A regional approach to understanding farmer suicide rates in Queensland

'It sort of broke me': A thematic analysis of the psychological experiences and coping strategies employed by Australian fire-affected farmers

INTRODUCTION

People exposed to bushfires are known to be at heightened risk of experiencing mental health challenges. When farms are impacted, farmers often risk losing not only their homes but also their businesses, containing their livestock, infrastructure and identities.

OBJECTIVE

To understand the psychological experiences of farmers who have been exposed to fires on their farms and identify the coping strategies they already employ to recover and prepare psychologically for future bushfires.

DESIGN

In-depth, semi-structured interviews were conducted face-to-face or via Zoom. Thematic analysis was used to analyse the data, using a descriptive, essentialist approach. Sixteen farmers and/or their spouses (50% female; median age of 50.8 years), who owned and/or played an active role in the operation of a farming or pastoral enterprise and had been affected by a farm fire within the last 20 years, participated. Participants resided in inner regional, outer regional and remote South Australia and New South Wales.

FINDINGS

Seven overarching themes and 22 subthemes resulted: (1) intense emotions in the aftermath, (2) long-term psychological challenges, (3) deliberate focus on organising, prioritising and completing recovery-focused tasks, (4) importance of seeking and/or accessing support to rebuild, (5) adopting a positive attitude and outlook, (6) (dis)engaging from/with community and social connection and (7) various strategies employed to self-regulate emotions.

DISCUSSION/CONCLUSION

This study demonstrates the unique set of psychological challenges Australian farmers experience in the wake of a farm fire and the coping strategies they report using to help them manage. Findings will inform the development of contextually and culturally appropriate bushfire recovery and preparedness initiatives that are tailored to meet the unique needs of farmers and build upon their existing strengths.

Understanding farmers' barriers to health and mental health-related help-seeking: The development, factor structure, and reliability of the Farmer Help-Seeking Scale

PURPOSE

The aim of this research was to develop a contextually and culturally appropriate scale to assess farmers' barriers to health-related help-seeking.

METHODS

An initial pool of items was developed from the academic literature and input from an expert panel of farmers, rural academics, and rural clinicians. A draft 32-item questionnaire was then developed and sent to farmers registered with FARMbase, which is an Australian national farmer database.

FINDINGS

Two hundred and seventy-four farmers completed the draft questionnaire (93.7% male, 73.7% aged 56-75 years). An exploratory factor analysis identified 6 factors; "Health Issues are a Low Priority," "Concerns about Stigma," "Structural Health System Barriers," "Minimization and Normalization," "Communication Barriers," and "Continuity of Care.". Test-retest reliability was examined with a further 10 farmers (90% male, Mean age = 57, SD = 5.91), who completed the questionnaire twice (at 2- to 3-week intervals). Results indicated moderate-good test-retest reliability.

CONCLUSIONS

The resulting 24-item Farmer Help-Seeking Scale provides a measure of help-seeking that is specifically designed to capture the unique context, culture, and attitudes that can interfere with farmers' help-seeking, and inform the development of strategies to increase health-service utilization in this at-risk group.

Psychological Morbidity in the Farming Community: A Literature Review

The mental health of the farming community across industrialised nations has long been a major concern. Using an adapted procedure for a systematic literature review of observational epidemiological studies reporting prevalence (informed by the Joanna Briggs Institute method), this paper reviews peer-reviewed literature that explicitly compares farmer and non-farmer mental health (n = 48). In doing so, it provides a central and accessible evidence base for researchers and practitioners, and simultaneously reveals a stark lack of consensus; specifically, 54.0% of measures deployed to assess farmer mental health determined it to be the same as or even better than non-farming populations. This ambiguity sits in sharp contrast to the unequivocally worrisome farmer suicide statistics. Informed by the literature, the paper discusses potential reasons for this mismatch, including (i) farmers' progression through a different "pathway" to suicide that is not always preceded by mental illness, and (ii) a failure of current methods to accurately gauge the mental health status of farmers. The paper concludes by recommending more research into farmers' "pathway" to suicide, and highlights the need for a dedicated and multi-disciplinary programme of methods research that will afford a more culturally appropriate and effective means of understanding mental health in the farming community.

