Introduction
Stress is a recognized phenomenon among a majority of Americans. Its affects can be felt in the work place, where it can reduce productivity, and in the home, where it has been associated with family violence. Efforts to assist those in need have been undertaken by both the public and the private sectors. Crisis hotlines and outreach clinics are available to offer assistance for those having problems coping with stress, and most Americans are aware of their services. Violent behavior, including homicide, suicide, rape and family violence is a continuing health problem of major concern. Homicide and suicide are leading causes of death among persons 15-34 years of age.
Prevalence
Stress
An estimated 86% of the adult population believes that psychological stress exists.
84% of males surveyed and 88% of females surveyed reported having experienced stress. 40% of those surveyed reported that they experience at least a moderate amount of stress during an average week.
Among those surveyed, 83% of the college graduates, 71% of the high school graduates and 50% of those persons with less than a high school degree reported having experienced stress.
63% of the blue collar workers, 83% of the professionals, 71% of those unemployed, 67% of the homemakers and 79% of the white collar workers reported having experienced stress.
Of those who reported having experienced stress, 35% believed that stress had a negative impact on their lives. 33% said stress had not had any affect on their lives.
Professionals reported illness due to stress more frequently than any other occupational group (23%). They are followed by part-time employees (21%), unemployed persons (21%), white collar workers (20%), homemakers (18%), blue collar workers (13%) and retirees (9%).
Sources of Stress
Among those surveyed, persons earning more than $30,000 per year cited financial and work-related problems as the most frequent causes of stress.
Those persons earning less than $30,000 per year most often cited problems with friends and family as the primary cause of stress.
47% of the 18-29 year olds surveyed reported being able to solve an upsetting problem during the past year. 65% of those 65 years and older reported that they were able to solve an upsetting problem over the past year.
"The proportion reporting the existence of an upsetting situation is greatest for respondents 18-29 years old (22%). Proportions for the remaining age categories vary from 19% for those aged 30-to 44 to 12% for those aged 55-to 64."
It is estimated that 500,000 or more Vietnam veterans are in need of emotional help. Up to 30% of their drug abuse, violence, emotional instability are alleged to be a direct result of exposure to combat and atrocities.
Public Awareness and Service Delivery
77% of those surveyed did not consider seeking help in dealing with personal or emotional problems; 5% considered, but did not seek help, and an estimated 15% of the population actually sought help from a variety of sources.
Of those surveyed, 17% of the women and 12% of the men sought help. 81% of the men and 74% of the women did not consider seeking help.
Survey respondents who had at least a high school education sought help more readily than those who did not.
Help-seeking behavior did not vary across income levels.
Among those surveyed, 91% had never been a member of a self-help group. 5% had participated in a self-help group during the past year and 3% were currently participating in a self-help group.
Respondents were most often familiar with the following agencies: emergency medicare centers, alcohol and drug abuse centers, community mental health agencies, child abuse services and crisis hotlines or help centers. 45% knew of a suicide prevention hotline.
"A community-based emergency center had been contacted by 30% of those sampled; less than 8% had ever contacted a community mental health agency, an alcohol or drug abuse center, a child abuse service, a crisis hotline or a stress service. 1% had contacted a battered woman's shelter, a rape crisis center, a suicide prevention service or a Parents Anonymous group."
Blue Cross of Western Pennsylvania reports that for 136 persons who used insured outpatient psychiatric benefits, medical costs dropped from $16.47 to $7.06 per month.
A Washington-based health maintenance organization reported that users of mental health counseling benefits reduced their nonpsychiatric physicians visits by 30.7% and lab X-ray services by 29.8%.
According to a study recently conducted by the National Institute for Occupational Safety and Health, the costs of "executive stress" (based on conservative estimates) are as follows: cost of executive work-loss days: $2,861,775,800.; cost of executive hospitalization: $248,316,864.; cost of executive outpatient care: $131,058,235.; cost of executive mortality: $16,470,977,439.
Violent Crime
Police reports collected by the FBI indicate that the number of violent crimes in the nation increased by 4% between 1984 and 1985. Murder increased by 2%, forcible rape by 4%, robbery by 3%, and aggravated assault by 6%.
Each year about 6 million persons—3.2% of all Americans—are the victims of a violent crime.
Violent crime victims are more likely to be:
- men rather than women (except for the crime of rape),
- Blacks rather than whites or members of other racial groups,
- Hispanics rather than non-Hispanics,
- people with low incomes (less than $7,500 per year).
In 1981, an estimated $223 million in medical expenses was incurred by victims of assaults, robberies, and rapes.
Child Abuse
In 1984 an estimated 1.7 million children were referred to child protective services because of child abuse and neglect in the United States. This represented a 158% increase in the number of such reports between 1976 and 1984.
Neglect, alone or in combination with abuse, accounted for 58% of all reports to child protective services in 1984.
Reports of child sexual abuse have increased by approximately 1600% since 1976. This increase reflects greater public awareness of the existence of the problem, changes in reporting and investigative policies, expansions in definitions of child sexual abuse to include extra-familial abuse, and the increase in the number of treatment programs.
Severe physical child abuse may be decreasing in the United States. Data from two national surveys conducted in 1975-1976 and 1985 indicate a 47% decline in severe violence towards children in intact families with children ages 3 to 17.
