Alongside perennial concerns like “work” and “money,” sociocultural issues including mass shootings, access to health care and the 2020 presidential election now cause the most stress for American citizens, according to the annual “Stress in America” survey from the American Psychological Association (APA).

The survey was conducted between Aug. 1 and Sept. 3 and polled 3,617 adults across the U.S., according to an APA press release. “While overall stress levels have not changed significantly over the past few years, the proportion of Americans who say they are experiencing stress about specific issues has risen over the past year,” the survey explains.

Among those surveyed, 56% of adults said the 2020 election is already a “significant stressor,” a year out from Election Day — an increase from the 52% who said the 2016 presidential election was stressful. (The election is proving to be a more stressful topic for survey respondents identifying as Democrats, versus those identifying as Republicans, by almost 25%.) This year’s survey also cites 69% of adults pointing to health care, specifically the costs thereof, as a notable point of stress. And 71% cited mass shootings as stressful — the most common source of stress among those surveyed, with a rise of almost 10% from the APA’s 2018 survey.

Read more: A Third of Americans Avoid Certain Places Because They Fear Mass Shootings

Other stressful topics cited include climate change, immigration, national security and abortion. These topics presence as “hot-button” issues in the news cycle is likely not a coincidence, the APA found — of keeping up with the news cycle in 2019, 54% of those surveyed said they “want to stay informed,” but that the news is stressful. 39% of respondents said they have “taken steps over the past year to reduce their news consumption.”

The impact of discrimination was also deemed stressful by a majority of survey respondents identifying as part of a minority community. 63% of people of color surveyed said that discrimination has kept them from having a fully productive life. 64% of LGBT adults surveyed said the same thing.

Stress levels as a whole decreased drastically across respondents categorized by age group, the survey found. Members of the baby boomer generation and “older adults” were found to have to “significantly lower average stress levels” and their younger Gen X, Gen Z and millennial peers. (These stress levels were drawn on a scale of 1 to 10, with Gen X and younger all reporting stress levels above the median point, while boomers and older were below.)

“There is a lot of uncertainty in our world right now,” Arthur C. Evans Jr., APA’s chief executive officer, said in a statement accompanying the survey’s release. “While [there] are important societal issues that need to be addressed, the results also reinforce the need to have more open conversations about the impact of stress and stress management, especially with groups that are experiencing high levels of stress,” Evans said, according to the press statement.

“Research shows us that over time, prolonged feelings of anxiety and stress can affect our overall physical and mental health,” he noted, in correlation with findings that 59% of those surveyed felt they had not received enough emotional support to mitigate their stress levels.

According to the APA, the best ways to manage stress are to get a good amount of sleep every night, exercise regularly and maintain a healthy network of social support.

Get our Health Newsletter. Sign up to receive the latest health and science news, plus answers to wellness questions and expert tips. Please enter a valid email address. Sign Up Now Check the box if you do not wish to receive promotional offers via email from TIME. You can unsubscribe at any time. By signing up you are agreeing to our Terms of Use and Privacy Policy . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Thank you! For your security, we've sent a confirmation email to the address you entered. Click the link to confirm your subscription and begin receiving our newsletters. If you don't get the confirmation within 10 minutes, please check your spam folder.

Write to Josiah Bates at josiah.bates@time.com.