A thematic analysis of the personal factors influencing mental health help-seeking in farmers

PURPOSE

It is crucial to understand the micro-level personal factors that impact farmer mental health help-seeking, given that farmers are at increased risk of suicide yet show reduced mental health help-seeking behaviors.

METHODS

Ten farmers, 10 farmers' partners, and 8 general practitioners (ie, family physicians) from Australia completed qualitative semi-structured interviews. Braun and Clarke's method of thematic analysis was used to analyze the data.

FINDINGS

The analysis resulted in 4 themes: "mental health literacy," "stigma of mental illness and help-seeking," "support, the partners' role in help-seeking," and "the intersectionality between being a farmer, age, and gender." Farmers' knowledge and understanding of mental health and treatments was varied. Stigma was reported to be reducing, but still present toward both mental illness and mental health help-seeking. Support from a partner was reported to facilitate help-seeking if delivered tactfully. Lastly, being older and male were reported to negatively impact farmer mental health help-seeking.

CONCLUSION

The findings contribute to understanding farmer mental health help-seeking and could inform quantitative research and the development and implementation of interventions to promote mental health help-seeking in this group.

Disadvantaged by More Than Distance: A Systematic Literature Review of Injury in Rural Australia

Rural populations experience injury-related mortality and morbidity rates 1.5 times greater than metropolitan residents. Motivated by a call for stronger epidemiological evidence around rural injuries to inform prevention, a systematic review of peer-reviewed literature published between January 2010 and March 2021 was undertaken to explore the epidemiology of rural injury and associated risk factors in Australia. A subsequent aim was to explore definitions of rurality used in injury prevention studies. There were 151 papers included in the review, utilizing 23 unique definitions to describe rurality. People living in rural areas were more likely to be injured, for injuries to be more severe, and for injuries to have greater resulting morbidity than people in metropolitan areas. The increase in severity reflects the mechanism of rural injury, with rural injury events more likely to involve a higher energy exchange. Risk-taking behavior and alcohol consumption were significant risk factors for rural injury, along with rural cluster demographics such as age, sex, high socio-economic disadvantage, and health-related comorbidities. As injury in rural populations is multifactorial and nonhomogeneous, a wide variety of evidence-based strategies are needed. This requires funding, political leadership for policy formation and development, and implementation of evidence-based prevention interventions.

Participant perspectives of an online co-design process to develop a prevention-focused mental health and well-being platform for primary producers

OBJECTIVE

To explore participant experiences of an online co-design process to develop a web-based preventative mental health and well-being intervention targeting primary producers in rural Australia.

SETTING

Rural Victoria, Australia.

PARTICIPANTS

Participants from a primary producer background, including horticulture, fisheries, animal cultivation and farm consultancy, were eligible for the study if they had participated in both the co-design and beta testing processes for a primary producer platform.

DESIGN

A qualitative study using semi-structured phone-based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes.

RESULTS

Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant diversity, (2) impact of online delivery on co-design participation, (3) experiences of the co-design process, (4) maintaining a shared vision and goals and (5) acting on the co-design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co-design using face-to-face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face-to-face.

CONCLUSIONS

Using an online co-design method to develop a preventative mental health and well-being web-based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co-design process and identify opportunities to improve participant engagement and experience with the online format.

Understanding and addressing psychological distress experienced by farmers, from the perspective of rural financial counsellors

OBJECTIVE

To explore rural financial counsellors' experiences interacting with psychologically distressed farmers and identify contextually appropriate methods to maintain their own well-being and link farmers to psychological supports, within their existing roles.

SETTING

Rural, regional and remote Australia.

PARTICIPANTS

Fifty rural financial counsellors participated. They worked across 6 Australian states/territories.

DESIGN

Individual semi-structured telephone interviews were audio-recorded with consent. Qualitative data were analysed using thematic analysis. Themes were identified using an essentialist, bottom-up approach.

RESULTS

Forty-six themes emerged relating to the 5 topics explored: (a) how to recognise distress in farmers (eg inability to focus/make decisions, deterioration in presentation/organisation, anger, blaming); (b) impact of farmers' psychological distress on the financial case management process (eg slows, disrupts or stops it, negatively impacts counsellor well-being); (c) strategies for working effectively with distressed farmers (eg flexibility, open-ended questions, listening to story, simplicity, instilling hope); (d) referral of distressed farmers to psychological support (eg willing if tried themselves/positive reports, lack of local rural face-to-face services, stigma and lack of understanding of importance challenging, a farming focus and support from family/ community assists); and (e) strategies to maintain their own well-being (eg compartmentalising, exercise, supervision).

