Addressing Farm Stress through Extension Mental Health Literacy Programs

Substance Use Among Illinois Farmers

BACKGROUND

 People in agriculture face unique stressors and occupational hazards, and relatively little is known about substance use in this population. The purpose of this study was to describe substance use among farmers in Illinois.

METHODS

 We conducted a mail survey of Illinois farmers that included the Brief ASSIST to assess substance use for lifetime and past three-month use of ten different substances. The survey also included questions about farming characteristics, mental health, stress, coping, social support, and demographic characteristics. We used chi-square and non-parametric tests to assess group differences.

RESULTS

 Alcohol, tobacco, cannabis, and sedatives were most reported as used for a lifetime and in the past three months. About three-quarters of the sample had recently used alcohol. Recent tobacco use was associated with not being married, less education, and less concern about climate-related farm stress. Recent sedative use was associated with greater concern about isolation-related farm stress. People who reported multiple substance use were at a greater risk for suicide and were more likely to meet the criteria for generalized anxiety disorder. None of the participants reported recent use of cocaine, heroin, inhalants, or hallucinogens.

CONCLUSION

 Specific social and cultural aspects of farming and farm communities may contribute to substance use among people working in agriculture. Future research can help to better understand this intersection and make recommendations for programs and resources to promote adaptive coping strategies.

Growing Resilience in Tough Times (GRITT): Development and Randomized Trial of a Farmer Mental Health Literacy Intervention

OBJECTIVES

Farmers in the United States (U.S.) are exposed to myriad stressors and experience their negative effects, including higher rates of suicide than individuals in some other occupations. However, interventions to address mental health amongst farmers have faced barriers, such as farmers' perceived stigma regarding mental health, time constraints, and geographical isolation. Using text-messaging for intervention delivery may help to address some barriers, as text messages are private, delivered directly to one's phone, and require no travel. Our objective was to develop and assess the feasibility, acceptability, and initial efficacy of a text-messaging mental health literacy intervention tailored to U.S. farmers: Growing Resiliency in Tough Times (GRITT).

METHODS

U.S. farmers (N = 134) were randomly assigned to an intervention group, who received 12 weeks of text messages regarding mental health literacy, or a control group, who received no treatment. Online pre-test and post-test surveys assessed mental health knowledge, familiarity with relevant mental health resources, self-efficacy to manage stress, and perceived stress. Feasibility was assessed via recruitment and retention data, and intervention group participants completed post-test measures to assess acceptability.

RESULTS

Results indicate that intervention group participants were highly satisfied with the intervention and had higher post-test scores on multiple facets of mental health literacy and self-efficacy to manage farm stress than control group participants. The intervention group experienced a significant drop in perceived stress from pre-test to post-test. Participant retention was relatively high (84%). However, recruitment difficulties call into question intervention feasibility.

CONCLUSION

Though the intervention was efficacious in enhancing mental health literacy, improving stress management self-efficacy, and reducing stress, difficulties with participant recruitment indicate the need for continued intervention research in this context.

What Do Farmers Need for Suicide Prevention: Considerations for a Hard-to-Reach Population

Purpose

Farmers have suicide rates much higher than the general population, with elevated mental health symptoms and high stress levels. Farmers are a hard-to-reach population due to occupational demands and a culture where conversations about mental health are often stigmatizing. This study explored ways to tailor suicide prevention strategies to unique characteristics of farmers by speaking with groups close to farmers who were open to discussing stress and suicide prevention: women married to farmers and agricultural Extension agents.

Methods

Focus groups with women married to farmers (N=29) and interviews with agricultural agents from the university's local Cooperative Extension offices (N=13) from rural Georgia counties explored effective ways outreach and education about suicide prevention, mental health, and coping could be provided to farmers. Using a thematic analysis approach, qualitative coding was completed by two researchers (Cohens kappa=0.86), with initial codes collapsed into common themes.

Results

Four themes were identified: 1) Barriers due to the nature of farming, including time demands of farming and cultural stigma in help-seeking; 2) Acceptable messaging, including framing conversations as part of general health; 3) Make information accessible by making it brief, clear, and omnipresent through multiple media; and 4) Elements of effective information and education, including emphasizing "you're not alone" and connection, how to access supports and crisis services, educating people close to farmers, and motivating farmers by emphasizing that they could help another farmer with the information.

Conclusion

Due to farmers' stoic identities and reluctance to admit mental health struggles, speaking with those close to farmers may help us better understand what is needed to tailor farmer suicide prevention strategies. The insights shared by participants suggest that culturally responsive outreach and education strategies, strengthening relationships through peer support, and gatekeeper training with specific trusted others are important ways to tailor suicide prevention strategies for this hard-to-reach group.