Among the possible reasons for the reported decline in severe child abuse are increased use of planned parenthood (including abortion) by the U.S. population, compulsory child abuse and neglect reporting laws in the 50 States, and the appearance of new preventive and treatment programs for child abuse and neglect.
Spouse Abuse
Data from national surveys conducted in 1975-1976 and 1985 indicate that severe violence by husbands against wives has declined. The rate for such violence decreased from 38 per 1,000 couples in the initial survey to 30 per 1,000 couples in 1985. Relative to the 1975-1976 rate, this represents a 26.6% decline in severe wife beating over the 10-year period and comes close to statistical significance.
Severe violence by wives against husbands decreased only slightly between 1975-1976 and 1985. Although the meaning and significance of this violence is poorly understood, it appears that much of it was in self-defense or in retaliation for violence inflicted by husbands.
Murders of wives by husbands, and of husbands by wives, accounted for 8.3% of all murders nationally in 1985.
Although spousal violence is usually thought of in terms of intact marriages, available data suggest that violence of this type is even more frequent among persons who have been divorced or separated from each other.
Homicide
Homicide was the 11th leading cause of death in the United States in 1983. However, the relative rank of homicide as a cause of death varied greatly by race. In 1983, homicide was the 5th leading cause of death among Blacks, the 14th leading cause of death among whites, and the 9th leading cause of death among persons of other races.
Homicide takes its greatest toll among young persons ages 15 to 34. In 1983, homicide was the leading cause of death for Blacks in this age group.
The toll that homicide takes among the young is also reflected in the number of years of potential life lost (YPLL) before age 65. For Blacks in 1983, homicide was the 3rd leading cause of YPLL; for whites and others, it was the 6th leading cause of YPLL.
Males account for nearly 75% of homicide victims. Black males have a 1 in 21 lifetime chance of being murdered; white males have 1 chance in 131.
Most homicides in the United States are committed with firearms. In 1985, firearms accounted for 3 out of 5 homicides nationally. Cutting or stabbing instruments were employed in 1 out of 5 homicides.
Nearly 3 out of every 5 homicides committed in 1985 were perpetrated by persons acquainted with the victim (47%) or by relatives (17%). Arguments are the leading precipitants of homicide and accounted for nearly 40% of homicides nationally during the period 1981-1985.
Rape
In 1983, an estimated 154,000 rapes and attempted rapes occurred nationally, or roughly 1 for every 600 females 12 years of age and older.
Most rape victims are young. The ages with the highest victimization rates for rape and attempted rape are 16 to 24 year olds.
Most victims of rape or attempted rape are white, reflecting the general racial composition of the population. However, the likelihood of being a rape victim is significantly higher for Black women (2.5 per 1,000 annual rate) than for white women (1.5 per 1,000).
Two-thirds of rapes and attempted rapes are committed by men who are strangers to the victim. More than three-fourths of all rapes involve one assailant and one victim. Weapons are used in about one-fourth of rapes and attempted rapes.
Social stigma traditionally attached to rape makes it difficult for many victims to report the crime to police. Only half of the victims of rape and attempted rape surveyed nationally during the period 1973-1982 had reported the crime to police.
Aggravated Assault
Aggravated assault is an unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury, but not resulting in death.
In 1985, there were 300 reported victims of aggravated assault for every 100,000 persons nationwide. Rates were highest in metropolitan areas (342 per 100,000) and lowest in rural counties (129 per 100,000).
Weapon distribution data for 1985 showed that 21% of reported aggravated assaults involved the use of firearms, and that 31% were committed with blunt objects and other dangerous weapons.
During the five-year period 1981-1985, the reported number of aggravated assaults increased by 9% across the nation.
The term "reported aggravated assaults" refers only to data on such assaults contained in police reports. Recent research has indicated that police reports do not adequately reflect the true extent of aggravated assault in the nation. One study of 41 acute care hospitals in Northeast Ohio found that close to 3 out of 4 cases of assault seen in hospital emergency departments were not reported to police.
Control of Violent Behavior
In 1984, the year end prison population in the United States numbered more than 463,000 persons. This was the largest number of prisoners ever confined in the nation and the 10th consecutive year in which the national year end prison population reached an all-time high.
Since 1980, the national prison population has increased by more than 40%. While an estimated 100,000 new prison beds were added in 1980-1984, the number of prisoners increased by more than 130,000 during the same period.
Although the number of female prisoners has greatly increased in recent years, and reached a total of 20,853 nationally in 1984, women still account for a very small percentage of the total prison population. In 1984, less than 1 in 20 prisoners were female.
A record 223,551 persons were being held in local jails as of June 1983. This represents a 41% increase over the total population recorded in the previous national jail census conducted in 1978.
Relative to the U.S. population, the number of jailed persons rose from 76 per 100,000 in 1978 to 98 per 100,000 in 1983.
With the exception of Massachusetts, every state had more women in jail in 1983 than in 1978, but women still account for only 7% of the national jail population.
The number of juvenile jail detainees is small and relatively stable, totaling 1,736 nationwide in 1983 and 1,611 in 1978.
More than 1.5% of the adult U.S. population is under some form of correctional supervision on a given day. Nearly two-thirds of these are under some form of probation; the remainder are in prison (17%), jail (8%), or on parole (10%).
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