Introduction

Teens report stress levels far higher than what they believe is healthy.Despite our understanding that stress takes a toll on our physical and mental health, this year’s Stress in America™ survey reveals a portrait of American stress that is high and often managed in ineffective ways, ultimately affecting our health and well-being.

But the most concerning news is not what’s happening to adults.

Survey findings suggest that the patterns of unhealthy stress behaviors we see in adults may begin developing earlier in our lives. Many American teens report experiencing stress at unhealthy levels, appear uncertain in their stress management techniques and experience symptoms of stress in numbers that mirror adults’ experiences.1 These findings are especially sobering when paired with research that suggests physical activity, nutrition and lifestyle — all wellness factors the survey revealed to be affected by stress in teens and adults — not only contribute to adolescents’ health now, but also to habits that can be sustained into adulthood.2

While the United States spends more than any other country on health care and leads the world in the quality and quantity of its health research, these trends do not add up to better health outcomes.3 The U.S. experiences poorer health outcomes than many other high-income countries, even while spending more money per person on health care. Compared to peers in these countries, Americans have less access to primary care, consume the most calories per person and are more likely to live in environments designed around automobiles. Research suggests that these factors contribute to the nation’s poor health outcomes and survey findings show that stress influences our health behaviors, setting up teens and adults alike for potential chronic illnesses that affect quality of life and the country’s health care expenditure.4

While no one can avoid all stressful situations, Stress in America portrays a picture of high stress and ineffective coping mechanisms that appear to be ingrained in our culture, perpetuating unhealthy lifestyles and behaviors for future generations.

A culture of unhealthy stress

Teens are more likely than adults to report that their stress has a slight or no impact on their physical or mental health.Over the years, the Stress in America survey has found that Americans experience many stressful situations. Issues related to money and work continue to be the most commonly mentioned stressors for adults (71 percent report money, with 69 percent reporting work and 59 percent reporting the economy as significant sources of stress). These issues are complex and difficult to manage, often leading to more stress over time; in fact, 78 percent of American adults say their stress level increased or stayed the same over the past five years. Even more — 84 percent — say the same about the past year. All the while, American adults continue to report higher stress levels than what they believe to be healthy (5.1 vs. 3.6 on a 10-point scale, where one is "little or no stress" and 10 is "a great deal of stress") and 37 percent of adults say stress has left them feeling overwhelmed in the past month. Stress is also affecting adults’ health — 30 percent say their stress level has a strong or very strong impact on their physical health and 33 percent say the same of the impact on their mental health.

While the news about American stress levels is not new, what’s troubling is the stress outlook for teens in the U.S. In many cases, American teens report experiences with stress that follow a similar pattern to those of adults. They report stress at levels far higher than what they believe is healthy and their reported stress levels are even higher during the school year. Meanwhile, teens report that stress is having an impact on their performance at home, work and school.

Teens report that their stress level during the school year far exceeds what they believe to be healthy (5.8 vs. 3.9 on a 10-point scale) and tops adults’ average reported stress levels (5.8 for teens vs. 5.1 for adults). Even during the summer — between Aug. 3 and Aug. 31, 2013, when interviewing took place — teens reported their stress during the past month at levels higher than what they believe to be healthy (4.6 vs. 3.9 on a 10-point scale). And more than one in 10 teens say they experience stress at extreme levels over the summer; 13 percent rated their summer stress level as an eight, nine or 10 on a 10-point scale (high stress levels are defined as an eight, nine or 10 with low stress levels being a one, two or three on a 10-point scale). And that percentage actually doubles during the school year — 27 percent of teens report experiencing a level of stress that is an eight, nine or 10 on a 10-point scale during the school year. What’s more, few teens report their stress is on the decline: only 16 percent report that their stress level has declined in the past year. At the same time, 31 percent of teens say that their stress level has increased in the past year and 34 percent believe their stress levels will increase in the coming year.

While school is the most commonly mentioned source of stress for teens (83 percent report that school is a somewhat or significant source of stress), stress also appears to be affecting teens’ performance at home and work, as well as school:

  • Ten percent of teens report receiving lower grades than they are capable of due to stress.
  • More than half (59 percent) of teens report that managing their time to balance all activities is a somewhat or very significant stressor.
  • Due to stress, 40 percent of teens neglected their responsibilities at home and 21 percent say the same about work or school responsibilities.
  • Twenty-six percent report snapping at or being short with classmates or teammates when under stress.
  • Almost three in 10, or 29 percent of teens, report general procrastination due to stress.
  • Social interactions, relationships and events often occupy much of teens’ lives and 78 percent report that having good relationships with friends is very or extremely important to them. Despite this, stress caused 17 percent of teens to cancel social plans with friends or family in the last month.

