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https://oxygennotincluded.gamepedia.com/Stress
I have never played with the hardest settings before so I have not really payed attention to it.
There are so many things - if they have low oxygen they actually get morale debuff, hotter than comfortable, colder than comfortable, etc etc etc. You could read the wikipedia if you want to but a quick way to see what's affecting your particular dupes in game is to hover above the morale number in the dupe info panel.
On harder difficulties you may want to invest in a massage table or two (in fact, might as well make a proper massage room using the room overlay to see what the requirements for that are) whereas on normal difficulties you would never think about it. I sure never thought about stress until I dipped my toes into the highest difficulty and then I learned the hard way.
another small tip to help highly stressed dupes is to stick them in the neural vacillators you find scattered about; one of the 4 traits they can acquire is one that reduces stress. Yes it can take a while to get the right trait but it's just a small tool to help deal with stress if you have that option available.
Like wcs150 wrote there are a lot of ways to gain stress but I speak with experience. You don't actually need massage tables at all because it's always one of the 3 reasons why your dupes gain stress:
1. 99% likely: Puddles are your worst enemy. NEVER leave them alive. Eliminate puddles immediately when you notice them.
2. 0,9% likely: Overpressure. Easy to deal with once you notice the area.
3. 0,1% likely: Low morale. You can kinda keep stress low even with +0 or +1 morale as long as dupes have to never deal with 1. or 2. stress sources.
Actually there's also 4. which is mourning for dead. You can cancel the debuff by building gravestone but it's usually just best to give up when things start to go downhill.