At least Cleveland is not first on this list. (this is a long one folks,sorry)

Sinking property values, high unemployment and prices, and poor environments add to the pressure felt by residents in these metros.

Few enjoy their commute. Just ask Stephen Dinwiddie, M.D., a psychiatrist at the University of Chicago.

"I think anybody who, like I do, commutes on the Kennedy on a daily basis knows exactly what stress is," he says, of his daily home-to-work commute on Chicago's expressway that extends from the Chicago Loop to O'Hare International Airport. "It takes anywhere from 30 minutes to several centuries--at least subjectively."

But more pressing factors make Chicago for the second year in a row the country's most stressful city. Crowding, poor air quality, a high 11% unemployment rate and free-falling home values have created a cocktail of constant worry affecting many in the Windy City.

Los Angeles, Calif., ranks second, followed by New York, N.Y., Cleveland, Ohio, and Providence, R.I.

Behind the Numbers

To find the country's most stressful cities, we examined quality of life factors in the country's 40 largest metropolitan statistical areas, or metros--geographic entities defined by the U.S. Office of Management and Budget for use by federal agencies in collecting, tabulating and publishing federal statistics. We looked at June 2009 unemployment figures provided by the Bureau of Labor and Statistics and cost of living figures from the Council for Community and Economic Research. We examined median home-price drops from Q1 2008 to Q1 2009 that were provided by the National Association of Realtors. Population density based on 2008 data from the U.S. Census Bureau and ESRI also factored. Last, we examined the number of sunny and partly sunny days per year, based on 2007 data from the National Environmental Satellite, Data and Information Service, as well as air-quality figures, based on 2007 data from the U.S. Environmental Protection Agency.

The economic climate is clearly kicking up stress levels. In March, the National Sleep Foundation reported that more than a quarter of 1,000 survey participants were sleeping less because of the economy.

The recession has also forced Americans to skimp on health care. In a February telephone poll of 1,200 adults conducted by the nonprofit Kaiser Family Foundation, 53% of respondents said they cut back on health care costs by avoiding doctor's visits, skipping dental checkups and not filling prescriptions, among other strategies.

Year-over-year housing-price drops may also be behind Americans' anxiety.

"A forty-three percent drop is something that could easily be classified as a housing-market cataclysm," says Andres Carbacho-Burgos, economist at Moody's Economy.com, of the Q1 2008 to Q1 2009 median home-price plunge in San Francisco. That's compared with the national median home-price dip of 14.7% during that same time. "Over that long a period of time a drop that significant for San Francisco, or for the Bay Area as a whole, indicates just that the economy has turned sour and that credit is very, very tight and has been over the past year."

What's more, the drastic decline is not representative of the housing market as a whole--rather of the composition of homes being sold, says Walter Molony, spokesman for the National Association of Realtors. Almost 50% of homes sold nationwide in the first quarter of 2009 were distressed homes. One-third of those were short sales, and two-thirds were foreclosures, Molony says.

Though there are signs of a bottoming in some markets, falling home prices can immediately impact residents in two ways: first by affecting employment in the housing-related or real estate fields, and second by reducing consumer spending in metro areas with relatively large home-equity declines. Consumer spending in July was flat, erasing hopes of a kick-started economy.

And few are going to start spending when jobs are scarce. Perhaps no one knows that better than residents of Detroit. There, unemployment is 17.1%, thanks to the collapse in the auto industry. Employee cutbacks in General Motors plants and other makers of car parts led to the drastic 14.8% unemployment rate increase from May to June 2009, says Steve Cochrane of Moody's Economy.com.

Other cities have different reasons for stress: Pittsburgh comes in second for the least amount of sunny days, and ninth for low air quality. While for years we’ve been told to avoid certain skin cancers by staying out of the sun, new research showed a link between low vitamin D levels and increased propensity to the common cold. It’s also believed that vitamin D receptors in cells and tissue may help regulate the immune system. Irritants in the atmosphere can cause increased incidences of asthma, chest tightness or cough.

But there are ways to stay sane in cities while the state of the economy stays stressful. Dinwiddie says it's important to identify what's causing stress to be able to tackle it, and to find a good balance between work and home. He also points out that one of the good things about big cities is that they offer a variety of things that can rapidly change an individual's environment. "It's easy, for example, to go to the beach or catch a Cubs game," he says. "Although I suppose some people wouldn't consider that to relieve stress."

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