Despite the impact that stress appears to have on their lives, teens appear less aware than adults of the impact that stress can have on their physical and mental health. Teens are more likely than adults to report that their stress level has a slight or no impact on their body or physical health (54 percent of teens vs. 39 percent of adults) or their mental health (52 percent of teens vs. 43 percent of adults). Yet teens report experiencing both emotional and physical symptoms of stress in similar proportions to adults, including feeling irritable or angry (40 percent of teens vs. 41 percent of adults), nervous or anxious (36 percent of teens vs. 37 percent of adults) and tired (36 percent of teens vs. 37 percent of adults).

Stress affects teens’ health and well-being, whether or not they know it

The impact of stress on teens’ physical health is clear. In particular, long-term, high stress can weaken immune systems and exhaust the body.5 Research also shows that even otherwise healthy teens who experience consistent stress have higher levels of inflammation, which has long been associated with development of cardiovascular disease.6 Even the common cold is influenced by stress — people living with chronic stress get more frequent and severe viral infections.7

When asked about experiences in the past month:

  • Forty percent of teens report feeling irritable or angry and 36 percent report feeling nervous or anxious.
  • Almost one-third (32 percent) of teens say stress makes them feel as though they could cry.
  • Many teens report feeling overwhelmed (31 percent) and depressed or sad (30 percent) as a result of stress.
  • More than one-third of teens report fatigue/feeling tired (36 percent) and having lain awake at night because of stress (35 percent).
  • Nearly one-third of teens (32 percent) say they experience headaches, 26 percent report changes in sleeping habits and 21 percent say they experience upset stomach or indigestion as a result of stress.
  • Nearly one-quarter of teens (23 percent) have skipped a meal because of stress.
Teens report symptoms of stress during the past month, with 74% Reporting having had more than one symptom.

Regardless of the high levels of stress that teens report and the symptoms of stress they report experiencing, they often do not know what to do to manage their stress. Nearly half (42 percent) of teens say they either are not doing enough to manage their stress or they are not sure if they are doing enough to manage it. While 51 percent of teens report that stress management is very or extremely important to them, most teens do not regularly make time for stress management. More than one in 10 teens (13 percent) never set aside time to manage stress, while the majority (55 percent) only set aside time for stress management a few times a month or less.

When teens look to manage their stress, only a small number engage in physical activities for stress management, such as exercising or walking (37 percent) or playing sports (28 percent). Instead, many teens turn to sedentary activities to cope, such as playing video games (46 percent), surfing the Internet or going online (43 percent) and watching television or movies (36 percent). But those teens who do engage in more physically active stress management behaviors report lower stress levels and better health behaviors overall, especially when it comes to sleep, exercise and weight. It is critical to examine the effect of stress on teens’ health, especially their weight, as this generation of young people may be the first to have shorter life expectancies than their parents due to increased diagnoses of being overweight, obese and having chronic illnesses.8


Teens who exercise once a week or more report lower average stress levels in the past month than their peers who exercise less than once a week or not at all (4.4 vs. 5.1 on a 10-point scale).

In addition, only 30 percent of those who exercise once a week or more report increased stress levels over the past year, compared with 38 percent of teens who exercise less than once a week or not at all.

Teens of “normal weight,” defined as having a body mass index (BMI) from 18 to 24, report lower stress levels than “obese/overweight” teens, defined as having a BMI of 25 and above (4.4 vs. 5.2 on a 10-point scale in the past month and 5.5 vs. 6.4 during the school year).


Teens who sleep longer fare better. The average stress level during the past school year for teens who slept less than eight hours on school nights is 6.5, compared to 5.2 for teens that slept at least eight hours on school nights.

More teens engage in sedentary activities to cope with stress than use physical activities for stress management.

In addition to marked differences in stress among teens who engage in active behaviors compared with those who engage in sedentary activities, the survey reveals that teens with high stress during the past school year are more likely to engage in sedentary behaviors than are teens with low stress during the past school year.

More than half (54 percent) of teens with high stress say they surf the Internet or go online to manage stress, compared to just 24 percent of teens with low stress.

Teens with high stress report spending an average of 3.2 hours a day online compared with only two hours a day for teens with low stress during the past school year.

Almost half of teens with high stress (48 percent) say they watch television or movies for more than two hours a day. Only 20 percent of teens with low stress do the same.

More than half (52 percent) of teens with high stress report feeling tired due to stress. Just 16 percent of teens with low stress say the same.

Teens with high stress are much more likely (44 percent) to say they nap to manage stress than are teens with low stress (21 percent).

