Toward a Public Health Approach to Farmer Suicide Prevention: The Potential Power of Systems Change

OBJECTIVE

Suicide among farmers has, over the past 20 years, garnered attention from scholars around the world. The purpose of this paper is twofold. First, this paper will present a framework for considering farmer suicide that builds upon the Interpersonal-Psychological Theory of Suicidal Behavior and extends our current explanations of suicide to include a multilevel, multifactorial focus on individual, interpersonal, community and systemic factors at the root of stressors contributing to suicide among farmers. Secondly, a blueprint for farmer suicide prevention, leveraging the Water of Systems Change Model, is proposed.

METHOD

In the spirit of conveying multi-layered influence on farmer suicide while highlighting relevant levels for prevention a parsimonious, prevention-based model of farmer suicide is presented.

RESULTS

The Water of Systems Change (WSC) model incorporates research to bring attention to the community, organizational, and societal conditions that keep a problem, such as farmer suicide, from being eradicated.

CONCLUSION

Suicide is a societal issue that requires a multi-level response. Farmer suicide is a particular concern, as farmers provide for and support all of us. It is incumbent upon public health and the community-at-large to improve our policies, systems, and contexts to create an environment in which farmers are also provided for and supported.

Mental Health Among LGBTQ+ Farmers in the United States

OBJECTIVES

The objective of the current study is to describe mental health among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people who work in agriculture in the U.S.

METHODS

This study uses a survey of LGBTQ+ adults who work in agriculture in the U.S. (N = 148), including questions about LGBTQ+ identity, farming background, depression symptoms (PHQ-8) and diagnosis, anxiety symptoms (GAD-7) and diagnosis, suicide risk, and stress. Data were analyzed using SPSS, including descriptive statistics, chi-square tests, and Mann-Whitney U tests.

RESULTS

Over one-third (36.1%) had probable depression (PHQ-8 ≥ 10), and 71.9% were experiencing mild to severe depression symptoms. Nearly half (46.2%) had probable anxiety disorder (GAD-7 ≥ 8), and 69.7% experienced mild to severe anxiety symptoms. Over half (51.7%) were at significant risk for suicide. Greater proportions of men had probable anxiety disorder, probable depression, and suicide risk compared to non-men. Greater proportions gay participants had probable depression, as did beef producers. Perceived stress was higher for men, lesbian and gay participants, transgender participants, and those in beef production. Resilient coping was highest among participants who were genderqueer or genderfluid, bisexual, and those in field crop production.

CONCLUSION

LGBTQ+ farmers in the current sample experienced depression and anxiety at higher rates than general farming or general LGBTQ+ samples, although suicide risk was lower than for general LGBTQ+ samples. Future research should explore how working in agriculture may be protective against suicide risk for LGBTQ+ farmers, as well as how specific farm stressors are related to LGBTQ+ farmer mental health.

Impact of Training on Addressing Farmer Mental Health in Occupational Therapy Practice

Farmers experience high rates of mental health conditions and suicide. It is within occupational therapy's scope to address mental health conditions in patients as it pertains to their participation in meaningful occupations. The aim of this study is to assess the efficacy of training provided to occupational therapy practitioners and students on addressing farmer mental health. Participants were directly recruited from occupational therapy state associations and graduate programs in the American Midwest to attend a 1-hour presentation and complete pre- and post-training surveys. A total of 119 participants completed the pre- and post-training surveys. Both occupational therapy practitioners and students significantly increased their confidence in assessing and addressing mental health concerns and providing resources to farmers following the training. Occupational therapy-specific training can increase therapists' confidence in addressing farmer mental health. Further research should assess multi-faceted interventions related to farmers' mental health in occupational therapy practice.

High levels of anxiety and depression in women farmers from Ecuador: A cross-section study in Coastal and Highlands regions

BACKGROUND

Previous studies have shown that women farmers are particularly vulnerable to mental health disorders such as depression and anxiety.

AIMS

This study aimed to investigate the prevalence of anxiety and depression in women farmers from Ecuador Coastal and Highlands regions.

METHOD

General Anxiety Disorder‑7 (GAD‑7) and Patient Health Questionnaire‑9 (PHQ‑9) were applied. In addition, self-reported number of children, days off, hours of work, pesticide use, sleep habits and years of work in agriculture, were also collected. This cross-sectional study occurred during 2023 with 443 women, for Coastal (197) and Highlands (246), respectively. Multivariable binary logistic regression models were performed to obtained adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI).

RESULTS

34.5% of Coastal women had depression, while 27.2% of Highlands women had depression. 20.3% of coastal women farmers had anxiety, while in the Highlands 24.8% had anxiety. Coastal mestizo and montubio women exhibited lower probability of depression, but this was not significant in the Highlands. Coastal women farmers that did not have children showed lower odds of depression (aOR 0.05, 95% CI [0.01, 0.34]). A lower likelihood of depression was observed in coastal women that worked more than 8 hours (aOR 0.22, 95% CI [0.07, 0.72]). Women from the Highlands that had shortened sleep duration exhibited lower odds of depression and anxiety.

CONCLUSIONS

A higher proportion of depressed women farmers was observed in the Coast region and slightly higher numbers of anxiety cases in the Highlands. The number of children may cause workload and is correlated with depression in Coastal women.

Exploring factors affecting psychological resilience of farmers living in drought-affected regions in Iran: a qualitative study

Introduction

Drought, a prevalent consequence of climate change, significantly impacts mental health among farmers. Enhancing psychological resilience is crucial to mitigating these effects. This study aims to explore the concept and factors affecting the psychological resilience of farmers living in drought-affected regions in Iran.

