What stresses us out the most? That depends on a number of factors, including how “stress” is defined.

That can be difficult to pin down, because everyone reacts differently to stress factors, and what is stressful for one person might have little effect on others — or actually be pleasurable.

According to the American Institute of Stress (AIS) — a Texas-based non-profit dedicated to helping “Service Members and civilians navigate stressful situations to have a happier, more rewarding life” — the most common definition of stress is probably “physical, mental, or emotional strain or tension.”

Stress has been linked to numerous diseases and chronic conditions. How exactly it affects the brain, though, is not very clear, according to experts. Stress may cause biochemical changes in the body, including increasing cortisol levels. This is one way it can hinder memory. Here are other things that can lead to memory loss and brain shrinkage.

How is stress affecting you? The AIS publishes an online test, the Holmes-Rahe Life Stress Inventory, that will help you determine just that.

Devised in by psychiatrists Thomas Holmes and Richard Rahe, the test ranks a list of 43 life events, each one weighted for level of stress. Participants are asked to answer yes or no as to whether they have experienced any of these within the past year. The higher the number of yes responses and the larger their weight, the greater the chance that the subject will experience a “major health breakdown” within the next two years.

The first ten events on the list are: death of spouse, divorce, marital separation from mate, detention in jail or other institution, death of a close family member, major personal injury or illness, marriage, being fired at work, marital reconciliation with mate, and retirement from work.

Among the other events are some that would obviously be stressful, like sexual difficulties, death of a close friend, foreclosure on a mortgage or loan, troubles with the boss, or changing to a new school. Others might seem like they’d be stress-relieving — for instance, outstanding personal achievement, vacation, major holidays. (People do often feel let down after the year-end holidays, though. Luckily there are easy tricks to beat post-holiday stress.)

How accurate are the results of the Holmes-Rahe test? According to an analysis of it published in the journal Occupational Medicine, it is “surprisingly consistent despite the cross-cultural differences one would expect.” However, says the journal article, since “Most people experience major life events infrequently hence a better measure might look at the stresses and strains of daily life.”

Citing 2017 research from the American Psychological Association, the AIS reports that the most common sources of stress are concerns about the future of our nation, money, work, the political climate, and violence/crime. So where do people experience stress the most? These are the most stressed out cities in America.

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