CONCLUSION

Rural financial counsellors play an important role by recognising signs of distress in farmers and referring them to appropriate psychological supports. However, this is a demanding role and ensuring counsellors have appropriate services to refer farmers to, and support with their own well-being, is imperative.

"Don't … Break Down on Tuesday Because the Mental Health Services are Only in Town on Thursday": A Qualitative Study of Service Provision Related Barriers to, and Facilitators of Farmers' Mental Health Help-Seeking

The suicide rate of farmers is approximately double that of the general Australian population, yet farmers employ fewer help-seeking behaviours (Arnautovska et al. in Soc Psychiatry Psychiatr Epidemiol 49:593-599, 2014; Brew et al. in BMC Public Health 16:1-11, 2016). Therefore, it is crucial to understand if, and how health services and system might influence farmer help-seeking. To shed light on this, the current study employed qualitative semi-structured interviews with 10 farmers, 10 farmers' partners and 8 medical practitioners. Thematic analysis, guided by Braun and Clarke's (Qual Res Psychol 3:77-101, 2006) techniques, was used to analyse the data. Three themes were devised concerning the interaction between farmers and health services, including 'health service interactions', 'services are provided within a complex system' and 'emerging technologies: the users, practitioners, and systems'. The findings underscore the importance of interactions between a farmer and a service provider, with farmers wanting their provider to have an understanding of farming life. Help-seeking was also shaped by access, availability, and practitioner constancy. Lastly, a complex relationship between digital mental health services and farmer help-seeking was reported, with factors related to the farmers, the practitioners and the infrastructure/systems discussed. The outcomes have implications for health service and policy reform, developing and providing interventions for farmers to promote health services interaction as a way of mental health help-seeking.

The ripple effect: a digital intervention to reduce suicide stigma among farming men

BACKGROUND

Compared with the general population, Australian farmers-particularly men-have been identified as at greater risk of suicide. A complex range of factors are thought to contribute to this risk, including the experience of Stigma. stigma also impacts those who have attempted suicide, their carers, and those bereaved by suicide-manifesting as shame, guilt, social isolation, concealment of death, reduced help seeking and ongoing risk of suicide. This paper evaluates the effectiveness of an intervention, tailored for the farming context, designed to reduce stigma among farming men with a lived experience of suicide.

METHODS

The digital intervention used an adult learning model providing opportunity to share insights, reflect, learn and apply new knowledge among people with shared farming interests, suicide experience and cultural context. A range of content-tailored to the gender, farming type and suicide experience of participants-included video stories, postcard messages, education and personal goal setting. Pre- and post- assessment of suicide stigma and literacy was complemented by qualitative data collection during the intervention and participant feedback surveys.

RESULTS

The intervention was successful in reaching members of the target group from across Australia's rural communities-with diverse geographic locations and farming industries represented. One hundred and sixty-nine participants from the target group (farming males aged 30-64 years) were recruited. While the Stigma of Suicide Scale failed to identify a reduction in self- or perceived-stigma, qualitative data and participant feedback identified behavioural indicators of stigma reduction. Four subthemes-'growth', 'new realisations', 'hope' and 'encouragement'-highlighted attitudinal and behaviour change indicative of reduced stigma associated with mental health and suicide. Participants' baseline suicide literacy (Literacy of Suicide Scale) was high when compared with previous community samples and total literacy scores did not demonstrate significant improvement over time, although literacy about the link between suicide and alcoholism did significantly improve.

CONCLUSIONS

These results highlight opportunities in groups with high suicide literacy for targeted stigma reduction and suicide prevention efforts for both the target group and other populations within Australia and internationally. Results also highlight the need to reassess how stigma change is understood and evaluated across a wider range of population groups.

TRIAL REGISTRATION

This research project was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12616000289415) on 7th March, 2016.

Suicide in Rural Australia: Are Farming-Related Suicides Different?

