In the past few weeks, surveys from the American Psychological Association (APA) and from Gallup paint a strikingly consistent picture of sharply rising stress and anxiety in the nation. That should worry all of us because it will inevitably harm the nation’s health both in the near term and for a long time to come. We have already been experiencing a rising stress epidemic for several decades now, with significant increases both in stress-related illnesses and in physical measures of the stress that we carry around every day. Sharp increases in stress and anxiety in just one year accelerate that already worrisome trend.
The year-over-year changes in both national surveys are far larger than we typically see. All are in a negative direction, showing greater daily stress and increasing anxiety about the future. This is virtually unprecedented, especially because of structural factors (unemployment, wages, the overall economy), all point in a positive direction. In APA’s "State of Our Nation" report, over half of the population (59 percent) describes 2017 as being the “lowest point in our nation’s history.” This isn’t just a “snowflake effect” among (supposedly) over-sensitive Millennials (59 percent) but is also endorsed by Gen Xers (61 percent), Boomers (57 percent), and even the “Greatest Generation” at ages 72 and up (56 percent). This seems at first glance quite a paradox: World War II? Vietnam? Kennedy and King assassinations? September 11?
We can begin to unravel this paradox by taking a closer look at the sources of worry. And, we now understand how toxic stress works to “get under the skin” leading to worsened health and increased mortality.
Gallup’s index, which combines responses to multiple areas of stress and well being, reveals a distinct and easily understood pattern of change between 2016 and 2017. The greatest increases in stress and anxiety are among Blacks, Hispanics, women, and those with low incomes. Among ethnic groups, Whites show only a very small increase overall, but the increase among women is substantial. The stress index for men overall is unchanged. The greatest increase of any group is among low-income Americans (less than $24,000 annually). Only those at the highest income ($120,000 and above) show a decreased level of stress.
It can come as no surprise that the groups most negatively affected over the past year are those who have been targeted by the policies and attitudes of the Trump Administration. The principal drivers of stress and anxiety are fear, uncertainty, and a lack of control over one’s life and future, and these have grown markedly over the past year. Plans by the Department of Justice to reform police practices in response to the Black Lives Matter movement have been reversed, and local law enforcement has been emboldened by Trump’s encouragement to “not be too nice” when arresting suspects. Deportation weighs heavily on many immigrants, including their friends and families who are already citizens. The barely hidden “Muslim ban” has had a similar effect.
And it’s not just law enforcement. The FBI has just reported a dramatic increase in hate crimes based on race and ethnicity in the past year. Even before the latest revelations about systemic sexual assaults by powerful men, the realization that the newly elected President has described such assaults as a perk of power served to undermine any confidence that norms could contain egregious behavior. Digging even deeper into the Gallup survey, we can see that one of the largest negative shifts on a specific item is “there is a leader that creates enthusiasm for the future”; further confirmation of the source of much of the increased stress.
It would be a grave mistake to attribute these changes to mere sour grapes in light of the narrow electoral losses of 2016, or to a predictable litany of liberal complaints. The level of self-reported stress and anxiety is a “leading indicator” that physical health consequences will ensue. Elevated (toxic) stress “gets under the skin” by over-activating the system that our bodies use to deal with threat, danger, and challenge. The healthy version is that when confronted with a challenge, our stress response system amps up to provide energy and focus to cope with the challenge: the standard flight-or-fight response. When the challenge has been met, the system “down-regulates” to a calmer state. But when it’s hard to imagine how to deal with the threats, or when they are constant and unremitting, our stress system remains on high alert, flooding our bodies with an excess of stress hormones, especially cortisol, which are harmful to our health. In our research comparing different wealthy countries (Keating, Siddiqi, & Nguyen, 2013), we’ve seen this pattern evolve over several decades in response to large-scale increases in income and social inequality and decreases in social mobility.
But the health risks don’t stop there. We now know that toxic stress in mothers during pregnancy, or for an infant whose parents are unable to provide adequate nurturing and stimulation, can cause long-lasting biological changes, known as epigenetic modifications, that render the infant’s stress response system particularly unable to regulate itself (Keating, 2016). Put simply, excess stress in the present creates a lifelong burden of unhealthy stress reactivity that carries into the next generation (Keating, 2017). The risks to our nation’s health are no longer merely hypothetical. The early warning signs and their causes are there for the looking.
The best correctives to fear, uncertainty, and lack of control are to be found in efforts to change the current reality, even if the prospects for positive change are farther off and have lower odds than we might like. Especially, working with others toward such change—in organizations or through more spontaneous collective action—has immediate benefits, since social support is a primary antidote in dealing with stress both behaviorally and physiologically. Toxic stress is real and dangerous, but so is resilience. Recognizing the many risks of the current state of affairs, including the harm to the nation’s health, should add urgency to our motivation for remedial action.
Keating, D. P. (2017). Born Anxious: The Lifelong Impact of Early Life Adversity – and How to Break the Cycle. New York: St. Martin’s Press. [stmartins.com/bornanxious]
Keating, D. P., (2016). The transformative role of epigenetics in child development research. Child Development, 87(1), 135-142.
Keating, D. P., Siddiqi, A., & Nguyen, Q. (2013). Social resilience in the neoliberal era: National differences in population health and development. In P. Hall & M. Lamont (Eds.), Social Resilience in the Neo-Liberal Era. New York: Cambridge Univ. Press.