Measuring Gatekeeper Instructor Comfort to Inform Suicide Prevention Train-The-Trainer Recruitment & Training in Agricultural Communities

Farmers experience psychological distress and suicide at consistently higher rates than workers in other industries. A gatekeeper is an individual who has been trained to recognize warning symptoms of possible suicidal ideations in others. Gatekeeper programs are recognized by the federal Substance Abuse and Mental Health Services Administration as a best practice for suicide prevention. While gatekeeper programs offer promise to addressing the increasing worldwide suicide rate, how to develop these networks in communities with largely ingrained stigma and taboo related to mental health and suicide remains unanswered. Three of this study's researchers were part of the development and pilot of an agricultural community gatekeeper program and questioned how gatekeeper instructor psychological comfort could be conceptualized and operationalized for the purpose of informing gatekeeper instructor recruitment and training. After a thorough review of the literature, the researchers constructed a conceptual developmental model of gatekeeper instructor comfort and created a Gatekeeper Instructor Comfort Measure instrument which was then piloted with Kentucky K-12 and university agricultural educators. The researchers of this study employed the Rasch model to determine whether the developmental model of gatekeeper instructor comfort held together empirically. Infit and outfit mean squares (0.73 to 1.33) indicate that the items measure one construct, or are unidimensional, while person reliability and separation statistics indicate that the Gatekeeper Instructor Comfort Measure is composed of enough items to differentiate respondents into almost four strata of gatekeeper comfort. The Gatekeeper Instructor Comfort Measure's fit to the Rasch model indicates that the instrument meets the requirements of invariant measurement and should serve as a useful measure for other researchers. The instrument's item difficulty hierarchy also serves as a guide for those training gatekeepers on how to target different gatekeeper outcomes sequentially or developmentally. Researchers recommend restructuring item responses to enable greater discrimination between categories and then piloting the instrument again with a more diverse sample. The revised measure could be used pre- and post-gatekeeper instructor training to determine the impact of training on gatekeeper comfort.

Measuring Mental Health Service Preferences Amongst Illinois Dairy Producers

OBJECTIVES

To mitigate mental health concerns of farmers, research is needed to investigate strategies that encourage help-seeking behavior in this population. This study attempts to identify those help-seeking strategies. Six mental health service options were examined.

METHODS

A survey, implementing a best-worst scaling choice experiment, was disseminated to members of the Illinois Milk Producers Association. Two methods of analysis were conducted. The first, a count-based method, employs a simple count-based approach to measure the relative preferences for the six mental health service options in question. The second is more complex and employs a latent-class logit regression model to measure individual preferences.

RESULTS

The mental-health service options, ranked in order from most preferred to least preferred were: 1) speak to family and friends, 2) keep it to myself, 3) utilize programs offered by agricultural organizations, 4) search online for self-help resources, 5) talk to a mental health professional, and 6) use "tele-health" support services.

CONCLUSION

This study examined an important gap in the literature concerning help-seeking preferences of dairy farmers. It is the first to utilize a choice experiment approach to assess help-seeking preferences among this understudied population. Results provide important empirical evidence to support distinct categories of farmers who may be weighing options regarding how to best address their mental health concerns.

Factors Influencing Farmers' Use of Adaptive and Maladaptive Coping Strategies

OBJECTIVES

Chronic stress is associated with a variety of negative outcomes for farmers in the United States (U.S) and worldwide, who face near-constant exposure to internal (e.g. family conflict) and external (e.g. weather) stressors. Research indicates that farmers' stress may be reduced by engaging in adaptive coping strategies and avoiding maladaptive coping strategies. However, little is known about what predicts their coping strategy use. Informed by the transactional theory of stress and coping, the present manuscript seeks to identify factors associated with U.S. farmers' use of adaptive and maladaptive coping strategies.

METHODS

U.S. farmers (N = 135) completed survey assessments of factors theorized to be associated with coping strategy choice (maladaptive beliefs about farm stress management, farm stress management self-efficacy, age, and sex) as well as measures of adaptive and maladaptive coping.

RESULTS

Farm stress management self-efficacy was a significant, positive predictor of adaptive coping, and maladaptive beliefs about farm stress management were a significant, positive predictor of maladaptive coping. Maladaptive beliefs about farm stress management and farm stress management self-efficacy interacted to predict maladaptive coping, such that the positive relationship between maladaptive beliefs about farm stress management and maladaptive coping was significant at higher levels of self-efficacy. Sex was unrelated to coping strategies, and age was negatively associated with maladaptive coping strategies but unassociated with adaptive coping strategies.

CONCLUSION

The findings point to the utility of increasing farm stress self-management self-efficacy to increase farmers' adaptive coping and reducing maladaptive beliefs about farm stress management to reduce maladaptive coping. Efforts to promote adaptive coping by increasing self-efficacy should also target maladaptive beliefs farmers hold toward stress management, because increasing self-efficacy may also increase the likelihood of maladaptive coping when maladaptive beliefs are present.

Farmer Mental Health Interventions: A Systematic Review

The prevalence of mental health disorders and suicide amongst agricultural producers is a global problem. Community leaders, researchers, policymakers, and clinicians have mobilized to develop programs to address this issue. This study reviewed a wide range of mental health interventions targeting farmer mental health spanning over 50 years and examined their reported effectiveness and constraints. A total of ninety-two articles on farmer mental health were included in a final systematic review. Most articles were written concerning mental health literacy and peer and paraprofessional support interventions in the United States and Australia. Among the 56 studies reporting empirical evaluative data, 21 were mixed-method, 20 quantitative, 11 qualitative, and 5 literature synthesis. Non-experimental, self-reported, and qualitative data suggest efficacy of mental health literacy programs, peer and paraprofessional support, and community-based and agroecological interventions. However, most interventions were not subject to rigorous evaluation and only one intervention was evaluated using a control condition. The heterogeneity of existing studies and paucity of rigorous evaluation proscribes firm conclusions related to program-type efficacy. This review demonstrates that there is still a need for a stronger and broader evidence base in the field of farmer mental health interventions, which should focus on both holistic, multi-component programs and targeted approaches.