Rural Australians experience a range of health inequities—including higher rates of suicide—when compared to the general population. This retrospective cohort study compares demographic characteristics and suicide death circumstances of farming- and non-farming-related suicides in rural Victoria with the aim of: (a) exploring the contributing factors to farming-related suicide in Australia’s largest agricultural producing state; and (b) examining whether farming-related suicides differ from suicide in rural communities. Farming-related suicide deaths were more likely to: (a) be employed at the time of death (52.6% vs. 37.7%, OR = 1.84, 95% CIs 1.28–2.64); and, (b) have died through use of a firearm (30.1% vs. 8.7%, OR = 4.51, 95% CIs 2.97–6.92). However, farming-related suicides were less likely to (a) have a diagnosed mental illness (36.1% vs. 46.1%, OR=0.66, 95% CIs 0.46–0.96) and, (b) have received mental health support more than six weeks prior to death (39.8% vs. 50.0%, OR = 0.66, 95% CIs 0.46–0.95). A range of suicide prevention strategies need adopting across all segments of the rural population irrespective of farming status. However, data from farming-related suicides highlight the need for targeted firearm-related suicide prevention measures and appropriate, tailored and accessible support services to support health, well-being and safety for members of farming communities.

[Sentinel program: Example of suicide prevention for an agricultural population in Switzerland]

OBJECTIVES

In the field of suicide prevention, the identification of risk groups is important, as is the training of front-line workers, to raise awareness of suicide issues. Agricultural workers represent a group at high risk of suicidal behavior due to various factors (low income of farmers, work related to climatic conditions, social isolation, poor access to primary care). The main objective of this article is to present the implementation of prevention training in suicide prevention for a population of agricultural workers in two cantons of French-speaking Switzerland (Vaud and Neuchâtel) which represent a population of about 980,000 inhabitants. The second objective is to identify the experiences of the participants in this training and their expectations.

METHODS

Suicide prevention training sessions are organized in collaboration with public health departments, agriculture departments and suicide prevention professionals. Each session is led by four trainers experienced in suicide prevention and belonging to the "Groupement Romand Prévention du Suicide" (GRPS) which manages the training and other training modules on this topic in French-speaking Switzerland. The GRPS guarantees the content of the training as well as the updating of scientific knowledge. The training model is based on a concept that alternates between brief theoretical contributions, exchanges between participants in plenary sessions and role playing in small groups. The training has two main objectives: on the one hand to work on the participants' representations of suicide and to modify their posture by training "sentinels", i.e. "peers" who can establish a link between suffering individuals and the available support resources. On the other hand, to give key messages: dare to talk about the suicidal question and to not remain alone with this.

RESULTS

Between December 2016 and May 2018, nine sessions were held in the two cantons of Vaud and Neuchâtel with a total of 220 participants. The sessions took place in agricultural schools or buildings related to agriculture. Invited to express themselves on the theme of suicide as well as on the concept of training, agricultural workers all verbalized the importance of this issue and were often very moved when the subject was discussed. The topics addressed by the participants were the taboo aspect of the subject, the difficulty of talking about it and the need to be able to address the subject (breaking the isolation). Participants also highlighted the need for peers to act as relays for help.

CONCLUSIONS

The sessions were highly appreciated by the organizers concerned, particularly by the public health and agricultural departments. Participants expressed their satisfaction at the opportunity to express their views on this subject, regretting that such initiatives are all too rare. Although studies highlight the difficulty of emotional expression in the agricultural field, we observed on the contrary a great facility of the participants to express their emotions in relation to the suicidal theme. We have highlighted that the issue of suicide in this population is linked to several causal factors, as is the suicidal issue more broadly. Factors specific to this population emerged from the sessions, including working conditions and difficulties related to the family environment of farmers. There is a need to strengthen suicide prevention with training programs among the agricultural population. We also note the major importance of improving access to mental health care which is often very deficient in rural areas.

