A National Mental Health Crisis
Each year, the American Psychological Association (APA) surveys people across the United States about stress: its sources; its intensity; and how people are responding to stressors, both mentally and physically. Since 2007, when the Stress in AmericaTM survey was first conducted by the Harris Poll on behalf of APA, we have seen various external factors negatively affect stress levels, from economic downturns to the impact of racism to political conflict.
Our 2020 survey is different. It reveals that Americans have been profoundly affected by the COVID-19 pandemic, and that the external factors Americans have listed in previous years as significant sources of stress remain present and problematic. These compounding stressors are having real consequences on our minds and bodies.
It is the unusual combination of these factors and the persistent drumbeat of a crisis that shows no sign of abating that is leading APA to sound the alarm: We are facing a national mental health crisis that could yield serious health and social consequences for years to come.
There is no question: The COVID-19 pandemic has had a substantial impact on the lives of all Americans, and it will continue to do so. It has disrupted work, education, health care, the economy, and relationships, with some groups more negatively impacted than others.
The sheer magnitude of the COVID-19 crisis is hard to fathom. As of the published date of this report, the death toll from the COVID-19 pandemic has topped 215,000 in the United States, according to Johns Hopkins University. This is more Americans than died in World War I (116,516 deaths1), the Vietnam War (58,2092), and the Korean War (36,5163) – combined.
Behind this devastating loss of life is immense stress and trauma for friends and families of those who died; for those infected; for those who face long recoveries; and for all Americans whose lives have been thrown into chaos in countless ways, including job loss, financial distress, and uncertain futures for themselves and their nation.
The potential long-term consequences of the persistent stress and trauma created by the pandemic are particularly serious for our country’s youngest individuals, known as Generation Z (Gen Z). Our 2020 survey shows that Gen Z teens (ages 13-17) and Gen Z adults (ages 18-23) are facing unprecedented uncertainty, are experiencing elevated stress and are already reporting symptoms of depression.
We need to act right now to help those who need it, and to prevent a much more serious and widespread mental health crisis.
Faced with troubling and escalating stress levels across the country, APA reached out to psychologists specializing in child development, parenting, racial disparities, education, and employment to gather actionable advice. These experts include Emma Adam, PhD; Mary Alvord, PhD; Leslie Hammer, PhD; Byron McClure, EdD; Mia Smith-Bynum, PhD; and Erlanger “Earl” Turner, PhD. APA thanks them all for their thoughtful, supportive counsel.
The 2020 Stress in AmericaTM report summarizes findings on national stress levels and proposes strategies to help us recover from this crisis. APA is committed to helping people emerge from this time in our history poised to embrace and shape a brighter future together.
Multiple Sources of Stress and Associated Symptoms Overwhelming Americans
Despite several months of acclimating to a new reality and societal upheaval spurred by the COVID-19 pandemic, Americans are struggling to cope with the disruptions it has caused. Nearly 8 in 10 adults (78%) say the coronavirus pandemic is a significant source of stress in their life And, 2 in 3 adults (67%) say they have experienced increased stress over the course of the pandemic.
When considering the physical and emotional toll of increased stress, nearly half of adults (49%) report their behavior has been negatively affected. Most commonly, they report increased tension in their bodies (21%), “snapping” or getting angry very quickly (20%), unexpected mood swings (20%), or screaming or yelling at a loved one (17%).
These symptoms may stem from stress caused by the pandemic, which is compounded by societal stressors that have been pervasive in previous years. Compared with 2019, the majority of adults still say health care (66%), mass shootings (62%) or climate change/global warming (55%) is a significant source of stress. Around half say the same about the rise in suicide rates (51%), immigration (47%), widespread sexual harassment/assault reports in the news (47%) or the opioid/heroin epidemic (45%). Only reports of mass shootings as a significant source of stress have declined significantly since 2019 (71% in 2019).
Nearly 2 in 3 adults (65%) say the current amount of uncertainty in our nation causes them stress. Further, 3 in 5 (60%) say the number of issues America faces currently is overwhelming to them. This finding speaks to the hardships many Americans may be confronting at this moment. Issues they are stressed about are not going away, they are piling up.
Along with the personal and national issues that are causing them significant stress, Americans now also are more commonly worried about the long-term well-being of the country. More than 3 in 4 adults (77%) say the future of our nation is a significant source of stress, up significantly from 2019 when 66% of adults said the same And more than 7 in 10 Americans (71%) say this is the lowest point in our nation’s history that they can remember. In 2019, only 56% of Americans shared this sentiment.