 

Teen girls: Already bearing the brunt of stress

More teen girls than boys report symptoms and unhealthy behaviors as a result of stress , particularly appetite and dietary changes.Since the Stress in America survey first began tracking Americans’ stress in 2007, women have consistently reported stress at rates higher than men and are more likely to report experiencing symptoms of stress and more trouble managing stress (trended stress data by gender).

Unfortunately, it looks like this pattern might emerge early in our lives. In fact, teen girls report an average stress level in the past month of 5.1 on a 10-point scale — higher than boys’ reported average stress level of 4.1 — and on par with what adults report experiencing (5.1). The survey also found that more teen girls than boys report symptoms of stress and are more likely to say their stress impacts their happiness a great deal or a lot.

Thirty-seven percent of teen girls report feeling depressed or sad in the past month due to stress compared to 23 percent of teen boys.

Thirty-six percent of teen girls report increased stress levels over the past year compared with 27 percent of teen boys.

Teen girls report having more trouble managing stress than teen boys: Only 34 percent of teen girls say they are doing an excellent or very good job at managing stress compared with nearly half (47 percent) of teen boys.

More teen girls than boys report symptoms and unhealthy behaviors as a result of stress. Teen girls report appetite and dietary changes due to stress with more frequency than teen boys — a trend that continues among adults.

Forty-five percent of teen girls report feeling irritable or angry due to stress in the past month compared with 36 percent of teen boys.

Forty-four percent of teen girls report feeling as though they could cry due to stress in the past month compared with just 20 percent of teen boys.

Forty-two percent of teen girls report feeling tired due to stress in the past month compared with 30 percent of teen boys.

Stress appears to affect teen girls’ relationship with food. In the past month, they report eating too much or too little because of stress (39 percent vs. 14 percent of teen boys), a change in appetite when stressed (22 percent vs. 8 percent of teen boys), skipping a meal due to stress (31 percent vs. 15 percent of teen boys) and overeating or eating unhealthy foods because of stress (35 percent vs. 17 percent of teen boys).

When it comes to adults, women are more likely to report skipping meals due to stress than men (36 percent vs. 23 percent), overeating or eating unhealthy foods because of stress (43 percent vs. 32 percent) and changes in appetite because of stress (21 percent vs. 14 percent) in the past month.

Teen girls also report feeling more social pressures than teen boys:

  • More than one-third of teen girls (34 percent) say they feel pressure to be a certain way, compared to less than one-quarter of teen boys (22 percent).
  • Sixty-eight percent of teen girls say that some aspect of their appearance is a somewhat or very significant source of stress, compared with 55 percent of teen boys.
  • Thirty percent of teen girls say they feel bad when comparing themselves to others on social media (compared with only 13 percent of teen boys) and 39 percent say that how others perceive them on social media is a significant source of stress (compared with 29 percent of teen boys).
Setting a bad example

Adults who engage in healthy and/or active stress management behaviors are more likely to report lower stress levels.While teens’ experiences with stress are less than positive, survey findings suggest that examples of healthy stress management may be hard for teens to find. Young people learn a lot about healthy behaviors from watching and imitating adults, especially their parents.9

Adults’ average stress is 5.1 on a 10-point scale and 21 percent report experiencing extreme stress levels. More than six in 10 (61 percent) adults report that stress management is very or extremely important to them, yet they do not regularly make much time for it. In fact, half of adults (50 percent) set aside time for stress relief just a few times a month or less. Some adults do not take any action at all to help manage their stress — one in 10 adults (10 percent) say they do not engage in any stress management activities.

Nearly half (44 percent) of adults say they are either not doing enough or are not sure whether they are doing enough to manage their stress.

Stress also affects many adults’ happiness. More than one-third (36 percent) of adults say stress affects their overall happiness a great deal or a lot.

Parents of children under age 18 are challenged by unhealthy behaviors as a result of stress in the past month.

Almost half of parents say they have overeaten or eaten unhealthy food due to stress (45 percent vs. 38 percent of all adults) and report skipping meals because of stress (42 percent vs. 30 percent of all adults).

When it comes to sleep, more than half of parents (54 percent) have lain awake at night due to stress, compared to 43 percent of all adults.

Parents who sleep less than eight hours a night are nearly twice as likely as other adults who sleep less than eight hours a night (28 vs.16 percent) to report they are not getting more sleep because they have too many things to do.

Adults struggle to manage their stress and tend to rely on sedentary activities that may actually add to their stress in the long run. While 43 percent of adults exercise or walk and nine percent play sports to manage stress, screen time wins when compared to physical activities for stress management — 62 percent of adults engage in stress management activities involving screen time:

  • Forty-two percent surf the Internet or go online to manage stress.
  • Forty percent watch two or more hours of television or movies a day to manage stress.
  • Twenty-one percent play video games to manage stress.
  • Seven percent sound off on social media to manage stress.