An Analysis of Farmers' Human Characteristics as Drivers of Their Anxiety

Background: Past research has shown farmer anxiety and stress have significantly affected many farmers and their families due not only to the impact on feelings of happiness and success, but also on output efficiency, accident rates, and health. The past approach to ameliorating anxiety has been through utilizing coping mechanisms such as sharing with significant others, venting, planning, self-blame, and positive thinking. A problem has also been farmers' reluctance to voice difficulties and seek help.Method: An alternative, more basic approach to anxiety amelioration is possible. This involves isolating the human characteristics that lead to anxiety, and subsequently modifying these to reduce anxiety and its associated impacts. Accordingly, the extensive literature on anxiety and stress was reviewed to facilitate developing an hypothesis outlining the important components explaining farmer anxiety. To assess the parameters of farmer anxiety, a random survey of New Zealand farmers was used to obtain their ratings on their anxiety. Regression models were used to quantify the relationships.Results: Specific farmer personal characteristics were shown to be highly related to anxiety. These included a farmer's personality, objective set, belief in their ability to control outcomes, as well as education and age.Conclusion: This analysis provides the information required to direct counseling efforts to modify the anxiety creating personal variables and, consequently, reduce anxiety and its impact on a longer term basis.

Suicide and Accidental Death for Australia's Farming Families: How Context Influences Individual Response

This article presents qualitative data to explore the experience of farming family members faced with accidental or suicide death and understand how this is experienced within the farming context. Individual semistructured interviews were conducted with 25 members of Australian farming families bereaved by suicide or accidental death. Qualitative data was thematically analyzed. Three interconnected themes were identified: acceptance of risk, normalization of death, pragmatic behavior patterns and connection to place. Bereavement and reconstruction of meaning following suicide or accidental death for farming families is influenced by the cultural, social, geographical, and psychological contexts of farming families. This article challenges traditional conceptions of suicide and accidental death as necessarily experienced as "violent" or "traumatic," bereavement as experienced similarly across western cultures, and the reaction to suicide or accidental death as one that challenges people's understanding of their world and leaves them struggling to find a reason why the death occurred.

A Pest to Mental Health? Exploring the Link between Exposure to Agrichemicals in Farmers and Mental Health

The current literature acknowledges that occupational exposures can adversely affect mental health. This review seeks to elucidate the current understanding of the effect of agrichemical exposure on mental health in the agricultural sector, including low-dose, chronic pesticide exposure. This scoping review adopted a snowballing and saturation approach. The review highlights inconsistencies in linking poor mental health and pesticide use. While some studies specifically showed that both high- and low-dose pesticide exposure were associated with poor mental health, consistent and rigorous research methods are lacking. The review also proposes terms to delineate exposure types described in the literature. The review outcomes direct efforts to protect the health, wellbeing and safety of farming communities across the globe.

Social factors and Australian farmer suicide: a qualitative study

BACKGROUND

Farmers and farm workers have been recognised as a group at high risk of suicide in Australia; however this risk is not without geographic and demographic variation. This study aims to identify and better understand the complex interplay of risk and protective factors surrounding farmer suicide, with an emphasis on social influences, so as to inform tailored and effective suicide prevention initiatives.

METHODS

Focus groups were conducted in three diverse sites across two states in Australia with men and women separately to gain perceptions about suicide risk and protective factors and attitudes towards suicide and help seeking. The three communities in each state represented areas with a suicide rate similar to, above, and below the state average. The communities were also diverse in their population, types of farming, geographic location, distance from and access to services. There were a total of 33 female and 30 male participants.

RESULTS

Qualitative analysis indicated three major interrelated social factors: (1) changing rural communities, (2) community attitudes and stigma and (3) relationship issues.

CONCLUSIONS

The biopsycho-ecological model is considered useful to better understand and address social, as well as individual and environmental factors, pertaining to farmer suicide.

Farm suicides in New Zealand, 2007-2015: A review of coroners' records

OBJECTIVE

Economic recessions and severe weather events are often associated with increased suicide rates. The Global Dairy Crisis 2015/2016 led to an economic downturn in the New Zealand dairy farming industry and, coupled with droughts in some regions and floods in others, raised fears about increased suicide rates among farmers. However, little was known about suicides in the farming sector. This study reviews characteristics of recent farm-related suicides in New Zealand and assesses the extent to which financial stresses contributed to the deaths.

METHODS

Data were abstracted from coroners' records for a consecutive series of 185 people in farm- and agriculture-related occupations who died by suicide between 2007 and 2015 and for whom coronial inquiries had been completed.

