Americans are increasingly concerned about political discourse and the forces driving violence in the United States, according to new Gallup findings.

The survey shows 69% of Americans believe Republicans and their supporters have gone too far with inflammatory rhetoric, while 60% say the same of Democrats — sharp increases from 2011.

Seventy-one percent say extremist viewpoints spreading online are to blame “a great deal” for recent political violence, with majorities also citing inflammatory language from political figures and failures in the mental health system.

Gallup and West Health report continued dissatisfaction with U.S. healthcare, as Americans give their local systems an overall grade of C. Quality and access earned C+ marks, while cost received a D+, with no state scoring an A in any category.

Holiday spending expectations have also dipped, with Americans estimating they will spend $778 on gifts — the lowest November projection since 2016.

Read more at Gallup.