Louisiana is the second most stressed state, according to a report by WalletHub. Michelle Many with LSU Health New Orleans believes that’s because so many people in the Bayou State are poor. Many says a lack of money can prevent people from getting the psychological help they need.

“When you have good income, you can pay for mental health services out of pocket. When you have insurance provided by your employer, then you have access to a greater variety of providers,” Many said.

Many says it’s not surprising WalletHub ranked the Bayou State the worst state for psychologists per capita, since access is governed by income. The report finds Louisiana’s crime rate is the fourth worst in the nation and high crime rates can also take a toll on a person’s mental health.

“Where there is a higher level of poverty, there tends to be more crime, and where there’s more crime, people are more stressed,” Many said.

According to WalletHub, Louisiana has the 4th highest rate of adults in poor health. Many says when people are living in poverty, they sometimes have to make decisions that make sense financially, but not in terms of health.

“It may mean that you worry about things like copays or things that are not covered, and so you tend to put off getting healthcare attention until things get much worse and you have to go,” Many said.