Anxious in Seattle: Report shows it’s the most stressed major city in the U.S.

a woman with an umbrella stands by the river and looks at the Seattle skyline.


In this article:

  • In a recent survey, Seattle-area residents reported the highest anxiety levels among the 15 largest metropolitan areas in the U.S.

  • Employment, finances, housing and childcare are among primary drivers of anxiety.

  • A Swedish clinical worker says exercise, consistent sleep and meaningful social connections can help reduce anxiety.

  • There’s help if you have been experiencing symptoms that have been affecting your life.

The Emerald City has no chill. A recent survey by the United States Census Bureau reported that the Seattle metropolitan area is the most anxious among the 15 largest metro areas in the U.S., with 54.5% of the adult population of King, Pierce and Snohomish counties — roughly 1.8 million people  saying they felt “nervous, anxious or on edge” for at least several days during the past two weeks.

The report is meant to inform the public and policymakers about the pandemic and its impacts on local communities. No doubt, COVID-19 has exacerbated many of the conditions that spur anxiety here in the Puget Sound area and nationally. We spoke with Alexandra Fleming, a licensed clinical social worker here at Swedish’s Center for Perinatal Bonding and Support, to help us understand the information in the report and for some advice about how to cope with anxiety.

What are your thoughts about this report?

Surveys like these generate interesting headlines, but I do think it can be hard to draw conclusions from them. It might be that people living in the Seattle metropolitan area are more familiar with mental health symptoms in general and therefore are more able to identify that what they are feeling is anxiety (interestingly, the article notes that only 13% of respondents reported feeling this way nearly every day, which was the same for many other metro areas).

But there is a value in starting conversations about anxiety and disseminating information about how anxiety can show up differently for different individuals. While anxiety is a common and universal part of the human experience, living with chronic anxiety can be limiting and seriously impactful. Helping connect individuals to mental health providers who can accurately diagnose and treat anxiety should be our top priority. Speaking as a therapist working in Seattle, this news did not surprise me. Anxiety is a common theme in therapy sessions, especially lately. People are feeling uncertain about the future, and COVID has upended our normal routines and structures of support. We’ve had to adapt again and again to new protocols for school, work, home and social gatherings. Lots of people have worried about loved ones getting sick from COVID in addition to job changes and economic uncertainty as a result of the lockdown. Add to this the threat of climate change, worsening income disparities, a growing awareness of racial injustice and political news and you wonder how anyone isn’t feeling anxiety.

Why do you think residents of the Seattle metropolitan area are so vulnerable to these levels of anxiety?

The Seattle Times notes that Seattle has not been more significantly impacted by COVID than other cities and asks why we are feeling more anxiety. I think one reason Seattle-area residents might be experiencing high rates of anxiety is our level of uncertainty; we can be employed and housed with our children in school today and things change quickly tomorrow. Many people in the Seattle area are transplants and don’t have family systems to fall back on for childcare or financial help. Many families I know had to scramble to cover childcare when schools shut down or one parent had to leave their career or significantly cut back on work. Schools and daycares are back open, but we all know that they can close at a moment’s notice when a teacher or student tests positive. The human brain does not like uncertainty, and we can find ourselves often running scenarios through our heads (something we call catastrophizing) to prepare for these what-if possibilities. Sometimes this planning part of our brain can serve us, however, sometimes the constant planning/worrying actually makes anxiety worse. Checking in about how often we’re going over and over the plans might be a way to recognize anxiety.

How do we know if we are feeling anxious in the moment or if it’s something more serious?

From a clinical perspective, we diagnose anxiety using criteria such as how often the anxiety is showing up, for how long and how much it is impairing the person’s ability to function. Every person has anxiety — we need it to survive and keep us safe. Without it, we would do things like attempt to cross the street without looking both ways, walk up to angry or growling animals and eat foods that were way past their expiration date. Feeling a little anxious can even help us improve performance. If we’re worried how we will do on a test, we might spend extra time preparing and studying.

However, we all know that too much anxiety can be quite difficult. When diagnosing anxiety, we ask questions about how the person feels anxiety: are they worried or troubled by racing thoughts and/or bodily symptoms like increased heartbeat or GI distress? We also ask if the person is feeling restless, easily fatigues, has difficulty concentrating, has increased irritability, increased muscle tension and/or sleep disturbances. If a person reports that they have been experiencing at least three of these symptoms for more days than not for at least six months, they might have what we call generalized anxiety disorder. We must remember that it’s important to have an actual clinician diagnose you versus diagnosing yourself. There are many kinds of anxiety disorders including phobias, obsessive-compulsive disorder, adjustment disorder with anxiety and perinatal anxiety, just to name a few. The most important thing is to work with a professional who can help get the diagnosis correct and develop the right treatment plan for you.

What are things we can do to help ourselves or a friend or loved one handle an episode of anxiety?

In general, I like to normalize anxiety. It makes sense to me that our brains are scanning for danger and making plans to address anything that might endanger us or our families. It helps to start out by acknowledging the things you have control over and the things that are out of your control. For instance, I can’t control the pandemic, but I can help stop the spread of COVID by having my kids mask up, wash their hands and get vaccinated when it becomes available. I think it also helps to write down all the things that are worrying you and then allow yourself some “worry time” to go over scenarios and plans. After this time is up, practice noticing that you are thinking about the worries again and try to mindfully say, “I already worried about that. I am going to try to stay present in this moment.” Taking slow deep breaths can be an effective tool to calm your nervous system response. There are several coping and grounding exercises that can help, as well as exercise, consistent sleep and meaningful social connection.

If our anxiety feels like a serious problem, what should we do?

If you feel like your anxiety has reached a level that is getting in the way of your daily functioning, meaning it’s preventing you from being able to work, be present with family or friends, interrupting sleep or affecting your appetite, it might be time to reach out to a mental health provider. Several providers are seeing patients over Zoom, so hopefully that removes one barrier to getting help. Your primary care physician can be a great source of frontline help. They can either prescribe medicine or refer you to a mental health professional for therapy or medication, if you need it.

Find a doctor

If you have questions about anxiety or mental health, contact Primary Care or Behavioral Health and Wellbeing at Swedish. We can accommodate both in-person and virtual visits.

Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.

Join our Patient and Family Advisory Council.

Additional resources 

If you are suicidal and need help, call the National Suicide Prevention Lifeline at 800-273-8255.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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About the Author

Whether it's stress, anxiety, dementia, addiction or any number of life events that impede our ability to function, mental health is a topic that impacts nearly everyone. The Swedish Behavioral Health Team is committed to offering every-day tips and clinical advice to help you and your loved ones navigate mental health conditions.

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