Gen Z Stress Amplified as They Face an Uncertain Future
While older Americans may be able to embrace the feeling of “this, too, shall pass,” Gen Z adults (ages 18-23) are at a pivotal moment in their lives, and are experiencing adulthood at a time when the future looks uncertain. This may be driving key differences in reported stress as Gen Z adults report the highest stress level during the prior month, on average, at 6.1 out of 104 This is significantly higher than all other generations: 5.6 for millennials (ages 24-41), 5.2 for Gen X (ages 42-55), 4.0 for boomers (56-74) and 3.3 for older adults (75+).
For comparison, the reported stress level, on average, across all adults is 5.0; this is on par with the level reported in 2019 (4.9) and 2018 (4.9). Despite this consistency, reported stress levels among Gen Z adults have been increasing slightly over the past two years, from 5.6 in 2018 and 5.8 in 2019 to the high of 6.1 recorded in 2020.
When looking at current events, it’s no surprise that Gen Z adults report key issues as a significant source of stress in their life, given that they have largely grown up during times of disruption and unrest. Specifically, many say the rise in suicide rates (62%), widespread sexual harassment/assault reports in the news (i.e., the #metoo movement) (58%) or the change in abortion laws (50%) is a source of stress, more so than Gen X, boomers and older adults. Gen Z adult women seem particularly afflicted as they are considerably more likely than their male counterparts to cite widespread sexual harassment/assault reports in the news (67% vs. 47%) or the change in abortion laws (64% vs. 35%) as a source of stress.
Further, nearly 8 in 10 Gen Z adults (79%) say the future of our nation is a significant source of stress in their life. And while 2 in 3 Gen Z adults (67%) say the 2020 U.S. presidential election is a source of stress, only 64% say they intend to vote in the election (compared with 71% of millennials, 79% of Gen X, 86% of boomers and 90% of older adults who intend to vote).
How to Support Gen Z
- Create meaningful opportunities for connections with family, culture and community. Although many have left home physically, these connections remain fundamental to youth well-being.
- Create traditions for Gen Z that celebrate milestones in new ways. They can be the generation that reinvents society by creating new celebrations and traditions that are meaningful.
- Facilitate access to mental health services during and after the pandemic. This can include telehealth services, interstate psychological services and increasing funding to better support mental health services provided within schools when this is over.
- Provide educational, work, training and employment opportunities specifically targeted at supporting this generation of young adults. They need to see a possible path forward for themselves.
- Thank our youngest generation for the sacrifices they’ve made for the greater good. This includes social involvement that is critical to their development, milestones such as graduations and proms, and even their education. We should acknowledge what they and many others are doing to keep us safe.
Emma Adam, PhD, Northwestern University; Earl Turner, PhD, Pepperdine University
Facing constantly changing circumstances around issues important to them, Gen Z teens (ages 13-17) are struggling with the uncertainty of their own futures, as well. Half (50%) say the pandemic has severely disrupted their plans for the future. A similar proportion (51%) report that the coronavirus pandemic makes planning for their future feel impossible.
Challenges in education may contribute to these feelings of disruption and an inability to make plans. The majority of Gen Z teens who are in school (81%) report they have been negatively impacted due to school closures as a result of the pandemic, such as having less motivation to do schoolwork (52%); having less involvement in sports, clubs or other extracurricular activities (49%); feeling that they didn’t learn as much as in previous years (47%); or having a hard time concentrating on schoolwork (45%). Given these disruptions, it’s no surprise that more than 2 in 5 Gen Z teens (43%) say the level of stress in their life has increased over the past year.
As with teens, college students are also grappling with changes to education. The vast majority of Gen Z adults in college (87%) report their education is a significant source of stress Going into this academic year, more than 8 in 10 (82%) said uncertainty about what the 2020-21 school year will be like was causing them stress. Now looking ahead, more than 2 in 3 Gen Z adults in college (67%) say the coronavirus pandemic makes planning for their future feel impossible.
How to Support Students
- Create space for students to talk about the things that are bothering them, even if those things are not related to school or schoolwork.
- Practice the rule of “Three Good Things” and ask your students to do the same. That is, at the end of each day, reflect on three good things that happened, large or small. This helps decrease anxiety, counter depression and build emotional resiliency.
