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

Supporting mental health in farming communities where and when it is needed most: A longitudinal analysis of risk and protective factors

The cyclical nature of agriculture exposes farmers to challenges that vary over time, influenced by a myriad of external factors beyond their control. This longitudinal study aimed to examine mental health trajectories for Western Australian farmers over a 12 month period, and determine associations with key risk and protective factors. Farmers and farm residents (N = 125) completed an online survey at three timepoints (baseline, 6 months and 12 months) that assessed anxiety, depression, stress, farming stressors, coping strategies, sense of belonging and social supports. Survey timing coincided with periods of harvest and seeding. Risk factors associated with poorer mental health among farmers included a range of dysfunctional and emotion coping strategies, family/relationship stressors, financial/external stressors and daily stressors. Protective factors included sense of belonging and social support. Stress was found to change over time and family/relationship stressors and financial/external stressors at baseline were found to moderate anxiety and stress at 6 months and 12 months. Addressing factors associated with poor mental health trajectories and bolstering factors that are protective for mental health over time will aid clinical and community services in tailoring their services to meet the needs of farmers.

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.

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.

"We're All in This Together": Farmers' Reactions to the Farmer Suicide Crisis

Farmer suicide rates continue to increase, with levels being 1.5 times higher than the national rate. This has led agricultural and public health groups to craft and distribute farm stress and suicide messages to help farmers. However, suicide rates remain at critical levels indicating that there may be a disconnect between existing efforts and farmer sensemaking of the crisis. Utilizing the Theory of Memorable Messages (ToMM), this study explored how farmers are reacting to messages and conversations about the farmer suicide crisis. Interviews with 25 participants found most had heard about farmer suicide concerns. When asked about their memorable conversations, farmers reflected a complex sensemaking process that included themes of memorable conversation types ranging from externalization to acceptance and message themes oriented around concern for self and others within these conversation types. Overall, most farmers externalized the risk of suicide to other farmers. However, even though participants did not see themselves at risk, their responses often showed deep concern for helping other farmers. These results are discussed in light of sensemaking and memorable conversations, with practical implications for future messaging efforts around farmer suicide.

Farming, finance and family: factors associated with anxiety, depression and stress among Western Australian farmers

Farming is a challenging, stressful and rewarding occupation involving many factors that are beyond farmers' control. The aim of this study was to investigate correlates associated with the anxiety, depression and stress of farmers in Western Australia. Farmers and farm residents (N = 124) completed an online survey assessing anxiety, depression, stress, farming stressors, social supports, coping strategies and sense of belonging. Higher financial/external trade and societal pressures, family/relationship tension, use of coping strategies such as self-blame, venting, disengagement and planning, lack of succession planning and considering selling the farm, and lower social support and sense of belonging, were associated with higher anxiety, depression and/or stress. The findings highlight the specific impacts of financial and family pressures on poorer mental health status among farmers. Clinical and community interventions that build on naturally occurring strengths, such as family support and community connectedness, are needed.

A Comparison between Farm-Related Stress, Mental Health, and Social Support between Men and Women Farmers

Agricultural producers have worse mental health than the general population; however, recent research has not considered differences in stressors and mental health conditions by gender. A survey was mailed to a random sample of farmers in Illinois to screen for symptoms of anxiety and depression and identify sources of stress and social support. Men experienced more stress related to environmental and economic conditions than women, while women tended to have slightly higher levels of geographic isolation stress than men. Overall, there were no significant differences by gender in the proportion meeting the criteria for depression or anxiety; however, the results are higher than what is observed in the general population. Among those farmers who experience higher levels of stress about geographic isolation, the odds for women farmers to experience depressive symptoms are four times more than men farmers (OR 4.46 (0.91, 21.8); p = 0.06). Additional research should examine the relationship between social support and mental health. Interventions to reduce stress by gender should be considered.

Exploring risk factors and their differences on suicidal ideation and suicide attempts among depressed adolescents based on decision tree model

BACKGROUND

Suicide has been recognized as a major global public health issue. Depressed adolescents are more prone to experiencing it. We explore risk factors and their differences on suicidal ideation and suicide attempts to further enhance our understanding of suicidal behavior.

METHODS

2343 depressed adolescents aged 12-18 from 9 provinces/cities in China participated in this cross-sectional study. We utilized decision tree model, incorporating 32 factors encompassing participants' suicidal behavior. The feature importance of each factor was measured using Gini coefficients.

