More than half of Americans say that the present day is the worst period of American history that they can remember, according to a new survey of stress in the United States.

The American Psychological Association (APA) just released the results of its annual Stress in America survey, which revealed that the biggest stressor Americans face is the state of the U.S. The APA surveyed 3,440 American adults in August, and 63% of them said the future of the nation is a “very” or “somewhat” significant source of stress. That’s slightly more than other common stressors, like money at 62% and work at 61%.

When the survey polled Americans on what specific issues cause them stress about the country, 43% said health care and 35% said the economy. Around 30% of people reported being stressed about trust in the government, crime, hate crimes and terrorist attacks.

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Women reported higher levels of stress than men—particularly around hate crimes, wars and terrorist attacks. In 2017, women experienced a slight increase in their stress levels compared to 2016, and men experienced a slight drop.

The fact that many Americans cited the present as the lowest point in U.S. history is notable, the authors of the paper write, given that many of the people surveyed have lived through a variety of tragedies, including World War II, the Vietnam War and the September 11 terrorist attacks.

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The new survey results show similar levels of stress to last year, but the effects of stress on people seem to be more pronounced today, the APA reports. 45% of Americans said they have lain awake at night in the past month due to stress, compared to 40% who reported doing so in 2016.

56% of people also mentioned that they want to stay informed, but that the news causes them stress; 72% said the media “blows things out of proportion.”

“The bottom line is that stress can have real health consequences,” said Arthur C. Evans Jr., the APA’s chief executive officer, in an email to TIME. He added that more people than in 2016 reported symptoms of stress, like headaches, stomachaches, feeling anxious or overwhelmed or feeling as though they could cry. “When stress becomes chronic or stress levels exceed a person’s ability to cope, it is a concern.”

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Still, there have been some positive outcomes to national stress levels. Just over half of Americans said that the state of the country has inspired them to volunteer and support causes they love, and 59% have taken some kind of action, like signing a petition or boycotting a company due to its political or social views and actions.

“It is important that people learn healthy ways to manage stress that may make them lower their stress over the long term and therefore reduce their risk for other health conditions,” says Evans. Healthy habits to fight stress include getting enough sleep, eating healthy, exercising, limiting exposure to stressors like the news and finding ways to get involved in organizations that are in line with a person’s values, the APA notes.

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