Our Health at Risk

Researchers have long known that there is a strong link between stress and overall health.* Year after year, findings from the Stress in America™ survey have reinforced this research. Participants’ responses have revealed high stress levels, reliance on unhealthy behaviors to manage stress and alarming physical health consequences of stress — a combination that suggests the nation is on the verge of a stress-induced public health crisis. Data from the latest Stress in America survey suggest that the concern about stress and health is especially critical among adults 50 and older who serve as caregivers for a family member and those who have been diagnosed with obesity and/or depression.

Caregivers Under Fire

In 2011, the first of the Baby Boomers (people born between 1946 and 1964) turned 65, joining the ranks of America’s older citizens. According to the U.S. Department of Health and Human Services’ Administration on Aging, the number of older Americans in the U.S. — persons 65 years or older — is expected to nearly double by the year 2030.* The nation is bracing for the impact of providing health care services to these 72 million adults, but what may be lacking is concern about the impact on caregivers.

Findings from the latest Stress in America survey show those who serve as caregivers — providing care to both the aging and chronically ill — for their family members report higher levels of stress, poorer health and a greater tendency to engage in unhealthy behaviors to alleviate that stress than the population at large. What’s more, while lower stress levels are often associated with older adults, those older adults with caregiving responsibilities report more stress and poorer physical health than their peers.

Caregiver Stress and Health

Caregivers can feel overwhelmed by the responsibilities that come with providing care to a family member. Caregivers report significantly higher levels of stress than the general population, believe they are doing a poor job of managing and preventing their stress, and perceive themselves to be in poor health. One-third of caregivers interviewed reported caring for a loved one, most often a parent, for at least 40 hours each week. The median age of caregivers included in the survey is 49, two years older than the median age of the survey’s general population.

According to estimates from the National Alliance for Caregiving, 65.7 million Americans served as caregivers for an ill or disabled relative in the past year.* While caregiver roles may vary, the impact of stress on such a large percentage of the U.S. population is a health care concern worth noting. In fact, research shows that family caregivers are at added risk for emotional and physical health problems. For example, according to the Journal of the American Medical Association, highly strained family caregivers are at risk for premature mortality.* Other studies indicate that caregivers are at risk for increased mortality, coronary heart disease and stroke, particularly under conditions of high strain.*

The Stress in America survey revealed:

  • More than half (55 percent) of caregivers report that they feel overwhelmed by the amount of care their aging or chronically ill family member requires.

  • Caregivers are more likely than those in the general population to report they are doing a poor/fair job at several healthy behaviors, including managing stress (45 percent vs. 39 percent) and getting enough sleep (42 percent vs. 32 percent).

  • Caregivers are more likely than those in the general population to report doing a poor/fair job in preventing themselves from experiencing stress (55 percent vs. 44 percent) and fully recovering after it occurs (39 percent vs. 31 percent).

  • Caregivers are not only more likely to report stress, but also report it at a higher level than is reported by the general public. On a scale of 1 to 10 where 1 is little or no stress and 10 is a great deal of stress, the mean level of stress reported by caregivers was 6.5 as compared to 5.2 by the general public.

  • Caregivers are more likely than the general public to say their stress has increased in the past 5 years (59 percent vs. 44 percent).

The latest Stress in America survey results show caregivers report being in poorer health than the rest of the nation, with higher rates of high cholesterol, high blood pressure, overweight/obesity and depression. Research demonstrates that older adults in caregiver roles may be particularly vulnerable because caregiving demands may tax their health and physical abilities and compromise their immune response systems; similarly, the stress associated with caregiving can exacerbate existing chronic health conditions.* And, due to the demands on their time, caregivers are less likely to engage in preventive health behaviors than non-caregivers.*

Caregivers are more likely than those in the general population to have a chronic illness (82 percent vs. 61 percent). This trend carries through as caregivers and the general population age. Caregivers aged 50 and older are more likely than those in the same age bracket in the general population to report experiencing physical symptoms (92 percent vs. 70 percent, respectively) and non-physical symptoms (86 percent vs. 63 percent, respectively) of stress in the past month.

  • Caregivers are more likely to say that their health is fair or poor (34 percent vs. 20 percent) and are also significantly more likely to cite personal health concerns as a significant source of stress (66 percent vs. 53 percent).

  • Caregivers are more likely to report experiencing physical (94 percent vs. 76 percent) and non-physical (91 percent vs. 71 percent) symptoms of stress when compared to the general population. In particular, caregivers are far more likely than the general population to lay awake at night (60 percent vs. 44 percent), overeat or eat unhealthy foods (53 percent vs. 39 percent) or skip a meal (48 percent vs. 29 percent) because of stress.

  • Caregivers are more likely than the general population to report that they get sick five times a year or more (17 percent vs. 6 percent).

  • Caregivers are more likely than those in the general population to report that they believe their stress has a strong/very strong impact on their body/physical health (47 percent vs. 37 percent).