- Take your foot off the gas and remind yourself that we are in a global pandemic. Encourage young people to do their best but give them space when they don’t have the energy or motivation. Providing young people this flexibility can keep them from feeling overwhelmed.
- Find creative and safe ways for young people to socialize. Maintaining social contact is important for young people and their development, but it should be done in a way that mitigates the spread of COVID-19. Schools can help by organizing safe social interactions for students to participate in so they feel they are still part of a community.
Byron McClure, EdD, school psychologist, Washington DC; Earl Turner, PhD, Pepperdine University
While More Intense for Gen Z, Stress and Declining Mental Health Affect Americans Broadly
As disruptions from the pandemic continue, more Americans are reporting symptoms of prolonged and acute stress. This is particularly true for Gen Z adults, who are the most likely to report certain struggles.
Nearly 1 in 5 adults (19%) say their mental health is worse than it was at this time last year By generation, 34% of Gen Z adults report worse mental health, followed by Gen X (21%), millennials (19%), boomers (12%) and older adults (8%). More than half of all adults report they were very restless (53%) or they felt so tired they just sat around and did nothing (52%) in the past two weeks. Further, Gen Z adults are the most likely to report experiencing common symptoms of depression, with more than 7 in 10 noting that in the past two weeks they felt so tired they sat around and did nothing (75%), felt very restless (74%), found it hard to think properly or concentrate (73%), felt lonely (73%) or felt miserable or unhappy (71%).
Beyond the toll on their mental health, more than 3 in 4 Gen Z adults (76%) report negative health impacts due to the coronavirus pandemic (along with 71% of millennials, 59% of Gen X, 53% of boomers and 28% of older adults). The most commonly reported impacts among Gen Z adults include disrupted sleep patterns (31%), eating more unhealthy foods than usual (28%) or weight changes (28%).
A decline in social interaction due to the pandemic may be a contributing factor. Despite being considered the most connected generation, Gen Z adults are the most likely to say they have felt very lonely during the pandemic. More than 6 in 10 Gen Z adults (63%) agree with this sentiment, compared with 53% of millennials, 43% of Gen X, 35% of boomers and 17% of older adults. Gen Z adults report these feelings even though more than 8 in 10 (86%) report living in a household with at least one other adults.
Further, Gen Z adults and millennials are the most likely to report negative impacts on their relationships due to the coronavirus pandemic (63% of Gen Z adults and 61% of millennials compared with 42% of Gen X, 36% of boomers and 22% of older adults). The negative effects on relationships most commonly reported by Gen Z adults include decreased closeness with friends (26%), decreased closeness with family (23%) or decreased closeness with community (20%).
Although the effects on the mental health of younger adults are more likely to be reported, nearly half of all adults (47%) report negative effects on their relationships due to the coronavirus pandemic. The most reported effects are similar to those felt among Gen Z adults, such as decreased closeness with family (20%), friends (20%) or community (13%).
Further, the majority of adults (61%) say they could have used more emotional support than they received over the past 12 months, but this proportion swells to more than 8 in 10 Gen Z adults (82%) who say they could have used more support. By comparison, 75% of millennials, 61% of Gen X, 43% of boomers and 30% of older adults say the same. Looking more closely, nearly 1 in 4 adults (23%) note they could have used a lot more emotional support in the past 12 months. This is a significant increase compared with the 17% of adults who said the same in 2019.
Parents Report Significant Stress Related to Their Children’s School, Future
Parents are bearing an enormous burden during the pandemic. Daily lives and routines seem to change in an instant. Many schools remain closed. Child care was discontinued abruptly and in some areas remains largely unavailable. Work situations changed rapidly: Jobs were lost, essential workers continued employment with the health and safety of their family in the balance, and for many, work was shifted into the home. This all occurred at a time when social contact was largely lost due to the recommended physical distancing guidelines.
Given the wide-reaching disruption for this part of the population, it may not be surprising to see that parents5, on average, report a higher level of stress during the past month than those who are not parents (5.4 vs. 4.7). This significant gap persists when asked specifically about their stress level related to the coronavirus pandemic (5.9 parents vs. 5.3 non-parents, on average).
Reflecting the strain on family and the disruption of education during the pandemic, 7 in 10 parents (70%) say family responsibilities are a significant source of stress in their life. And when it comes to their children’s school, the majority (63%) say the coronavirus pandemic made the 2019-20 school year extremely stressful for them.