RESULTS

The decision tree model demonstrated a good fit with high accuracy (SI = 0.86, SA = 0.85 and F-Score (SI = 0.85, SA = 0.83). The predictive importance of each factor varied between groups with suicidal ideation and with suicide attempts. The most significant risk factor in both groups was depression (SI = 16.7 %, SA = 19.8 %). However, factors such as academic stress (SI = 7.2 %, SA = 1.6 %), hopelessness (SI = 9.1 %, SA = 5.0 %), and age (SI = 7.1 %, SA = 3.2 %) were more closely associated with suicidal ideation than suicide attempts. Factors related to the schooling status (SI = 3.5 %, SA = 10.1 %), total years of education (SI = 2.6 %, SA = 8.6 %), and loneliness (SI = 2.3 %, SA = 7.4 %) were relatively more important in the suicide attempt stage compared to suicidal ideation.

LIMITATIONS

The cross-sectional design limited the ability to capture changes in suicidal behavior among depressed adolescents over time. Possible bias may exist in the measurement of suicidal ideation.

CONCLUSION

The relative importance of each risk factor for suicidal ideation and attempted suicide varies. These findings provide further empirical evidence for understanding suicide behavior. Targeted treatment measures should be taken for different stages of suicide in clinical interventions.

Male Farm and Agricultural Worker Suicides in Kansas, 2016-2020

OBJECTIVES

There is limited research on the factors that contribute to suicides among farm and agriculture workers. The purpose of this analysis was to examine the socio-demographic characteristics and circumstances that may increase risk of suicide for a farm worker by using the detailed data from the Kansas Violent Death Reporting System (KS-VDRS).

METHODS

KS-VDRS is a state-based system and was used to look at suicides among farm and agricultural workers that occurred in Kansas from 2016 to 2020. Frequencies, percentages, and age-adjusted rates were calculated to compare trends between farm/agriculture workers and other major occupational groups (non-farm/agriculture). Females were not included in this analysis due to low counts in the occupational group.

RESULTS

In Kansas, male farm and agriculture workers die by suicide at a rate of 147.5 per 100,000 population, which is 3 times that of the average male workers (45.2 per 100,000 population). Male suicide decedents in farming and agriculture-related occupations were older with a mean age of 54 years and less educated (73% had a high school diploma or less) than their non-agriculture counterparts (mean age 44 years, and 57% had a high school diploma or less). Common circumstances around time of death were current depressed mood (58.6%), current mental health problem (41.4%), and physical health problem (31.4%).

CONCLUSION

KSVDRS provides valuable information on the circumstances surrounding suicides, and this can inform prevention efforts within and across states. Numerous factors may contribute to the increased risk of suicide among farmers and those who work in agriculture. Physical health problems, family relationship problems, and financial problems are more commonly reported among this population compared to other male workers. Findings from this report highlight the complexity of suicide risk within the farm and agriculture industry in Kansas and reinforce the need for state-specific data and tailored prevention efforts.

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.

Stress and suicidal ideation among first-generation farmers: A cross-sectional study with 1,288 farmers in Georgia

PURPOSE

The suicide rate among farmers is higher than that of the overall working population. Literature on farmer mental health in Georgia (GA) has been scarce and mostly focused on suicide as a result. Literature on stressors or coping are mostly qualitative studies. This study looks at the influence of being a first-generation farmer on farm-related stressors and coping mechanisms.

METHODS

This cross-sectional study inventories mental well-being, stressors, and coping mechanisms for different types of farmers in GA, USA. The online survey ran from January 2022 through April 2022. Participants (N = 1,288) were asked about demographics, work descriptors, health care access, specific stressors, stress levels, and coping mechanisms.

FINDINGS

Two-thirds of our sample were first-generation farmers. First-generation farmers had a higher stress score on average, as well as being more likely to feel depressed, and feel hopeless. They also showed less diverse coping mechanisms than generational farmers, with alcohol in their top 3 coping mechanisms. First-generation farmers were also much more likely to experience suicidal ideation: 9% daily and 61% at least once in the past year (vs generational: 1% daily; 20% once in the past year). Binary logistic regression indicated that having more diverse coping mechanisms is a protective factor against suicidal ideation within the previous year. The same model indicated that being a farm owner or farm manager, being first-generation, being unhappy with one's role, feeling sad or depressed, and feeling hopeless were all risk factors.

CONCLUSIONS

First-generation farmers experience more stress and exhibit more risk factors for suicidal ideation than generational farmers.

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.