  • Even younger caregivers, age 49 years and younger, were less likely than their counterparts in the general population to report that their overall health is excellent/very good (28 percent vs. 43 percent, respectively).

Stress Affects Caregivers’ Quality of Life More Than Their Peers

For Americans overall, getting older typically brings with it lower levels of stress. But for adults with caregiving responsibilities, stress levels remain high in the senior years. Caregivers report more stress as they age and report that it has a growing impact on their quality of life. They also report less satisfaction in their peer relationships as they age.

  • At age 50 years and older, caregivers report average stress levels of 6.5, whereas those of the same age in the general population report average stress levels of 4.8. At age 49 and younger, the difference in average stress levels is narrower — 6.5 for caregivers compared to 5.4 for the general population.

  • The higher levels of stress among older caregivers appear to be more chronic. Caregivers who are 50 and older are more likely than those in the same age bracket in the general population to report that their stress level has increased in the past 5 years (62 percent vs. 37 percent) and past year (60 percent vs. 38 percent).

  • Caregiving may take a toll on the quality of relationships. Caregivers age 50 and older are less likely than those in the same age bracket in the general population to report they are very satisfied with relationships with their spouse or significant other (50 percent vs. 69 percent), relationships with friends (48 percent vs. 64 percent) and health (19 percent vs. 30 percent).

In addition, it appears that caregivers manage stress in less healthy ways than the general population. For example, they are more likely to report watching TV or movies for more than 2 hours a day (43 percent vs. 33 percent) and smoking (20 percent vs. 10 percent) in order to manage stress.

Caregivers Find It Difficult to Make Improvements in Their Lives

Those who care for ill or disabled family members report they have been encouraged to make positive changes in their lives that would lead to reduced stress and improve their health. But they say they find it difficult to maintain those changes.

  • Caregivers are more likely than the general population to report they have received recommendations to eat a healthier diet (44 percent vs. 35 percent), reduce stress (38 percent vs. 26 percent), get more sleep (32 percent vs. 24 percent) and quit smoking (20 percent vs. 13 percent).

  • Caregivers who decided to make a change were less likely than the general population to report that they were successful when it came to eating a healthier diet (6 percent vs. 18 percent), exercising more (8 percent vs. 25 percent), losing weight (11 percent vs. 30 percent) and reducing stress (10 percent vs. 21 percent) for a period of 3 months.

Many caregivers handle their added responsibilities independently, but some do obtain support from family members. This additional support appears to make a substantial difference in their lives.

  • Caregivers who feel adequately supported have, on average, significantly lower levels of stress than those who do not (5.9 vs. 6.9).

  • Caregivers who feel supported are less likely than those who do not feel supported to report symptoms of anger/irritability (48 percent vs. 69 percent) and feeling depressed or sad (39 percent vs. 55 percent).

  • Caregivers who feel supported are also significantly less likely than those who do not feel supported to report feeling a sense of loneliness and isolation (24 percent vs. 47 percent) and less likely to report that they have isolated themselves from others when feeling stressed (24 percent vs. 42 percent).

  • Caregivers who feel supported are significantly more likely to report that they actively use a strategy to help themselves manage stress (97 percent vs. 82 percent).

  • Caregivers who feel supported are more likely to report that they are doing an excellent/very good job at recovering fully or recharging after they have been stressed out (47 percent vs. 22 percent), recognizing how they manage stress (41 percent vs. 26 percent) and managing or reducing stress when they experience it (36 percent vs. 22 percent).

Stress Takes a Toll on Those with Obesity and Depression

Obesity has reached epidemic proportions in the United States. Currently, 68 percent of adults (age 20 years or older) in the nation are overweight or obese and 33.8 percent are obese.*

The Centers for Disease Control and Prevention reports about one in 10 American adults suffers from depression, and that those aged 45 – 64 years are more likely than other age groups to meet the criteria for depression.*

Obesity and depression are often exacerbated by stress. Those who suffer from these conditions report that they are unable to take the necessary steps to relieve their stress or improve their health and, therefore, engage in maladaptive coping behaviors.

  • People suffering from depression (6.3) or obesity (6.0) report significantly higher average stress levels than the rest of the population (5.2).

  • People with depression or obesity are more likely than others to report feeling overwhelmed (61 percent and 55 percent, respectively, vs. 34 percent general population).

  • People with depression (27 percent) or obesity (24 percent) are more likely than the general population (20 percent) to report feeling dissatisfied with their lives and less likely (76 percent for the general population vs. 69 percent for those depressed or obese) to report feeling satisfied with family relationships.

  • They are twice as likely as the general population to report feeling lonely or isolated (21 percent of the general population vs. 46 percent of those who are depressed and 41 percent who are obese) as a result of stress.

  • Those with depression (33 percent) or who are obese (28 percent) are significantly more likely than the general public (21 percent) to say they do not think they are doing enough to manage their stress.