Method

This study utilized a conventional qualitative content analysis method. Twenty-six participants, divided into two groups of experts and farmers, were selected through purposive sampling. Data collection was conducted via in-depth semi-structured interviews. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and was carried out between June 2023 and February 2024.

Results

The factors affecting the psychological resilience of farmers living in drought-affected regions were categorized into two main categories with nine subcategories. The first category, environmental factors, included economic factors, socio-cultural factors, drought adaptation methods, government policies, and infrastructural factors. The second category, intra-individual factors, comprised personal characteristics, health factors, psychological factors, and perception and knowledge.

Conclusion

The study revealed that both environmental and intra-individual factors influence the psychological resilience of farmers during droughts. It is recommended to implement intervention strategies, such as providing training and education on drought adaptation methods and managing agricultural and healthcare expenses. Further research is needed to expand this concept to various disasters and occupational groups in future studies.

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.

Farmers' Mental Health: The Mediating Role of Chronic Fatigue

The agricultural environment is known to be particularly harmful to farmers' psychological health. To better understand how its impact is modulated, this study mainly focuses on the mediating role of chronic fatigue between A) loneliness at work, autonomy, workload, government regulations and policies and financial hardship, and B) life satisfaction, positive affect and psychological distress. The study is based on a sample of 453 Canadian dairy farmers. Structural equation modeling analyses confirmed the mediating role of chronic fatigue in the relationships between the factors studied, with the exception of financial hardship. Implications for research and the psychological burden affecting agricultural workers are discussed.

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.

Promoting Farmer Appreciation in Kentucky through a Farmer Cultural Awareness Project

OBJECTIVES

To address the perception among farmers of lack of appreciation and being devalued by the non-farming public.

METHODS

Oral history interviews were conducted to gather farmers' viewpoints of what the non-farming public needs to know about their occupation.

RESULTS

The creation of a public awareness campaign utilizing interview data, including canvas bags, information cards, and a website.

CONCLUSION

The public awareness campaign provides the non-farming public with opportunities to learn about the lives of farmers and their contributions to society.

Profile and risk factors in farmer injuries: a review based on Haddon matrix and 5 E's risk reduction strategy

Farmers are considered a high-risk group for intentional and unintentional injuries. This review identified significant risk factors for agricultural injuries in farmers and explored injury prevention countermeasures based on the literature. Therefore, CiteSpace software was used to analyze the relevant literature in this field. Additionally, we identified both key risk factors and countermeasures using the Haddon matrix and the 5 E's risk reduction strategies conceptual framework, respectively. The risk factors were identified from four categories (host, agent, physical environment, and social environment) corresponding to three phases (pre-event, event, and post-event). Interventions of 5 E's risk reduction strategies including education, engineering, enforcement, economic, and emergency response have been proven effective in preventing injuries or reducing their severity. Our findings provide a comprehensive foundation and research direction for the study and prevention of injuries among farmers.

Depressive symptoms and suicide attempts among farmers exposed to pesticides

Pesticides safeguard crop health but may diminish cholinesterase activity in farmers, potentially leading to psychiatric disorders like depression and suicide attempts. This study, with 453 participants (225 pesticide-exposed farmers, 228 non-farmers) in Almería, Spain, aimed to investigate the presence of depressive symptoms and suicide attempts, the decrease acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity, and their relationship with pesticide exposure in farmers. Depressive symptoms were evaluated using the Spanish adaptation of the Beck Depression Inventory, and blood samples were analyzed for AChE and BChE activity. Farmers showed significantly increased risk of moderate/severe depression and suicide attempts compared to non-farmers (OR = 2.18; p = 0.001), with highest risks observed among mancozeb users (OR = 2.76; p = 0.001 for depression) and malathion users (OR = 3.50; p = 0.001 for suicide attempts). Findings emphasize elevated depression and suicide risks among pesticide-exposed farmers, particularly associated with chlorpyrifos, mancozeb, and malathion exposure.

Glyphosate: Impact on the microbiota-gut-brain axis and the immune-nervous system, and clinical cases of multiorgan toxicity

Glyphosate (GLP) and GLP-based herbicides (GBHs), such as polyethoxylated tallow amine-based GLP surfactants (GLP-SH), developed in the late 70', have become the most popular and controversial agrochemicals ever produced. Nowadays, GBHs have reached 350 million hectares of crops in over 140 countries, with an annual turnover of 5 billion and 11 billion USD in the U.S.A. and worldwide, respectively. Because of the highly efficient inhibitory activity of GLP targeted to the 5-enolpyruvylshikimate-3-phosphate synthase pathway, present in plants and several bacterial strains, the GLP-resistant crop-based genetic agricultural revolution has decreased famine and improved the costs and quality of living in developing countries. However, this progress has come at the cost of the 50-year GBH overuse, leading to environmental pollution, animal intoxication, bacterial resistance, and sustained occupational exposure of the herbicide farm and companies' workers. According to preclinical and clinical studies covered in the present review, poisoning with GLP, GLP-SH, and GBHs devastatingly affects gut microbiota and the microbiota-gut-brain (MGB) axis, leading to dysbiosis and gastrointestinal (GI) ailments, as well as immunosuppression and inappropriate immunostimulation, cholinergic neurotransmission dysregulation, neuroendocrinal system disarray, and neurodevelopmental and neurobehavioral alterations. Herein, we mainly focus on the contribution of gut microbiota (GM) to neurological impairments, e.g., stroke and neurodegenerative and neuropsychiatric disorders. The current review provides a comprehensive introduction to GLP's microbiological and neurochemical activities, including deviation of the intestinal Firmicutes-to-Bacteroidetes ratio, acetylcholinesterase inhibition, excitotoxicity, and mind-altering processes. Besides, it summarizes and critically discusses recent preclinical studies and clinical case reports concerning the harmful impacts of GBHs on the GI tract, MGB axis, and nervous system. Finally, an insightful comparison of toxic effects caused by GLP, GBH-SH, and GBHs is presented. To this end, we propose a first-to-date survey of clinical case reports on intoxications with these herbicides.

