Stress is highest in Cleveland and lowest in Fremont, California, according to a reporton stress in 150 U.S. cities released Monday by WalletHub.

Previous research has found a correlation between WalletHub's scores of overall stress levels and Overall Hospital Quality Star Ratings on CMS' Hospital Compare website, where hospitals with lower star ratings typically were located in cities with high stress levels.

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Methodology

For the list, researchers compared 182 U.S. cities, including the 150 most populated cities in the country. They assessed at least two of the most populated cities in each state. Researchers looked only at the city proper; they did not factor in the surrounding metro area.

To calculate the rankings, the researchers examined 40 relevant metrics across four key indicators:

• Work stress, including average hours in the work week, job security, traffic congestion, and income growth

• Financial stress, including median annual household income, median credit score, poverty rate, and affordability of housing

• Family stress, including separation and divorce rate, share of single parents, and cost of childcare

• Health and safety stress, including the percentage of adults in fair or poor health, metrics of mental health, the insured rate, and the crime rate per capita

Researchers graded each metric on a 100-point scale, with a score of 100 indicating the highest stress levels. To determine a city's overall score and rank, they calculated the weighted average across all metrics.

Overall city rankings

According to the report, the five most-stressed cities overall are:

1. Cleveland, OH, which scored 64.66

2. Detroit, MI, which scored 61.2

3. Gulfport, MS, which scored 57.03

4. Baltimore, MD, which scored 56.72

5. Philadelphia, PA, which scored 56.45

By contrast, the five least-stressed cities overall are:

1. Fremont, CA, which scored 28.58

2. South Burlington, VT, which scored 31.14

3. Madison, WI, which scored 31.27

4. Overland Park, KS, which scored 31.46

5. Fargo, ND, which scored 31.46

Health-specific rankings

WalletHub also identified the cities with the highest rates of health and safety-related stress, finding that such stress is highest in:

• Detroit, MI
• Cleveland, OH
• Charleston, WV
• Augusta, GA
• Fort Smith, AR

Health and safety-related stress was lowest in:

• Fremont, CA
• Columbia, MD
• Irvine, CA
• San Francisco, CA
• San Jose, CA

Notably, WalletHub acknowledged that stress is not always a negative thing, adding that stress can sometimes have a positive impact on a person's well-being. According to Psychology Today, "A little bit of stress, known as 'acute stress,' can be exciting—it keeps us active and alert."

However, when stress is unmanageable, it becomes "chronic." As a result, we become vulnerable to its negative effects, including health problems and loss of productivity. (Gooch, Becker's Hospital Review, 7/11; McCann, WalletHub, 7/11)