RESULTS

Farm suicides were heterogeneous: six distinct risk profiles were identified. Financial stresses made negligible contributions to farm suicides. Overall, risk factors for farm suicides differed little from risk factors for suicide in the general population. However, suicide risk in farmers was exacerbated by ready access to firearms: almost 40% of farm suicides involved firearms, compared to 8% in the general population over the same time. Among farm suicides, young male farm labourers predominated, rather than farm owners or managers. For many young men, relationship losses, acute alcohol intoxication and ready access to a firearm formed a common constellation of risk factors.

CONCLUSIONS

While coroners' records are variable and do not record specific information about financial stresses and weather events, it was clear that these issues made a negligible contribution to farm suicides. A range of rural suicide prevention initiatives are needed to address various farm suicide risk profiles. In particular, young male labourers often had no contact with health services prior to death, suggesting that rural suicide prevention efforts need to be positioned within community, farming and sports organisations, as well as health and social service providers.

Epidemiology of coronial deaths from pesticide ingestion in Australia

Pesticides in Australia are tightly regulated but it is unknown how this may affect the distribution of misuse and self-harm across Australia, both spatially and within subgroups in the population. We performed an observational study to examine spatial differences in suicide/deliberate poisonings with pesticides in Australia. We examined Coronial inquest cases of self-harm by pesticide ingestion for the years 2001-2013 (n=209). Coronial cases were older, more likely to be male, have lower SES status and live in outer regional areas as opposed to cities when compared to the general population. Case densities (cases/100,000 population) were lower in large capital cities and higher in agricultural areas: despite this half the cases occurred in major cities.

Research protocol for a digital intervention to reduce stigma among males with a personal experience of suicide in the Australian farming community

Background

Australian farming communities have up to twice the suicide rate of the general population. Men, particularly, demonstrate debilitating self- and perceived-stigma associated with an experience of suicide. The Ripple Effect is aimed to reduce suicide stigma within the social, cultural, geographical and psychological contexts in which it occurs.

Methods

A mixed-method design with multi-level evaluation will be effected following the development and delivery of a personalised website experience (combining shared stories, education, personal goal setting and links to resources) to farming men, aged 30–64 years, with an experience of suicide. Pre- and post-surveys will be used to assess changes in self- and perceived-stigma and suicide literacy. Online feedback from participants and semi-structured interviews during follow-up will be thematically analysed.

Discussion

This project will provide information about increasingly accessible, innovative approaches to reducing the debilitating health and wellbeing effects of suicide stigma on a population of Australia’s farmers.

Trial registration

This research protocol was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN: ACTRN12616000289415) on 7^th March, 2016.

Geographic variation in suicide rates in Australian farmers: Why is the problem more frequent in Queensland than in New South Wales?

Research on farmer suicide is limited in explaining the variations in farmers' demographic characteristics. This study examines farmer suicides in two Australian states: Queensland (QLD) and New South Wales (NSW). Standardized suicide rates over 2000-2009 showed a 2 times higher prevalence of suicide in QLD than NSW (147 vs. 92 cases, respectively). Differences in age and suicide method were observed between states, although they do not appear to account for the sizeable intra- and interstate variations. Suicide prevention initiatives for farmers should account for different age groups and also specific place-based risk factors that may vary between and within jurisdictions.

Suicide Mortality Across Broad Occupational Groups in Greece: A Descriptive Study

Background

Several studies have investigated the relationship between specific occupations and suicide mortality, as suicide rates differ by profession. The aim of this study was to investigate suicide mortality ratios across broad occupational groups in Greece for both sexes in the period 2000–2009.

Methods

Data of suicide deaths were retrieved from the Hellenic Statistical Authority and comparative mortality ratios were calculated. Occupational classification was based on the International Classification of Occupations (ISCO-88) and the coding for Intentional self-harm (X60–X84) was based on the international classification of diseases (ICD-10).

Results

Male dominant occupations, mainly armed forces, skilled farmers and elementary workers, and female high-skilled occupations were seen as high risk groups for suicide in a period of 10 years. The age-productive group of 30–39 years in Greek male elementary workers and the 50–59 age-productive group of Greek professional women proved to have the most elevated number of suicide deaths.

Conclusion

Further research is needed into the work-related stressors of occupations with high suicide mortality risk and focused suicide prevention strategies should be applied within vulnerable working age populations.