Depression in Brazilian farmers: prevalence and associated factors

BACKGROUND

The unique characteristics of rural areas and agricultural work can contribute to the genesis of diseases, including mental disorders such as depression.

AIMS

To estimate the prevalence of and factors associated with depression symptoms in Brazilian farmers.

METHODS

A cross-sectional epidemiological study involving 784 farmers of the state of Espírito Santo/Brazil was carried out. Depression was identified using the Mini-International Neuropsychiatric Interview. Hierarchical logistic regression was used to assess the associated factors.

RESULTS

The prevalence of depression symptoms among farmers was 16.8% (n = 132). Of those experiencing symptoms, 6.1% (n = 48) we're currently experiencing a depressive episode, and 10.7% (n = 84) a recurrent depressive episodes. The associated factors were: female gender (OR 1.63; 95% CI 1.04-2.54), not owning the land (OR 1.79; 95% CI 1.11-2.89), professional dissatisfaction (OR 1.99; 95% CI 1.18-3.35), previous pesticide poisoning (OR 2.87; 95% CI 1.45-5.67), complex multimorbidity (OR 1.95; 95% CI 1.15-3.31) and occurrence of previous depressive episodes (OR 9.83; 95% CI 4.39-21.99).

CONCLUSIONS

A high prevalence of depression symptoms was identified among rural workers. Sociodemographic, occupational, clinical, and professional dissatisfaction factors were associated with a higher risk of depression symptoms in this population.

Navigating Farm Stress: Traumatic and Resilient Dimensions of the Black Agrarian Frame

The current period of economic and social instability in the farm economy has generated renewed interest in the framing processes used by farmers to interpret and ascribe blame for the distress they have experienced. Studies show that agrarian frames are differentiated into types based on farmers' historical and contemporary racialized experiences. To investigate the role that agrarian frames play in navigating farm stress, we conducted a thematic analysis using data from interviews with 15 Black farmers from three Southern states. The results identify a Black Agrarian frame with two dimensions: traumatic and resilient. The traumatic dimension provides a system-blame narrative that highlights financial risk driven by institutions and racism as a core factor in farm stress. The resilient dimension describes collective action as a key coping strategy linked to understanding the farm as a multi-faceted asset. In conclusion, research on differentiated agrarian frames is an important component towards understanding how diverse populations navigate farm stress and the development of culturally appropriate resources for addressing it.

Indicators of occupational pesticide exposure are associated with psychiatric symptoms

In southeastern Spain, intensive and highly productive agriculture under plastic also poses a risk to human health, as evidenced by reports on acute pesticide poisoning and its effects on mental health. However, knowledge of chronic exposures and their relationship to psychiatric disorders is still limited. This study analyzed the relationship between occupational exposure to pesticides and psychiatric disorders in farmers from Almería. A cross-sectional study was conducted amongst a coastal population in Almería, where over 32,800 ha of land are dedicated to intensive agriculture in plastic greenhouses. A total of 409 people participated in the study: 203 farmers and 206 control subjects. The highest risk of psychiatric disorders was observed in farmers living in areas of high exposure to pesticides, working in greenhouses (intensive agriculture), without protective goggles and without wearing masks. This study supports previous evidence of an elevated risk of psychiatric disorders among farm workers exposed to pesticides.

Mental Health in Farming Communities

Occupational stressors are causing unprecedented levels of stress, depression, and suicide among our nation's farmers, and little is known about how farmers view their personal stress and potential stress-relieving strategies. The current study used a descriptive qualitative approach to conduct focus groups comprising farmers and farm family members (N = 26). Participants were recruited using a snowball approach based on the investigators' connections to farming communities. Preliminary analysis indicates that primary stressors are: lack of control over many aspects of farming and the public's lack of understanding/appreciation for farming. In addition, two communities identified high levels of anticipatory stressors. Despite these stressors, they continue to farm because of their love for farm life and their generational connection with the land. To decrease farmer stress, participants suggested educating the public about farm life and the impact farming has on the general public, creating social groups for farmers to talk to each other, and sharing the farmer story. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 39-43.].

A Cross-Sectional Study of Farmer Health and Wellbeing in Norway: The HUNT Study (2017-2019)

OBJECTIVES

Obtain a broad impression of the health and wellbeing of working farmers in a representative population.

METHODS

A cross-sectional study using data from a large, general population-based survey, The HUNT Study, Norway (HUNT survey 4, 2017-2019, response rate 54%). The study included 24,313 occupationally active participants aged 19 to 76 years, including 1,188 farmers. Prevalences are estimated for outcomes covering musculoskeletal, respiratory, and mental health as well as general health and life satisfaction, with adjustment for worker age and sex. The estimates for farmers are compared to skilled white collar workers and skilled manual workers.

