bs_bs_banner Who’s Stressed? Distributions of Psychological Stress in the United States in Probability Samples from 1983, 2006, and 20091 Sheldon Cohen2 and Denise Janicki-Deverts Carnegie Mellon University Psychological stress was assessed in 3 national surveys administered in 1983, 2006, and 2009. In all 3 surveys, stress was higher among women than men; and increased with decreasing age, education, and income. Unemployed persons reported high levels of stress, while the retired reported low levels. All associations were indepen- dent of one another and of race/ethnicity. Although minorities generally reported more stress than Whites, these differences lost significance when adjusted for the other demographics. Stress increased little in response to the 2008–2009 economic downturn, except among middle-aged, college-educated White men with full-time employment. These data suggest greater stress-related health risks among women, younger adults, those of lower socioeconomic status, and men potentially subject to substantial losses of income and wealth.jasp_900 1320..1334 Potentially stressful life events are thought to increase risk for disease when one perceives that the demands these events impose tax or exceed a person’s adaptive capacity (Lazarus & Folkman, 1984). In turn, the percep- tion of stress may influence the pathogenesis of physical disease by causing negative affective states (e.g., feelings of anxiety and depression), which then exert direct effects on physiological processes or behavioral patterns that influence disease risk (Cohen, Janicki-Deverts, & Miller, 2007). Psychological stress is thought to influence a wide range of physiological processes and 1The eNation surveys and the preparation of this paper were supported by Johnson and Johnson (J & J) Consumer & Personal Products Worldwide, A Division of Johnson & Johnson Consumer Companies, Inc. Data were collected by the Harris Poll and by eNation.J&Jplayed no role in structuring the paper; in collection, management, or interpretation of the data; or in preparation, review, or approval of the manuscript. The authors consult forJ&JConsumer Companies, Inc., on issues of stress measurement. The studies reported here do not use or address anyJ&Jproduct. The authors are indebted to Joel Greenhouse for statistical consult- ing; Ellen Conser for her comments on an earlier draft and assistance in preparing the manu- script; the John D. and Catherine T. MacArthur Foundation Network on Socioeconomic Status and Health; and members of the Pittsburgh Mind–Body Center (HL65111; HL65112) for their intellectual support. 2Correspondence concerning this article should be addressed to Sheldon Cohen, Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213. E-mail: [email protected] 1320 Journal of Applied Social Psychology, 2012, 42, 6, pp. 1320–1334. © 2012 Wiley Periodicals, Inc. doi: 10.1111/j.1559-1816.2012.00900.x PSYCHOLOGICAL STRESS IN THE U.S. 1321 disease states, with existing evidence supporting stress as a risk factor in depression (Hammen, 2005; Kessler, 1997; Mazure, 1998; Monroe & Simons, 1991), cardiovascular disease (Krantz & McCeney, 2002; Rozanski, Blumen- thal, & Kaplan, 1999), HIV/AIDS (Cole & Kemeny, 2001; Pereira & Penedo, 2005), delayed wound healing (Kiecolt-Glaser et al., 2005), upper respiratory infections (Miller & Cohen, 2005), autoimmune diseases (Heijnen & Kavelaars, 2005), and total mortality (Neilsen, Kristensen, Schnohr, & Gronbaek, 2008). Up to now, comparing stress levels in our society in different years or decades has been impeded by the lack of studies of stress in probability samples of the United States, particularly studies that use valid and compa- rable measures. In this article, we take advantage of data that were collected using a validated measure of psychological stress that was incorporated into three national surveys that were conducted on three separate occasions over the course of 26 years. The surveys were conducted by professional polling organizations for their own purposes. The first was a telephone survey con- ducted in 1983, and the remaining two were Internet-based surveys con- ducted just before (in November 2006) and during (April 2009) a severe economic downturn. The measure of psychological stress used in these surveys was the Per- ceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983; Cohen & Williamson, 1988). Higher levels of psychological stress as measured by the PSS have been associated with elevated markers of biological aging (Epel et al., 2004), higher cortisol levels (Pruessner, Hellhammer, & Kirschbaum, 1999; Ruiz, Fullerton, Brown, & Schoolfield, 2001; van Eck & Nicolson, 1994), as well as suppressed immune function (Burns, Drayson, Ring, & Carroll, 2002; Maes et al., 1999), greater