Parents report significant stress about the months ahead. Two in 3 parents of older teens ages 15–17 (67%) say the coronavirus pandemic made the 2019-20 school year extremely stressful for them personally, and a similar proportion (67%) say it has severely disrupted their child(ren)’s plans for the future More than 3 in 4 parents of children ages 8-12 (76%) agree the coronavirus pandemic made the 2019-20 school year extremely stressful for them, and a similar proportion (77%) say uncertainty about what the 2020-21 school year will be like causes them stress.
How Parents Can Support Their Children
- Acknowledge that this is a completely new situation that no one was prepared for, and as a result, there is a lot of uncertainty.
- Practice self-care in 15- or 30-minute increments throughout the day and help your kids to do the same. This can include a short walk, calling a friend or watching a funny show.
- Stay connected with each other, your friends and family. This will help you build emotional resiliency so you can support the needs of your children.
- Keep things in perspective and focus on the things that are going well. Remember, everyone is going through something right now as a result of the pandemic.
- It’s critical that young people do not work in the same place where they sleep. Creating separation in spaces between where young people should learn and where they can relax is useful. Encourage young people not to do their schoolwork on their beds and if possible find a dedicated space for school.
- Use this as an opportunity to help young people and teens think through their life plan and if it will actually make them happy. Parents and caring adults should remind young people that they should not be afraid to step away from their prior plans to try something new or different.
Mary Alvord, PhD, private practice, Rockville MD; Byron McClure, EdD, school psychologist, Washington DC; Mia Smith-Bynum, PhD, University of Maryland
Stress from Work, Financial Disruptions Disproportionately Impacting Lower-Income Americans
The impacts of the pandemic have left few unscathed. One important underpinning of this is stress related to the economy. More than 6 in 10 adults (63%) say it is a significant source of stress. This is significantly higher than the proportion who said the same in 2019 (46%) and is nearing levels reported during the 2008 recession (69%).
Looking at employed adults specifically, while they are just as likely to say work is a source of stress as they were in 2019 (64% of employed adults reported it as a source of stress in both years), more than half (56%) say that job stability is a source of stress, which is significantly higher than the proportion noting the same in 2019 (50%).
Among adults who were employed at some point during the pandemic, 68% report their job or employment has been negatively impacted by the coronavirus pandemic. The most commonly reported impacts are having their hours cut (19%), having to balance household responsibilities during work time (14%), being laid off (14%) or experiencing decreased productivity (14%). Adults who were employed during the pandemic with a household income of less than $50K are more likely than those with a household income of $50K+ to say they have been laid off (21% vs. 11%).
Nearly 2 in 3 adults (64%) say that money is a significant source of stress in their life, and around half of adults (52%) say they have experience negative financial impacts due to the pandemic.
Among those with a household income of less than $50K, 73% report that money is a significant source of stress, while 59% of those with a household income of $50K+ say the same. When looking at households that are at or below the federal poverty level6, this disparity widens (79% vs. 57% of those above the poverty level). Further, nearly 3 in 5 of those with a household income of less than $50K (58%) cite housing costs (e.g., mortgage or rent) as a significant source of stress in their life, compared with 44% of those with higher incomes. Without progress on the restoration of jobs and industries that were lost due to the pandemic, it is likely the trajectory of these disparities will not improve, but very well may decline.
How Employers Can Support Workers
- Provide flexibility to employees, whether it’s what they work on, when they work or how they work (how they work is particularly important for employers of frontline workers). Every single person has been impacted by the pandemic; providing flexibility at work will allow people to do their jobs while still being able to handle new stressors and responsibilities in their lives, such as a child’s education.
- Provide support. This can be emotional support through one-on-one check-ins or by reducing someone’s workload to just essential tasks. This also applies to co-workers, who can support each other by checking in and approaching each other with empathy.
- Provide clear communication to employees and supervisors about expectations, support resources and new policies that respond directly to impacts created by the pandemic. This reduces uncertainty at work, which is a major contributor to employee stress.
- Supervisors should not expect work to continue at the same level as before. Creating this expectation can lead to employee burn-out. Instead, help employees prioritize what work is critical and what can wait.
Leslie Hammer, PhD, Oregon Healthy Workforce Center
Discrimination Rises as Source of Stress, Particularly for People of Color
When talking about stress in 2020, we cannot ignore the topics of discrimination and racism. The murders of George Floyd, Breonna Taylor and many others have caused fear, anger and an increased awareness of the systemic racism that plagues our nation, and led to massive protests across the country. The majority of adults (59%), regardless of race, report police violence toward minorities is a significant source of stress in their life. This is significantly higher than the 36% of adults who said the same in 2016 when this question was first asked.