RESULTS

Farmers had a higher estimated prevalence of poor overall health (prevalence ratio [PR] 1.56 [95%CI 1.34,1.82]), chronically impaired mobility (PR 1.83 [1.53, 2.20]), long-standing musculoskeletal pain or stiffness (PR 1.29 [1.21, 1.37]), work-related respiratory attack (PR 4.32 [3.67, 5.08]), depression symptoms (PR 1.30 [1.04, 1.61]) and symptoms of psychological distress (PR 1.23 [1.04, 1.47]) than skilled white collar workers. The estimated prevalence of poor overall health (PR 1.19 [1.00, 1.41]) and work-related respiratory attacks (PR 1.44 [1.24, 1.67]) was also higher for farmers than skilled manual workers, after adjustment for age and sex. Farmers had greater odds of rating themselves less satisfied with life in general than skilled white collar workers (adjusted OR 1.17 [1.04, 1.31]).

CONCLUSIONS

These results are consistent with previous research and add evidence that farm work is associated with high prevalences of a broad range of adverse health outcomes. The associations with chronically impaired mobility, long-standing musculoskeletal pain, and poor self-rated health were strong. The adjusted PRs for work-related respiratory attacks relative to both comparison groups were particularly high. More research is needed to identify and evaluate interventions that can improve farmer health.

Let it out: A digital communication campaign to reduce suicide and mental health stigma in Kentucky farmers

Given the disproportionately high suicide rate of farmers in Kentucky and the unique cultural needs of farmers, a coalition was created to reduce the stigma of seeking help for mental health. A targeted communications campaign was developed to provide information to farmers at risk. This paper describes the development and launch of the campaign, including formative research, message development, campaign concepts, deployment of the campaign, and initial results. Events, traditional advertising, and social and digital media campaigns provided targeted brand awareness. Initial reception to the campaign was positive, especially with TV and radio watch- and listen-through rates and website traffic. The campaign requires expanded messaging and tactics and new partnerships to influence farmers. Practical and theoretical implications include the future use of paid digital strategies to confidentially influence farmers, additional research about culturally competent approaches toward subsets of farmers, and the amount of detail to provide about mental health conditions.

Risks & Protective Factors for Depression & Suicide Among Hawai'i Agricultural Producers

Studies have consistently shown that agricultural producers in the continental United States have disproportionately high rates of depression and suicide as compared to other occupations. It is not known whether this is true in Hawai'i, which is both geographically distinct and ethnically diverse. To examine rates of depression and suicide as well as potential risk and protective factors, a state-wide mental health needs assessment was conducted from November 2021 to September 2022. We conducted a survey with a nonprobability-based convenience sample targeting agricultural producers across Hawai'i, and performed descriptive statistics and logistic regression analyses. In a sample of 408 respondents, 35% (n = 143) had clinical depression symptomatology, and 8% (n = 33) had suicidal ideation based on the Patient Health Questionnaire-9. Older age was slightly protective in that every year of increase in age was associated with 0.98 times (95% CI: 0.96, 0.99) reduced odds of depression symptomatology, and 0.96 times (95% CI:0.94, 0.98) reduced odds of suicidal ideation. Identifying as East Asian had 2.04 times (95% CI: 1.16, 3.61) higher odds of depression symptomatology, and Southeast Asian had 3.04 times odds (95% CI:1.15, 8.00) of suicidal ideation. However, in the presence of stress and coping variables, the demographic factors became statistically non-significant. Instead, feeling stressed, uncertainty as the stressor, and media-focused coping were significant risk factors in increasing two to eight times the odds of depressive symptoms. For suicidal ideation, depression symptomatology increased odds by 31.95 (95% CI: 5.60-182.32), using media-focused coping increased 5.20 odds (95% CI: 1.66, 16.27), but problem-focused coping decreased 0.32 times odds (0.10, 0.99). Culturally specific prevention and intervention measures should be tailored for Hawai'i agricultural producers with an emphasis toward younger, East, and Southeast Asian producers and attention toward providing skillful coping strategies for effective stress regulation and management.

Occupational exposure to pesticides and symptoms of depression in agricultural workers. A systematic review

BACKGROUND

The use of pesticides can result in harm to both the environment and human health. There is a growing concern in the field of occupational health about the impact on the mental health of agricultural workers.

OBJECTIVES

The objective of this review was to systematize scientific evidence from the last ten years on the impact of occupational exposure to pesticides on the development of depression symptoms in agricultural workers.

METHODS

We conducted a comprehensive search in the PubMed and Scopus databases from 2011 to September 2022. Our search included studies in English, Spanish, and Portuguese that examined the association between occupational exposure to pesticides and symptoms of depression in agricultural workers, following the guidelines recommended by the PRISMA statement and the PECO strategy (Population, Exposure, Comparison, and Outcomes).

RESULTS

Among the 27 articles reviewed, 78% of them indicated a link between exposure to pesticides and the incidence of depression symptoms. The pesticides most frequently reported in the studies were organophosphates (17 studies), herbicides (12 studies), and pyrethroids (11 studies). The majority of the studies were rated as having intermediate to intermediate-high quality, with the use of standardized measures to assess both exposure and effect.

CONCLUSION

The updated evidence presented in our review indicates a clear association between pesticide exposure and the development of depressive symptoms. However, more high-quality longitudinal studies are necessary to control for sociocultural variables and utilize pesticide-specific biomarkers and biomarkers of depression. Given the increased use of these chemicals and the health risks associated with depression, it is crucial to implement more stringent measures to monitor the mental health of agricultural workers regularly exposed to pesticides and to enhance surveillance of companies that apply these chemicals.

