Americans believe discussing stress with their health care providers is important, yet many aren't having the conversation, reports a new study from the American Psychological Association.

According to its annual "Stress in America" report, 31% of Americans who categorize themselves as suffering from high stress never discuss stress management with their health care provider. Moreover, 32% of Americans say they believe it is very or extremely important to talk with their health care providers about stress management, but only 17% report that these conversations are happening often or always.

"The challenge is that, in many cases, the physician or other health care professional might not be bring it up at all, which then puts it on the individual or the patient to bring it up," says Dr. David Ballard, assistant executive director for marketing and business development with the American Psychological Association. "And these can be difficult conversations to have."

People who do have these conversations with their providers report a higher frequency of good relationships with friends and family, of doing well in school or their career, of having a healthy diet, and of achieving other healthy living goals, compared to those who say they get little or no support from their providers.

"We can't make a causal statement here - we can't say the support causes these things to happen - but it's certainly highly correlated with healthy living in many domains," said Dr. Norman Anderson, CEO and executive vice president with the American Psychological Association, during a webinar announcing the results of the annual survey.


Having the conversation: 5 tips

"Talking about how stress impacts work performance and the workplace is something we need to be doing so 20 years from now stress is more manageable and we're more resilient, instead of not having a handle on it," says Richard Citrin, Ph.D., and president of Citrin Consulting. Citrin and Ballard offer five suggestions for helping employees start having those conversations with their health care providers about stress:

1. Think like a doctor thinks. Physicians are trained to think in terms of symptoms, says Citrin. "When you're dealing with an issue like stress, an individual may experience [physical] symptoms," he says. Symptoms such as trouble sleeping or more frequent headaches may be related to stress, for example.

2. Make a list. Be prepared and make a list of symptoms and concerns for your doctor. Be specific, says Citrin. "Don't just say, 'I'm stressed at work,'" he advises. "Be specific and say, 'We've picked up a lot of new clients at work,' or, 'My husband is travelling a lot' or, 'My wife is finishing her internship at medical school,' so the provider can factor that in to what the concern is you're having."

3. Reframe your symptoms. "Sometimes a helpful technique is to describe how other people in your life might talk about what's going on," says Ballard. "So, rather than say, 'Here's what's going on with me,' say, 'My partner or spouse would say this is happening,' or, 'My boss and co-workers have been telling me X.'"

4. Exhibit honest emotion. Talking openly about emotions is often hard for people. "People may view it as a sign of weakness, and some doctors may find discussions of stress represent some kind of mental health issue that they can't easily fix," says Citrin. "Sharing your concern openly with the doctor will very often elicit the physician's empathy."

5. Don't rely solely on physicians. "Because stress is this generic term we use, physicians aren't necessarily geared to coming up with a solution. They're thinking about the diagnosis, the treatment or a referral," says Citrin. Psychologists, social workers, ministers or rabbis "are probably better suited to listen to your concerns and provide ideas on how to remedy the stress issues. If the situation is serious enough to warrant medication or other medical options, those professionals are going to be able to get you to the right medical person or suggest you see your own physician."

Employers are well-positioned to help employees deal with stress issues because we spend the majority of our waking lives at work, Ballard says. Making sure employee assistance programs are well-communicated is one way.

"Many employers offer EAPs but the ways to access those services and benefits aren't often communicated well," he says. "It's great to have an EAP, but it doesn't do much good if employees don't know how to access it."

Another is having a good behavioral health benefit as part of the organization's health insurance plan and making sure employees know how to access that as well, says Ballard.


Millennials especially stressed

The APA survey also suggests that Americans are struggling to keep their stress to levels they believe are healthy. Even though average stress levels across the country appear to be declining (4.9 on a 10-point scale vs. 5.2 in 2011), stress levels continue to surpass what Americans define as a healthy level of stress (3.6 on a 10-point scale.) What's more, 35% of Americans say their stress has increased this past year.

Millennials (age 18 to 33) in particular seem to have trouble managing their stress and getting health care that meets their needs. Millennials surveyed report an average stress level of 5.4 on a 10-point scale, exceeding the national average.

Nearly half of millennials do not believe or are not sure they are doing enough to manage their stress, and few say they get stress or behavior management support from their health care provider. Only 23% think that their health care provider supports them a lot or a great deal in their desire to make healthy lifestyle and behavior changes, and just 17% say the same about their health care providers' support for stress management.


Gen Y's catch-22

Millennials report jobs and money as their top stressors.

"It's kind of a catch-22 for them. The poor job market resulted in many more of them going to graduate school, thinking a better education would get them a better job, and then they accumulated a significant amount of debt through student loans, and then still got dumped out into a job market that, in this country, has been a problem now for a few years," said Dr. Katherine Nordal, executive director for professional practice with the APA. "Combine that with possibly moving back home into a family situation and being frustrated with not being able to move on with their lives ... the economy and the job market has really added to stress levels."


Stress by gender

Women, meanwhile, continue to report higher stress levels than men (5.3 on the 10-point scale, compared to men's 4.6.) Both genders agree, however, that 3.6 is a healthy level of stress, pushing women nearly two points beyond the level of stress they believe to be healthy.

More women report experiencing extreme stress than men. Twenty-three percent of women report their stress level at an eight, nine or 10 on the 10-point scale, compared to 16% of men.

What's more, women are more likely than men to say their stress is on the rise. More women say their stress levels have increased in the past five years (43% vs. 33% of men) and in the past year alone (38% vs. 32% of men.)


3 steps toward building stress resilience

Stress is a normal event in life, says Richard Citrin. Instead of trying to eliminate it completely, it's best to give employees the tools to become resilient. Here are three things he suggests:

1. Make meetings efficient. There's no reason meetings need to last an hour if they only need to be 35 minutes. "If a meeting can go for 30 minutes and get everything done, that creates a less stressful environment," he says.

2. Consider an email policy. Other than policies prohibiting rudeness or using email inappropriately, "we don't see anything about how we cc people on emails or bcc people on emails or how long they should be or whether we use emails as a communication instead of walking down the hall and speaking to someone," he says. "People are inundated. I don't know what the policy should be for every company, but I do believe companies should be looking at email as a stressor in the workplace and begin to think about healthy email policies."

3. Train managers. Ensure managers are trained in how to build efficient teams so projects get handled efficiently. "If another project comes on board and the manager knows it's going to create stress on the team, how does he or she distribute that work in an efficient and fair manner?" Citrin says.

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