Almost 40% of Americans are more anxious than they were at this time last year, according to a new American Psychiatric Association (APA) poll.

The APA surveyed 1,000 U.S. adults about their sources and levels of anxiety, and found that 39% reported being more anxious than they were at this time last year. Another 39% said they were equally anxious, while only 19% said they were less anxious than last year.

Approximately 40 million American adults — roughly 18% of the population — have an anxiety disorder, according to the Anxiety and Depression Association of America.

Safety, health and finances seemed to be the greatest sources of anxiety, according to the APA poll. Sixty-eight percent of respondents said “keeping myself or my family safe” and “my health” made them either somewhat or extremely anxious. Sixty-seven percent said the same of “paying my bills or expenses.” Politics and interpersonal relationships followed at 56% and 48%, respectively.

Even as anxiety spiked, however, few respondents said they had sought out mental health care — despite the fact that 86% strongly or somewhat agreed that mental health has an impact on physical health, and half agreed that stigma associated with mental illness has decreased over the last decade. Only 28% said they had seen a mental health professional of any kind.

Fifty-eight percent, however, said they felt they had very or somewhat adequate mental health coverage under their current insurance plan. Only 12% felt their coverage was “not that adequate” or “not adequate at all.” Eighty-one percent said they would know how to access mental health care if they needed it.

The spike in anxiety is perhaps unsurprising, given past American Psychological Association research that has found significant numbers of Americans also consider themselves stressed. As of December 2017, 63% of Americans said the future of the nation was a significant source of stress, and 59% felt that “the United States is at the lowest point they can remember in history,” according to the organization’s “Stress in America” survey.

Correction: The original version of this story misstated the name of the group that conducted the poll. It is the American Psychiatric Association, not the American Psychological Association.

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Write to Jamie Ducharme at jamie.ducharme@time.com.