Agricultural activities and risk of treatment for depressive disorders among the entire French agricultural workforce: the TRACTOR project, a nationwide retrospective cohort study

Background

Although depression is a major issue among farming population, to date, there have been few studies on specific agricultural activities. We aimed to investigate whether, among the entire French farm manager (FM) workforce, certain agricultural activities are more strongly associated with depression than others.

Methods

This nationwide retrospective cohort study used data from an administrative health database available to the TRACTOR project. This database pertains to the entire French agricultural workforce (overseas workers not included). Data were analyzed from January 2021 to December 2022. All FMs that worked at least once over the period 2002-2016 were included. The outcome measure was the association between 26 agricultural activities and the risk of depression measured as hazard ratios (HRs) after adjusting for age, sex, and pre-existing medical comorbidities. The time to first depression insurance declaration, or first antidepressant prescription claim was used as the underlying timescale. For each activity, the reference/control group included all FMs that never performed the considered activity between 2002 and 2016, while the exposed group included FMs that performed the considered activity at least once from 2002 to 2016. Four sensitivity analyses were conducted to test hypotheses, and to address potential sources of bias.

Findings

There were 84,507 (7.76%; 28.2 cases per 1000 person-years) depression cases among 1,088,561 FMs (mean age 46.6 [SD 14.1]). Compared to other activities, dairy farming (HR = 1.37, 95% confidence interval: 1.32-1.42), cow farming (HR = 1.53 [1.47-1.59]), poultry and rabbit farming (HR = 1.37 [1.27-1.50]), and mixed farming (HR = 1.30 [1.24-1.36]) were more strongly associated with depression. Sex differences were observed, with most of the time, risks higher for females than for males.

Interpretation

Agricultural activities at risk of depression among the entire French agricultural workforce were identified. These findings do represent a crucial first step on the road to implement effective preventive measures against depression to determine where additional resources should be allocated to screen for depression, along with intervention.

Funding

MIAI@Grenoble Alpes, and Mutualité Sociale Agricole.

An Effective Mental Health Literacy Program for Farm Financial Service Providers

OBJECTIVES

Mental health literacy programs related to agriculture can help enhance skills among agricultural community members and service providers to assist farmers and producers who are experiencing distress. The aim of the current article is to describe an agricultural mental health literacy education-based intervention program offered to USDA Farm Service Agency farm financial service providers. The program was implemented as a self-paced, online training through USDA's AgLearn platform to N = 500 FSA staff.

METHODS

Pre-/post-evaluations were used to measure objective and self-rated knowledge and skills. Correlations, paired-samples t-tests, ANOVA, and content analysis were used to analyze data.

RESULTS

The training resulted in significant improvements in objective and self-rated knowledge. While there were no gender differences in objective knowledge, men's self-rated knowledge and skills were significantly higher than that of women at pre-test; at post-test, there were no significant gender differences in self-rated knowledge and skills.

CONCLUSION

Evaluations of this agricultural mental health literacy program demonstrate its effectiveness for farm financial service providers. Expanding access to such trainings among agricultural service providers who interact with producers regularly can help improve agricultural communities' skills to initiate and engage in critical conversations about mental health.

Stressor or succour? Examining the association between conflict, livestock assets, and farmers' mental health in Nigeria

Farmers are disproportionately vulnerable to violent attacks in the conflict situation in Nigeria, with potential traumatising effects due to the destruction of agricultural livelihoods. In this study, we conceptualise the links between conflict exposure, livestock assets, and depression, using a cross-sectional nationally representative survey of 3021 Nigerian farmers to quantify the relationships. We highlight three main findings. First, conflict exposure is significantly associated with farmers exhibiting depressive symptoms. Second, holding higher herds of livestock, more cattle, and more sheep and goats while exposed to conflict is associated with higher risk of depression. Third, keeping more poultry is negatively associated with depressive symptoms. Finally, this study accentuates the significance of psychosocial support for farmers in conflict situations. The relationships between different livestock species and farmers' mental health may interest further research in strengthening the evidence.

Organizational Resources and Social Support Influences on Stress and Depression: A Comparison among Cooperative and Non-Cooperative Farmers

BACKGROUND

Farmers are disproportionally affected by depression and suicide. Social connectedness has been shown to reduce depression and suicide among the general population but its impact on farmers is less well-known. Our previous research indicated that farmers who had cooperative resources and social support reported decreased symptoms of depression. However, it was unclear whether farmers who were not cooperative members or utilized resources from non-cooperative organizations differed from cooperative farmers in mental health.

METHODS

A survey consisted of online self-completion and phone interviews was conducted among 307 participants (197 co-op, 110 non-co-op) to examine whether Midwest (north central United States) cooperative and non-cooperative farmers differ in perceived stress and symptoms of depression and whether potential differences were impacted by program use, program satisfaction, and social support.

RESULTS

Cooperative farmers reported lower perceived stress and symptoms of depression than non-cooperative farmers and the difference was statistically significant for perceived stress. Use of educational programs, such as training and mentorship, was associated with decreased perceived stress but not symptoms of depression. Satisfaction with programs and social support were associated with decreased perceived stress and symptoms of depression. Program satisfaction was observed to have more associations with decreased perceived stress and symptoms of depression than program use.