On a personal level, one-third of adults (33%) cite discrimination as a significant source of stress in their life, a significant increase from 25% in 2019. Among people of color7, more than 2 in 5 (44%) report discrimination is a significant source of stress in their life, compared with 38% of people of color who said the same in 2019. Looking at races individually, Black Americans are the most likely to report discrimination as a stressor (48% vs. 43% Hispanic, 42% Native American, 41% Asian and 25% white).
How People of Color Can Build Resilience
- It’s to be expected that people feel stressed, angry, outraged, frustrated or a host of other feelings because of systemic problems. Acknowledge those feelings and do what you can to take care of yourself as you continue to cope and manage in today’s reality.
- Participate in culturally affirming activities and continue to share experiences even if in-person gatherings are not possible. These activities will help you stay connected to your community.
- Limit exposure to news media and video of people being assaulted, harassed, or killed by law enforcement or other groups. For many people of color, watching these videos can cause trauma or trigger other negative emotions. This is particularly true for young people of color.
Mia Smith-Bynum, PhD, University of Maryland; Earl Turner, PhD, Pepperdine University
Presidential Election Increasingly a Significant Source of Stress for Americans
A presidential election looms, and though the political climate is often described as divisive, stress about the election exists on both sides of the aisle. Around two-thirds of adults say that the current political climate (68%) or 2020 U.S. presidential election (68%) is a significant source of stress. Regardless of political party, majorities say that the election is a significant source of stress (76% of Democrats, 67% of Republicans and 64% of Independents).
While tensions were also high during the last presidential election, the proportion of Americans who say they are stressed about the presidential election has increased dramatically since 2016, when 52% reported this stressor.
Despite Numerous Stressors, Americans Remain Hopeful
One of the key ways to maintain strong mental health in times of adversity is by remaining hopeful – something that a majority of Americans report, despite the compounding stress and negative impacts from the pandemic and other issues. Around 7 in 10 (71%) say they feel hopeful about their future. By generation, millennials (76%) are the most likely to agree with this sentiment, followed by boomers (72%), Gen X (71%), older adults (69%), and Gen Z adults (64%). Further, more than half of Americans (54%) say they feel they can use their voice to make a difference in the world.
1Chambers, J. The Oxford Companion to American Military History. (Oxford University Press, 1999, ISBN 0-19-507198-0), 849.
4On a scale of 1 to 10 where 1 means “little to no stress” and 10 means “a great deal of stress.”
5Defined as adults ages 18+ with at least one person under the age of 18 living in their household at least 50% of the time for whom they are the parent or guardian.
6Based on the 2019 U.S. Federal Poverty Guidelines.
7Adults who identify as a race or ethnicity other than white.
The 2020 Stress in America™ survey was conducted online within the United States by The Harris Poll on behalf of the American Psychological Association between Aug. 4 and Aug. 26, 2020, among 3,409 adults age 18+ who reside in the U.S. Interviews were conducted in English and Spanish. Data were weighted to reflect their proportions in the population based on the March 2019 Current Population Survey by the U.S. Census Bureau. Weighting variables included age by gender, race/ethnicity, education, region, household income and time spent online. Hispanic adults also were weighted for acculturation, taking into account respondents’ household language as well as their ability to read and speak in English and Spanish. Country of origin (U.S./non-U.S.) also was included for Hispanic and Asian subgroups. Weighting variables for Gen Z adults (ages 18-23) included education, age by gender, race/ethnicity, region, household income and size of household. Propensity score weighting was used to adjust for respondents’ propensity to be online. A propensity score allows researchers to adjust for attitudinal and behavioral differences between those who are online versus those who are not, those who join online panels versus those who do not, and those who responded to this survey versus those who did not. The survey also included a sample of 1,026 teens age 13-17 who reside in the U.S. Weighting variables included age by gender, race/ethnicity, parents’ highest level of education, region and size of household. Please add this sentence before the final sentence: The design and collection of teen data was supported by funding from the School of Education and Social Policy and the Institute for Policy Research at Northwestern University. Because the sample is based on those who were invited and agreed to participate in research panels, no estimates of theoretical sampling error can be calculated.