  • As compared to the general public (11 percent), more people who are obese (34 percent) or depressed (22 percent) report that their disabilities or health issues prevent them from making positive changes in their lives (i.e., reducing stress and improving health).

  • Those with obesity (87 percent) or depression (84 percent) are more likely to report having tried to eat a healthier diet in the past 5 years than the general public (77 percent) or to lose weight (73 percent depression and 90 percent obesity vs. 66 percent general population) in the past 5 years. They are also more likely to report having tried to reduce their stress levels (78 percent depression; 71 percent obesity; 60 percent general public).

  • Those with obesity or depression, however, are less likely to report success when eating a healthier diet (31 percent obesity; 33 percent depression; 44 percent general population) or reducing stress (28 percent obesity; 33 percent depression; 38 percent general population). Those with obesity are less likely to report successfully having lost weight (19 percent obesity vs. 30 percent general population) and reducing stress (28 percent obesity vs. 38 percent general population).

  • Stress management strategies most often reported by obese adults are watching TV for more than 2 hours daily, listening to music and eating. These sedentary behaviors can exacerbate weight issues. Nearly six in 10 (58 percent) adults with obesity report they watch TV for more than 2 hours a day in order to manage their stress, more than half listen to music (53 percent) and nearly one-half of those with obesity (49 percent) report they eat to manage their stress.

  • Adults with obesity or depression are significantly more likely than those in the other groups to report feeling self-conscious and embarrassed as reasons why they do not exercise more often (25 percent obesity and 18 percent depression vs. 8 percent general population).

  • More than half of those with depression (52 percent) or obesity (53 percent) say that their stress level has a very strong impact on their physical health (vs. 37 percent general population).

  • More than one in five adults with depression (22 percent) and nearly one-quarter of adults who are obese (24 percent) report that their physical health is worse/much worse compared to last year.

Year after year, the Stress in America survey paints a picture of a nation at a critical crossroads when it comes to stress and health. Overall, Americans appear to be caught in a vicious cycle where they manage stress in unhealthy ways, and seemingly insurmountable barriers prevent them from making the lifestyle or behavioral changes necessary for good health. Findings from the 2011 survey found that several groups of people in particular — caregivers and those living with chronic illness — are at heightened risk of experiencing serious consequences of stress that is too high and appears to be taking a toll on their emotional and physical health.

As we explore the impact of stress on Americans, it is critical that we explore systemic and individual solutions that can help people better understand and manage their stress so that they can improve their quality of life.


* This section of the report primarily focuses on caregivers (n=300) who responded to the question, “Do you currently care for an aging or chronically ill family member?”) and those living with a chronic illness [depression (n=350); diabetes (n=329); obesity (n=292); and heart disease (250)] within the general population.

* Administration on Aging, U.S. Department of Health and Human Services.(2010). Population. Retrieved from www.aoa.gov/agingstatsdotnet/Main_Site/Data/2010_Documents/Population.aspx

* National Alliance for Caregiving. (2009). Caregiving in the U.S. Retrieved from www.caregiving.org/data/Caregiving_in_the_US_2009_full_report.pdf

* Schulz, R., & Beach, S. R. (1999). Caregiving as a risk factor for mortality: The Caregiver Health Effects Study. Journal of the American Medical Association, 15, 2215–2219.

* Haley, W. E., LaMonde, L. A., Han, B., Burton, A. M., &Schonwetter, R. (2003). Predictors of depression and life satisfaction among spousal caregivers in hospice: Application of a stress process model. Journal of Palliative Medicine, 6, 215–224.

* Lee, S., Colditz, G., Berkman, L., &Kawachi, I. (2003). Caregiving and risk of coronary heart disease in U.S. women: A prospective study. American Journal of Preventive Medicine, 24(2), 113–119.

* Navaie-Waliser, M., Feldman, P. H., Gould, D. A., Levine, C., Kuerbis, A. N., &, Donelan, K. (2002).When the caregiver needs care: the plight of vulnerable caregivers.American Journal of Public Health, 92, 409–413.

* Schulz, R., Newsom, J., Mittelmark, M., Burton, L., Hirsch, C., & Jackson, S. (1997). Health effects of caregiving: The Caregiver Health Effects Study: An ancillary study of The Cardiovascular Health Study. Annals of Behavioral Medicine, 19, 11–116.

* Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010).Prevalence and trends in obesity among U.S. adults, 1999–2008.Journal of the American Medical Association,303(3), 235–241. Retrieved from http://jama.ama-assn.org/content/303/3/235.full

* Schulz, R., Newsom, J., Mittelmark, M., Burton, L., Hirsch, C., & Jackson, S. (1997). Health effects of caregiving: The Caregiver Health Effects Study: An ancillary study of The Cardiovascular Health Study. Annals of Behavioral Medicine, 19, 11–116.