CONCLUSIONS

Results reveal that organizational resources and social support can mitigate mental health risks among farmers. This study highlighted an opportunity for future investigation of social connectedness in addressing farmers' mental health.

A Needs Assessment of Ohio Farmers' Self-Reported Health Behaviors

The study purpose was a needs assessment, to identify and quantify health behavior risk-factors of Ohio farmers in sleep, mental health, fruit/vegetable serving frequency, physical activity, tobacco, alcohol and illicit drug use, and weight status. Guided by the RE-AIM implementation framework, the research question was What behavioral choices pose health risk factors for Ohio farmers? This cross-sectional, quantitative, descriptive study used Qualtrics' hyperlinks, QR codes, or paper-and-pencil surveys to collect data on seven focused health behaviors. The survey combined valid and reliable public domain questionnaires. The target audience included Ohio farmers representing various commodities. Extension educators at the county, regional, and state level provided access and data collection during their existing community-based programs and annual pesticide training sessions. The survey has been opened from January 20, 2020 to December 5, 2020 with modified recruitment during COVID. A convenience sample of 505 farmers participated. The majority self-identified as male, married, white, non-Latino, and worked full-time. The most frequent commodity was field crops. Most farmers reported 7-to-8 h of sleep, but the MOS SLP6 subscale indicated 89.5% of the farmers reported a score greater than 51. The two PHQ-2 questions showed 9.6% of the farmers scored >3, indicating a likely major depression disorder. Fruit and vegetable serving frequency appeared less than dietary recommendations. Time spent in physical activity did not meet guidelines. Almost 80% of the farmers said they did not use tobacco; the most common choice was chews and snuffs. Audit-C showed 31.4% of the men and 27.7% of the women can be categorized as hazardous drinkers. Illicit drug use was reported by 3.7%. Most farmers were obese or overweight. Male respondents were 83.5% overweight or obese; females 70.8% were overweight or obese. Males ages 55-64 years were mostly likely to be obese (58%) followed by males ages 35-44 years (46%). Results were compared to Ohio's Behavioral Risk Factor Surveillance System. These data will assist county Extension educators in identifying health prevention programming important for farm populations, utilizing community resources and services. While the findings of Ohio farmers may not be generalizable to other state farming communities, this survey and lessons learned can serve as a model for other Extension assessments.

Mental health of agricultural adolescents and adults: Preliminary results of a five-year study

Background

Work-related stressors common to agriculture have been associated with adverse mental health outcomes among adult farmers and ranchers. However, the mental health status of agricultural youth is unknown, despite farm and ranch youth being exposed to the same occupational hazards as their adult counterparts. The objective of this study was to estimate the prevalence of symptoms of depression and anxiety among farm adults and their adolescent child and examine the correlation between symptoms of mental health conditions and financial indicators described in the Family Stress Model (FSM).

Methods

Farm families were recruited to participate in online surveys by mail, email, and social media. One adolescent and at least one adult from each family were invited to complete on online survey. Where available, validated instruments were used to collect mental health, stress, family dynamics, and household financial variables. Descriptive statistics were used to describe sample demographics and prevalence of symptoms of depression and anxiety. Pearson correlations describe associations between variables within the Family Stress Model.

Results

Farm families (N = 122) completed the online survey. The mean age of farm parents was 41.4 years (SD = 4.4) and the mean age of farm adolescents was 15.4 (1.2). A majority of farm parents and farm adolescents were male, 58.2% and 70.5%, respectively. The sample was primarily white, non-Hispanic. In this sample of farm parents and adolescents alike, 60% met the criteria for at least mild depression, based on the Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire-A (PHQ-A). Similarly, among adolescents, 45.1% met the criteria for Generalized Anxiety Disorder (GAD), as did 54.9% of adults. As a measure of economic hardship, per capita income by itself showed relatively low correlations, even with other economic measures (r = 0.11 with negative financial events, r = 0.20 with financial needs, r = 0.17 with financial situation, and r = 0.27 with debt). Parent depressed mood was in turn highly associated with adolescent depression (r = 0.83), social anxiety (r = 0.54), and generalized anxiety (r = 0.69).

Conclusions

The results show a strong association between parent and adolescent mental health and parental depressed mood and debt. There is not a clear association between economic stress and mental health in this sample, but further work is needed to be done at a population level. Preliminary results are promising for application of the full Family Stress Model as we continue to accrue farm families into the study cohort.

The wellbeing paradox in Hungarian local sustainable agriculture: a health psychology approach

BACKGROUND

The literature suggests that farmers' work involves a number of operational difficulties. Although alternative food networks address the majority of their problems, they can potentially generate new hardships. The aim of this study is to examine the situational and engagement-related work difficulties associated with the everyday world of Community Supported Agriculture (CSA) farmers.

METHODS

This study used the health psychology approach, namely interpretive phenomenology, to understand the social determinants of farmers' working lives in CSA and to explore mental health challenges within the practices of local sustainable farming. To collect data, semi-structured, in-person interviews were conducted with CSA farmers in Hungary.

RESULTS

Our study shows that new modes of consumer-producer connectivity create novel situations and issues which farmers are forced to address. Three personal experiential themes emerge from the data to describe CSA farmers' work difficulties: (1) Conflicted autonomy; (2) The pressure of boxes; (3) Social overload. The difficulties for CSA farmers seem to be rooted in the economic characteristics of alternative agriculture where farmers organize food production for the satisfaction of consumer needs. In addition, structural conditions require several different CSA farmer roles, which could even be conflicting.

