Just how stressed are Americans? Enough to have an HBO documentary, One Nation Under Stress, that explores the connection between our increasingly stressed-out nation and the fall in U.S. life expectancy.

A U.S. Centers for Disease Control and Prevention (CDC) report in 2017 noted life expectancy was the lowest it had been in a decade and has been linked to an increase in what researches have called the “deaths of despair” – opioid overdose, alcohol-related liver cirrhosis and suicide.

Is stress the underlying cause of these preventable deaths? Research suggests so.

According to a study by Gallup, stress levels among Americans are higher than the overall world average. Additionally, the “Stress in America” annual survey conducted by the American Psychological Association found that as many as 63% of American’s are stressed about the future of the nation, money, work, the political climate, violence and crime.

Stress can affect anyone, at any time. No one is immune to the pressures that life can bring including Britney Spears. The pop star recently checked out of a mental facility for “all-encompassing wellness treatment.”

Spears said on Instagram: “My family has been going through a lot of stress and anxiety lately so I just needed time to deal.”

To close out Stress Awareness Month, HCA Today sat down with Dr. Frank Drummond, medical director for behavioral health services at HCA Healthcare, to talk about America’s stress epidemic and positive ways to cope.

Dr. Frank Drummond, HCA Healthcare’s medical director of behavioral health services

What is stress? And what do most people stress about?

Everyone deals with stress at some point in their lives. It’s a normal physical and psychological response to sudden dangers and long-lasting challenges. During stressful events your body releases a burst of chemicals, such as adrenaline. In the short term, stress can be helpful to give you energy to get things done. But in the long term, stress can lead to significant health problems.

Stress can either be a response to an event or an ongoing sense of worry.

Event stressors:

Some of the top five stressors involve life events, not always perceived as negative including:

  1. getting married
  2. having your first child
  3. losing a loved one
  4. going through a divorce, or
  5. financial difficulty or bankruptcy.
Life events, like divorce and bankruptcy, are top causes of stress.

Ongoing stressors:

The other type of stress is a cumulative effect of worrying and those stressors tend to be around money, family, partners and work-life.

One-quarter of U.S. workers say work is the biggest source of stress in their lives.

There’s also a category of worry about current events: the increasing number of mass shootings, political anxieties, and too much exposure to the news, resulting in a general worry that something bad will happen to you and your family.

According to the World Health Organization (WHO), stress has been classified as the health epidemic of the 21st century. What does this mean for Americans? 

The general level of worry and unhappiness in the modern world is creating a national epidemic of stress. It’s (stress) is becoming part of the “new normal” for people, causing a decrease in productivity and health problems that can be initially silent, but after a while can catch up and result in morbidities such as high blood pressure, diabetes, arthritis and inflammatory disease – all of which are made worse by chronic stress.

How does stress affect individuals mentally?

If stress gets out of balance, it can become chronic anxiety. Anxiety is considered an extended response to stress and can result in panic attacks, depression, a decrease in ability to function, and lower levels of energy. In its worst case, thoughts of suicide can be a side effect of excessive stress.

What happens to a person’s body under stress?

Fight-or-flight mode is the body’s response to perceived threats or stress. Chemical changes occur in the body to get it ready for physical action, the “fight”. Sometimes these changes can also make a person prepare to run, known as “flight.” During dangerous situations, our body’s chemical responses can help us to survive.

For example, an adrenaline rush could occur when someone runs away from trouble or danger or if a person is driving and has to slam on the brakes. Short-term stress can be very helpful in these situations.

However, if that fight-or-flight response is triggered by trauma or loss, an increased level of cortisol can change a person’s metabolism. Long-term effects of a change in metabolism can include diabetes or high blood pressure.

What are common signs or symptoms of stress?

The classic response to stress starts with teeth grinding or tightness in the shoulders. Symptoms of prolonged stress exposure also include:

  • muscle tension
  • headaches
  • low energy
  • fatigue
  • lethargy
  • lack of sleep

Many people also experience stress in their gut with symptoms of an upset stomach such as irritable bowel syndrome, diarrhea or severe constipation. High blood pressure and heart problems are also conditions caused by high chronic stress levels.

What are some tips to help manage stress?

People can’t always change the stressors or their life circumstances. My recommendation is for individual’s to do what they can to manage the things that they are able to.

Regular exercise is the number one treatment for the reduction of stress. Even 30 minutes of walking four times a week significantly decreases the anxiety associated with high levels of stress. Any sort of physical activity on a routine basis has been shown scientifically over and over again to be the best treatment for stress related disorders.

The second way to treat stress is to reconnect with people. Trying to find that way to connect with people and ground oneself against this internal world of stress can be very healing and therapeutic. Also, there have been studies that show a 30-second hug does the most for stress reduction of any sort of physical contact.

Seek out activities that can decrease stress naturally in a relaxing environment like yoga, meditation, going to church and prayer. Natural de-stressors have been shown to decrease the body’s response to stress.

Is there such a thing as “good stress”?

Biologically, stress comes from a natural positive response. Our bodies were made to be able to take care of ourselves and that includes things like getting ready for a speech, an interview, or an exam.  Stress can make a person more alert, more thoughtful, and quicker to respond. All of those are healthy levels of stress. That means the person cares about what they’re doing and it’s driving them to increase their performance. So, stress can be performance enhancing at the right level.

What is HCA Healthcare doing to help address stress in the country and for their colleagues? 

HCA Healthcare is expanding our behavioral health services beyond hospital care. One of the areas we’re focused on is women’s and children’s services in order to provide a continuum of care to our patients. We will be addressing everything from reproductive issues to post-partum depression.

The services we will provide include:

  • therapists available during stressful times,
  • screening to identify individuals who might benefit from counseling or therapy, and
  • a wide-range of services from one-time therapy to an ongoing support group and higher levels of service including hospitalization, if necessary.

We’re working to expand services across the country to have a broader scope and reach. We’re also providing enhanced services to patients in our emergency rooms.

Additionally, there are currently seven residency programs for psychiatry at HCA Healthcare-affiliated facilities and we’re adding them on every year.

For HCA Healthcare colleagues, we have included Teladoc – telemedicine, digital technology that allows our team members to speak with a specialist by phone 24/7.

What should people do if their feeling stressed?

Self-care is the best care. Taking care of yourself is the number one priority. Even though there is a lot going on in life, everyone still needs to make room for regular physical activity and find ways to reconnect with family or people. These are powerful tools to manage stress.

Don’t be a victim of excessive stress. This is the first step. Be aware of your own level of stress by monitoring your symptoms. If stress is interfering with your quality of life and your ability to perform on a daily basis, that’s a red flag. If your stress is chronic or becomes overwhelming, bring it up to your physician and consider speaking to a therapist who can help.

Finding the right type of therapist or the right kind of help and support group, can’t happen fast enough.