U.S. workers who have problems managing their day-to-day finances are more likely to experience unmanageable financial stress than those who have a handle on their finances.

That’s among the findings in the annual “Financial Stress Research” study from El Segundo, California-based Financial Finesse, which found that cash management is a primary underlying factor in determining an employee’s financial stress level.

Most employees, according to the study, continue to worry about their personal finances, with 25% of employees who took a financial wellness assessment in 2015 indicating high or overwhelming financial stress. Approximately a third were assessed as vulnerable to living beyond their means and having serious debt.

Employees suffering from unmanageable stress levels are generally the ones living paycheck to paycheck, with expenses exceeding their incomes and/or with large debt balances and no emergency savings. Just 36% of these have a handle on their cash flow, while only 16% have an emergency fund and 67% pay their bills on time.

Why should this worry employers? The stress employees feel translates to employers in terms of presenteeism, absenteeism and increased healthcare costs. For one thing, 60% of employees are losing sleep over their financial situations, resulting in a loss of 11.3 days of productivity per year.

The study cited a poll by AP-AOL that found that 29% of people with high levels of stress from debt have suffered from severe anxiety, and 23% have suffered from severe depression. But it doesn’t stop there; stress hormones increase overeating, which can lead to obesity and related health problems. Then there’s the increased risk of substance abuse.

Financial stress also affects smoking rates. Ex-smokers who had more than average levels of financial stress were significantly more likely to relapse, and current smokers who experienced above-average financial stress were significantly less likely to quit.

Stress’s effects on health and heart problems are well documented; the AP-AOL poll also found that 44% of people with high levels of stress from debt have suffered  from migraines, 27% have suffered from ulcers or digestive issues, and 33% have suffered from hypertension. People under high stress from debt are also twice as likely to have a heart attack.

— Check out 41% of Adults Not Saving for Retirement: Franklin Templeton on ThinkAdvisor.