CONCLUSION

This study provides participants' perspectives on the health and wellbeing costs of sustainable farming. Newer producer-consumer connections require both time and experience and involve extra effort or skills, but farmers often lack these abilities. The results show how perceptions of work processes relate to the general framework of CSA, which necessitates a distinct strategy for farm management.

Risk factors for depression in the elderly: An umbrella review of published meta-analyses and systematic reviews

BACKGROUND

Depression has been identified as one of the leading causes of the disease burden worldwide. Identification of the potential factors that increased or decreased the risk of depression could be important to provide prevention strategies. We aimed to conduct an umbrella review of risk factors for depression in the elderly and assessed the credibility of evidence of the association between each factor and depression.

METHODS

We searched PubMed and Web of Science from 1990 to April 11, 2021 for articles investigating associations between potential factors and depression. For each association, we recalculated the summary effect size and 95% confidence intervals using random effects models. The 95% prediction interval and between-heterogeneity were also reported. For publication bias, small-study effect and excess of significance bias were assessed.

RESULTS

Twenty-five publications met the inclusion criteria, including twenty-two meta-analyses and three qualitative systematic reviews. Approximately 1,199,927 participants and 82 unique factors were reported. Two factors were rated as convincing evidence and four factors showed highly suggestive evidence. These risk factors were aspirin use, individuals aged 80 years and above, sleep disturbances and persistent sleep disturbances, hearing problem, poor vision, and cardiac disease.

LIMITATIONS

Most studies that we included were of low quality.

CONCLUSIONS

We found several risk factors for depression with different levels of evidence, in which aspirin use and individuals aged 80 years and above presented the strongest evidence. Further research is warranted to support other findings from this umbrella review using a large, well-designed cohort study.

The problems of women working in greenhouse agriculture in rural area in Turkey: A phenomenological study from health and social perspective

Working in agriculture may cause serious health problems due to heavy working conditions and chemical exposure. This Husserlian phenomenological qualitative study was conducted with 22 women working in greenhouse agriculture to investigate the health and social problem(s). In the evaluation of the data, Colaizzi's seven-step content analysis method and thematic analysis were used. The Kappa analysis was performed with two independent experts to measure the reliability of comparative fit, and the value obtained in the analysis was 1.00 (perfect fit). Based on the content analysis, six themes were defined. All participants indicated that they had different reproductive health-related problems. Some participants stated that their children had respiratory system-related problems and that they were subjected to physical, verbal/emotional and sexual violence by their husbands. It is important to provide health education, counselling services and screening programmes for women who work in greenhouse agriculture and thus are in the at-risk group for poor health.

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.

Agricultural Cooperatives in Mental Health: Farmers' Perspectives on Potential Influence

Agricultural cooperatives are formed to promote farmers' economic, social, and legislative interests. Their role in influencing mental health is less known. We characterized farmers' experiences with cooperatives and identified the potential impact of cooperatives in promoting mental health. Semi-structured interviews were conducted in Wisconsin with 12 participants, including farmers, cooperative professionals, and agricultural extension educators. Participants were asked about stress among farmers; cooperative structures and services provided to farmers, and farmers' interactions with the cooperatives; and the role cooperatives play in reducing stress among farmers. Three main themes were developed: stress farmers were experiencing, available resources from cooperatives, and the role of cooperatives in promoting farmers' mental health. Stress farmers were experiencing was elucidated through the subthemes: increased stress, depression, and suicide and stressors involving finances, occupational pressure, relationships, isolation, and loneliness. Available resources from cooperatives were described in subthemes: cooperative characteristics, services, and engagement activities. The role of cooperatives in promoting farmers' mental health was discussed through subthemes: responder, community, facilitator, and divergent views on whether co-ops can protect farmers' mental health. Cooperatives provide members market stability, services, and opportunities for decision-making, social interaction, and civic engagement. These resources create a community where farmers feel a sense of belonging and retain a level of control. As rural communities continue to struggle with mental health resource shortages, identifying and evaluating community-based resources such as those offered by the cooperatives is imperative.

Mental Health Issues Among Farmers: An Online Continuing Education Program for Nurses

BACKGROUND

An asynchronous online continuing education (CE) program was created to increase nurses' awareness and knowledge of occupationally related mental health issues among farmers.

METHOD

The ADDIE (analysis, design, development, implementation, evaluation) model was followed to create the CE program. Articulate Storyline 3 (Articulate 360), a software tool, was used to build an interactive, e-learning, and virtual training module.

RESULTS

The course was completed by 113 nurses. Eighty-two (72.5%) of these nurses completed the course evaluation. Of these, 69 (84.1%) reported that the course met their expectations. The majority of respondents indicated that the material was presented in a clear, organized manner (80.0%, n = 80) and that all course objectives were met, including being able to identify sources of stress among farmers (86.3%, n = 80), recognize manifestations of stress among farmers (86.4%, n = 81), understand farmers' mental health status (86.3%, n = 80), and identify mental health nursing practices (87.3%, n = 79).

CONCLUSION

Nurses can provide more salient care to the farming population when they are equipped with an understanding of the culture and stress associated with farming. This online educational program has the potential to improve mental health care for farmers and their families. [J Contin Educ Nurs. 2021;52(10):482-488.].

