In an email to 24/7 Wall St., Vaile Wright, a director of research and special projects with the American Psychological Association (APA), noted one of these causes in particular. “[F]eelings about the future of our nation did differ in the different regions: Adults in the West (70 percent) were more likely than those in the South (63 percent), East (60 percent) and Midwest (56 percent) to consider the future of our nation as a somewhat or very significant source of stress.”

There are healthy and unhealthy ways to manage stress. The APA has found that poor individuals are more likely to engage in unhealthy behaviors to manage their stress, including smoking and drinking alcohol, and turning to violent behavior.

Nearly three-quarters of Americans surveyed reported feeling stressed about money at least sometimes, and nearly one-quarter reported money concerns as causing stress on a regular basis.

Metropolitan areas are often some of the most expensive places to live in a state, and areas where the population reports higher stress levels tend to be less affordable. Because of this, our stress factor index included the affordability ratio, which calculates how much homeowners spend on their homes as a share of their total income. We also included poverty levels as part of the stress factor index.

Americans tend to work longer hours than residents of other countries, and the United States is the only developed country where paid time off is not guaranteed. The typical American works about 35 hours a week. In the most stressed-out cities in 34 states, the average weekly hours spent at work exceed 35 hours. The likelihood of being stressed increases with work issues. This is why we also considered hours worked per week and unemployment levels.

High stress levels have tangible health consequences. “Stress is your body’s way of responding to adverse or just demanding circumstances. It usually involves a combination of both physical and emotional symptoms, such as headaches, stomach aches, discomfort, and feeling worried. But if left untreated or unmanaged, chronic stress can result in serious health conditions including anxiety, insomnia, muscle pain, cardiovascular disease, high blood pressure and a weakened immune system,” said Wright.

As one example, unhealthy reactions to stress such as overeating can result in higher obesity rates and, in turn, worse health outcomes. In 29 of the 50 stressed-out cities on this list, obesity rates are higher than the respective state figures.

To identify the most stressed city in every state, 24/7 Wall St. created an index of data measuring two of the most common sources of stress — money and work — in each state’s metropolitan areas. To capture money-related stress inputs we reviewed poverty rates, housing affordability, and food insecurity. For work-related stress inputs, we included average weekly work hours, average daily commute times in hours, and annual unemployment rates. With the exception of food insecurity and unemployment rates, which came from the United States Department of Agriculture (USDA) and the Bureau of Labor Statistics (BLS), respectively, all data used in the index came from the U.S. Census Bureau’s 2016 American Community Survey (ACS). The incidence of violent crime in each area is from the Federal Bureau of Investigation’s 2016 Uniform Crime Report. All data are for the most recent periods available. While the potential consequences of stress were not considered in our index, they were reviewed in each state’s MSAs. For states like Vermont and Hawaii, the most stressed city is the only metropolitan area in the state by default.