Like teens, adults who engage in healthy and/or physical activities for stress management, such as exercising once a week or more, report lower average stress levels than adults who exercise less than once a week or not at all (5.0 vs. 5.3 on a 10-point scale). Similarly, adults with higher stress are more likely than those with lower stress in the past month to engage in unhealthy and/or sedentary stress management behaviors, such as watching two or more hours of television or movies a day to help manage or relieve stress (51 percent vs. 27 percent).

Survey findings suggest that it is difficult to commit to coping mechanisms that have the potential to help us live well. Adults do not regularly practice activities that most effectively help them manage stress. While some adults say that sedentary activities are very or extremely effective stress relievers, more adults say that physical activities for stress management, such as exercise or sports, are very or extremely effective.

About four in 10 adults say they surf the Internet or go online (43 percent) or watch television or movies for more than two hours a day (40 percent) to relieve stress. Of those who use these strategies, only around one-third say these activities are very or extremely effective stress management techniques (29 percent of those who go online and 33 percent of those who watch TV).

Of the 43 percent of adults who exercise or walk to relieve stress, nearly two-thirds (62 percent) say it is effective at relieving stress.

Stress can be a Catch-22. Forty-three percent of adults who exercise to relieve stress have actually skipped exercise due to stress.

Teens need help coping

Although teens do not appear to recognize the potential impact of stress on their physical and mental health, they often struggle to cope. Only half of teens (50 percent) report feeling confident about their ability to handle their personal problems and 46 percent say they feel that they are on top of things fairly or very often. While their underdeveloped stress management skills are troubling, teens appear to be open to the role that professionals can play in managing stress. Teens are more likely than adults to report that psychologists can help a great deal or a lot with stress management (43 percent vs. 33 percent) and with making lifestyle and/or behavior changes (38 vs. 28 percent). However, only five percent of teens and adults report having seen a mental health professional for stress management.

Stress in America survey findings suggest that teens, while not always recognizing that stress affects their mental and physical health, do indeed feel the impact of stress. Many teens, especially teen girls, are mirroring adults’ high-stress lives and potentially setting themselves up for a future of chronic stress and chronic illness. Teens’ behaviors and stress are closely linked. And even though effective stress management is possible, the confluence of persistent stress, inability to effectively manage stress, and the challenges that their adult role models experience with stress and stress management put teens on an unhealthy trajectory. They do not have the support they need to develop effective stress management techniques or the skills required to identify and prevent long-term consequences of chronic stress.

In order to break this unhealthy legacy of stress in America, we need to focus on stress and mental health at a younger age. We need to create opportunities in schools, at home, in communities and in teens’ interactions with health care professionals to teach younger Americans about the effects of stress, help them learn healthy ways to cope, and give them the tools to form healthy lifestyles and behaviors that can reverse their current trajectory of chronic illness, poor health and shorter lifespans. We need to give them the skills to take control over their lives in healthy ways and allow them to grow into healthy adults.

Footnotes

1 1,018 youth respondents ages 13 to 17.

2 U.S. Department of Health and Human Services, Health Resources and Services Administration. (2003). U.S. teens in our world. Rockville, MD: U.S. Department of Health and Human Services.

3 Ibid.

4 Institute of Medicine. (2013). U.S. health in international perspective: Shorter lives, poorer health. Washington, DC: National Academy of Sciences.

5 McNeely, C., & Blanchard, J. (2009). The teen years explained: A guide to healthy adolescent development. Baltimore, MD: Center for Adolescent Health at Johns Hopkins Bloomberg School of Public Health.

6 Fuligni, A. J., Telzer, E. H., Bower, J., Cole, S. W., Kiang, L., & Irwin, M. R. (2009, April). A preliminary study of daily interpersonal stress and C-reactive protein levels among adolescents from Latin American and European backgrounds. Psychosomatic Medicine. Advance online publication. doi:10.1097/PSY.0b013e3181921b1f

7 U.S. National Library of Medicine. National Institutes of Health. Health topics: Stress. In MedlinePlus.gov. Retrieved from http://www.nlm.nih.gov/medlineplus/stress.html

8 Olshansky, S. J., Passaro, D. J., Hershow, R. C., Layden, J., Carnes, B. A., Brody, J., … & Ludwig, D. S. (2005, March 17). A potential decline in life expectancy in the United States in the 21 st century. New England Journal of Medicine. doi: 10.1056/NEJMsr043743

9 NIH News in Health. (2013, February). Shape your family’s habits. Retrieved from http://newsinhealth.nih.gov/issue/feb2013/feature1