are less likely to say they are achieving other aspects of well-being. More than two-thirds of adults with high stress (69 percent) say their stress has increased in the past year compared with only 13 percent of people with low stress (a 1, 2 or 3 on a 10-point scale) and 35 percent of Americans overall. Thirty-one percent of adults with high stress say that they never discuss ways to manage stress with their health care provider and 30 percent report their health care provider does not support them at all in managing their stress. 31 % When asked if “addressing mental health needs” describes the health care they receive, only a third (33 percent) of those with high stress agree. OF PEOPLE WITH HIGH STRESS Only 17 percent of those with high stress say that they are doing an never discuss stress management excellent or very good job of managing their stress, compared with 59 WITH THEIR HEALTH CARE PROVIDER percent of those with low stress and 37 percent of people nationwide. 3 Baum, A., & Polsusnzy, D. (1999). Health psychology: Mapping biobehavioral contributions to health and illness. Annual Review of Psychology, 50, 137–163. 4 Ibid. stressinamerica.org 5 Missing the Health Care Connection Adults with high stress are also less likely than those with low stress to say they are doing an excellent or good job at reaching healthy living goals like eating healthy (30 percent vs. 41 percent), being physically active (21 percent vs. 41 percent) and getting enough sleep (30 percent vs. 43 percent). The lack of support that people living with high stress receive from the health care system is reflected in their evaluation of the system — people living with high stress are less likely than people with low stress to give their health care an “A” grade (28 percent vs. 38 percent). HOW WELL ARE While those living with high stress are already at risk, many express YOU MANAGING STRESS? interest in discussing these issues with their health care provider. Achievement (Excellent/Very Good Job) Unfortunately, wide gaps appear between the value they place on of Stress Management Goals these issues and the frequency with which these conversations actually High stress Low stress take place. 59% Forty-eight percent of those with high stress think it is extremely or very impHoigrtha Sntrte stso discuss how to manage stress with their provider, while only 26 percent report that these conversations are happening often or always. Low Stress Forty-seven percent of those with high stress think it is extremely or very important to discuss their mental health, yet only 27 percent report that 17% these conversations are happening often or always. Forty-nine percent of those with high stress think it is extremely or very Managing stress important to discuss making lifestyle and behavior changes, but only 36 BQA70S1E0: H Higohw s wtreells asr ree ysopuo nddoienngt sa t( nac=h4i5ev4i)n; gLo ewac sht roef stsh reesesp?ondents (n=665) percent report that these conversations are happening often or always. stressinamerica.org 6