infection-induced release of pro- inflammatory cytokines (Cohen, Doyle, & Skoner, 1999), greater susceptibil- ity to infectious disease (Cobb & Steptoe, 1996; Cohen, Tyrrell, & Smith, 1993; Culhane et al., 2001; Dyck, Short, & Vitaliano, 1999), slower wound healing (Ebrecht et al., 2004), and higher prostate-specific antigen levels (Stone, Mezzacappa, Donatone, & Gonder, 1999). Persons who score higher on the PSS also report poorer health practices, such as sleeping fewer hours, skipping breakfast, and consuming greater quantities of alcohol (Cohen & Williamson, 1988). We address two questions in this article. The first question is as follows: Is psychological stress associated with sex, age, education, income, employment status, and/or race/ethnicity, and are distributions of stress across demo- graphic characteristics constant over the quarter century covered by the three surveys? The second question is as follows: Was the 2008–2009 economic downturn associated with a rise in psychological stress in the population in general or in specific demographic subgroups? 1322 COHEN AND JANICKI-DEVERTS Method Description of the Surveys Harris Poll Survey. Respondents were 960 male and 1,427 female resi- dents of the United States, 18 years of age and older (M age = 42.8 years, SD = 17.2), who completed a telephone interview conducted by Louis Harris and Associates, Inc., in 1983. Based on U.S. Bureau of Census information, a national area probability sample was developed from the distribution of the adult, non-institutionalized population of the United States. With counties as primary sampling units, a random-digit dialing procedure was used to select telephone numbers to be called within each sampling unit. The interviewer asked to speak to the person in the household who was both 18 years of age or over, and whose birthday had been most recent. The 2,387 persons meeting the criteria for inclusion in the analyses represented 69.6% of the 3,430 individuals with whom telephone contact was made (926 refused to be interviewed, and 117 terminated the interview prior to completion). eNation Survey. The 2006 and 2009 surveys each consisted of 2,000 adults 18 years of age or older (2006: M age = 46.8 years, SD = 14.7; 2009: M age = 44.6 years, SD = 15.5) in the contiguous United States. The surveys were conducted in November 2006 and April 2009, respectively. Each sample consisted of individuals selected from the online segment of Synovate’s Con- sumer Opinion Panel (SCOP), a national panel of households. Each sample was balanced to be representative of the general population based on region, sex, age, and household income data from the 2000 U.S. Census. Members of the samples received a customized e-mail inviting them to participate in a specific survey. Panelists were given up to 3 days to complete the online survey by connecting to a link contained in the e-mail invitation. If sufficient numbers of a particular demographic did not respond, new panel- ists were added as necessary to obtain appropriate demographic distribu- tions. Individuals were re-screened at the beginning of the survey to ensure that the demographic distributions were accurate. Measures Demographics. In all three surveys, age was assessed as years of age at the time of the interview; and sex was self-reported as male or female. Education was coded in 9 categories in the Harris Poll data and 10 in the eNation data. For analysis, the data were collapsed into the following five common catego- ries: less than high school, high school, some college/less than 4-year degree, bachelor’s degree, and advanced degree. The Harris Poll assessed race/ PSYCHOLOGICAL STRESS IN THE U.S. 1323 ethnicity with a single, 5-category item (Asian or Pacific Islander; Aleut, Eskimo, or American Indian; non-Hispanic Black; non-Hispanic White; and Hispanic). The eNation surveys assessed race/ethnicity with two items: a 4-category race item (White; Black; Asian or Pacific Islander; and other); and a 5-category Hispanic, Latino, or Spanish origin item (Mexican, Mexican American, Chicano; Puerto Rican; Cuban; other Spanish; and not Hispanic). To create comparable variables across samples, we collapsed categories in both cases, creating four alternatives: White, Black, Hispanic or other. The Harris poll assessed employment status using an 8-category item (employed full time, employed part time, in the military, unemployed, retired, homemaker, student, and disabled/too ill to work). The eNation surveys assessed employment status using a 7-category item (work for someone else full-time, work for someone else part-time, self-employed, retired, unemployed, homemaker, and student/disabled, etc.). For purposes of analysis, we collapsed these categories to create the following