Addressing Farm Stress through Extension Mental Health Literacy Programs

Agricultural producers have worse mental health than the general population, and often have limited access to mental health providers. Educational programs can strengthen knowledge of mental health including warning signs of stress and suicide, as well as assist individuals in developing communication skills and help-seeking behaviors. Cooperative Extension, the nation's academic outreach unit provided by land-grant universities, has a long history of providing agricultural education programs in the United States; this article describes the expansion of such programs to include mental health education for farmers and agricultural stakeholders in Michigan. Evaluation results of two programs developed by Michigan State University Extension demonstrate the programs are effective in improving understanding of agricultural economic trends, impacts of stress on the body, and warning signs of suicide among agricultural producers and stakeholders. Community-based education increases the capacity for mental health literacy programs to reach distressed farmers.

A comparison of farming- and non-farming-related suicides from the United States' National Violent Deaths Reporting System, 2003-2016

Farmers are at higher risk of suicide than other occupations and the general population. The complex suicide risk factors have not been examined in a large, population-wide study across a significant time period. This observational study draws on existing data from the United States' National Violent Death Reporting System (NVDRS), including 140,523 farming- or non-farming-related suicide decedents between 2003 and 2016 from across 40 states. "Farming-related" decedents included 2,801 suicides. Farmers had higher odds of being male, older, less well-educated, and American Indian/Alaska Native. Farmers had higher odds of using firearms and-when farmers used a gun-higher odds of using a long-arm weapon. Farmers had lower odds of having a known mental health condition or job problem, and lower odds of having made a previous suicide attempt or leaving a suicide note. Findings highlight the complexity of suicide risk within the context of farming in the United States and reinforce the need for tailored prevention efforts; employing means restriction of firearms; and emphasizing that traditional risk factors may not be as common in the farming population.

Examination of Symptoms of Depression among Cooperative Dairy Farmers

Farmers experience a high risk of stress, depression, and suicide. Risk factors are well documented but protective factors are seldom examined. Social support has been reported to reduce psychological distress among the general population but its effect on farmers is inconclusive. Agricultural cooperatives are typically created and owned by farmers to secure markets, access supplies and services, and participate in decision-making. It is unknown whether having cooperative resources impacts symptoms of depression. A survey was used to examine whether having access to cooperative programs and social support impacted symptoms of depression among dairy farmers. Farm bankruptcies, stress, depression, and suicide were identified as ongoing concerns. Having social support and cooperative educational opportunities and mentorship programs were associated with decreased symptoms of depression. Conversely, having cooperative policy discussions was associated with increased symptoms of depression. Results suggest that social support can potentially reduce symptoms of depression among farmers and having access to cooperative resources can reduce or increase it, depending on the type of program. Our findings identified an opportunity to further examine how programs provided by farmer-led organizations such as cooperatives can impact stress, depression, and suicide among farmers.

An Analysis of Suicide Risk Factors among Farmers in the Midwestern United States

Research on the complex relationships of variables contributing to farmer suicide is limited. The purpose of the study was to examine factors associated with suicide risk through the use of standardized instruments measuring psychological (depression, anxiety), social (social support), and contextual factors. A questionnaire was completed by 600 farmers in the Midwestern United States. A multiple linear regression model was used to analyze associations with suicide risk (SBQ-R), including depression (PHQ-9), anxiety (GAD-7), Brief COPE subscales (BC), social support (MSPSS), and select demographic and farming characteristics. The only variable that emerged as having a significant relationship with the natural log-transformed suicide risk score was coping through self-blame. While suicidality is often considered the outcome of mental illness, our findings do not suggest that suicide risk among farmers is related to mental illness, and a further examination of self-blame as a coping strategy is warranted.

Farmer Mental Health in the US Midwest: Key Informant Perspectives

In this study, we seek to illuminate: (1) the ways farm service providers and mental health professionals understand the drivers of farm stress, (2) the strategies, challenges, and opportunities farm service providers and mental health professionals identify for supporting the mental health needs of farm families, and; (3) opportunities for future research and outreach to improve the mental health of farmers in the U.S. Midwest region. We obtained qualitative data from a series of semi-structured key informant interviews with 19 subject matter experts, using content analysis to identify themes across four domains: main challenges, unique impacts by subpopulation, coping strategies, and interventions and recommendations. The key informants we interviewed identified a variety of acute and chronic stressors, including several that are structural, rather than individual and interpersonal, and which lie outside of the control of farmers themselves. They also highlighted diversity within farm populations by socio-demographic and farm characteristics as well as positive and negative coping strategies, with negative being more common. For interventions and recommendations, they stressed the importance of education on mental health, improving access to care, and addressing root causes of stress. While farmer stress is well-documented, less is known about the perspectives of farm service professionals and mental health providers who care for them. The insights from this study add important information on how to best support the immediate and long-term mental health needs of farmers and farm families in the U.S. Midwest and beyond.

Assessing Farm Stress and Community Supports in a U.S.-Mexico Border County

Imperial County, California, is a high-need, medically underserved area that has some of the worst overall health outcomes of all California counties. Given this and the high depression and anxiety rates in agricultural occupations, Imperial County farmers and ranchers may be at an increased risk of stress and poor mental health outcomes. An exploratory mixed methods assessment was used to collect information from 24 farmers and ranchers in Imperial County. Survey topics included questions about farm or ranch operations, farm-related stress, mental health, community support, and health behaviors. The results indicate that most respondents perceive unpredictable factors, such as government regulations, as the most impactful stressors related to their farm or ranch operations. Additionally, depression symptomatology scores were positively correlated with respondents' ability to obtain credit. Efforts to understand farm-related stress and how community support can help Imperial County farmers and ranchers mediate adverse physical and mental health effects through formal and informal networks are considered.