Sense of Meaning and Purpose Making Mitigates the Experience of Stress Among Hawai'i Farmers

Farming is widely acknowledged as being extremely challenging and stressful, yet also potentially very meaningful as farming is an important element of any society and connected to our cultural heritage. Only a few studies have empirically examined the association between sense of purpose in farming and well-being/happiness. This study explored whether a sense of meaning and purpose in being a farmer could mitigate the experience of stress. A cross-sectional survey between November 2021-September 2022 was conducted with a sample of 408 Hawai'i agricultural producers. Descriptive statistics and logistic regressions were conducted to explore factors that predicted farmers' endorsement of high meaning and purpose, and whether meaning and purpose could dampen the impact of stressors on the experience of stress. Results revealed that Hawai'i farmers were highly stressed but also had high sense of meaning and purpose. Predictors of meaning and purpose included operating smaller farms of 1-9 acres and having 51% or greater percentage of income from farming. Meaning and purpose in turn decreased odds of stress, and showed an interaction with stressor intensity such that the stress buffering effect of meaning was more salient for those with lower stressors than those with higher stressors OR = 1.12 (CI = 1.06,1.19). One possible stress management and resilience technique is to highlight and strengthen farmers' sense of meaning and purpose in the farming endeavor.

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.

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.

A cross-sectional study of alcohol, opioid use, and anxiety in agriculturally based occupations

PURPOSE

Although there are many studies that have examined substance use and mental health concerns in rural areas, there is a paucity of research related to the prevalence of substance use and mental well-being in agriculturally based occupations. This study aimed to determine the prevalence of alcohol and opioid misuse and anxiety among adults in agriculturally based occupations in the rural Midwest and to determine the risk factors for alcohol misuse.

METHODS

Data were collected via mailed surveys with 1,791 surveys returned. Participants completed the Alcohol Use Disorder Identification Test, the Drug Abuse Screening Test-1, the Generalized Anxiety Disorder Screener, and reported demographic data. Multivariable logistic regression was used to examine factors associated with alcohol misuse.

RESULTS

Younger age, male, not married, agriculturally based workers were significantly associated with alcohol misuse. For opioid use, the highest prevalence rate (10%) was found among direct agricultural workers who were not married and in the age group 19-39. The highest anxiety prevalence rate was found in participants aged 19-39 (15.5%) who also scored in the highest level of alcohol misuse with a prevalence rate of 27.9%.

CONCLUSIONS

Future research is suggested in the areas of gender identity and anxiety in agricultural populations and agriculturally based occupations as protective factors for opioid misuse.

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.

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.

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.

Characteristics of suicide among farmers and ranchers: Using the CDC NVDRS 2003-2018

BACKGROUND

Suicide is among the top 10 causes of premature death in the United States. This study provides details on farmer and rancher suicide decedents, including demographic information, mental health status, history of suicidal thoughts and attempts, and circumstances associated with death.

METHODS

Data for this study were obtained from the Centers for Disease Control and Prevention's National Violent Death Reporting System Restricted Access Database for the years 2003-2018. Descriptive statistics and adjusted odds ratios are presented for farm and nonfarm populations in addition to farm populations by age groups and sex.

RESULTS

This study found that almost half of the farmer suicide decedents were over 65 years old. Firearms were the most widely used method for farmers and ranchers regardless of age and sex. Young farmers and ranchers that died by suicide were more likely to have had relationship problems and older farmers and ranchers that died by suicides were more likely to have had a physical health problem. Male farmer and rancher suicide decedents were more likely to die by firearm than females, and female farmer and rancher suicide decedents were likely to have resided in a small metropolitan area, however, due to small numbers and suppression in the data, most sex comparisons were not able to be presented.

CONCLUSIONS

While no clear risk factor for suicide among farmers and ranchers emerged, results underscore the complex nature of suicide and the need for multifaceted, culturally competent interventions and campaigns that address suicide risk and prevention at the individual and community levels.

Farmer Suicide in Wisconsin: A Qualitative Analysis

PURPOSE

There is a need to address suicide among farmers in the United States and understand what contributes to suicide among American farmers. The purpose of this qualitative study is to analyze narrative data to uncover circumstances that were present in the lives of farmers who died by suicide.

METHODS

This study leverages data available in the National Violent Death Reporting System. For this study, we examined all suicides that occurred in Wisconsin between the years 2012 and 2016 and were extracted from the Wisconsin Violent Death Reporting System. Decedents were manually sorted by the "usual occupation" variable in order to identify farmers.

FINDINGS

During the study period, 73 farmers died, most of whom were White, non-Hispanic males. Four themes were identified in the thematic analysis: stymied by physical health issues, grief from loss of relationships, ready access to firearms in rural Wisconsin, and the burden of farming and the farm.

CONCLUSIONS

The findings from this study demonstrate how unique contextual factors lead to suicide among farmers. This study has implications for suicide prevention among farmers. Primarily, there is a need to address the accessibility of firearms, as their availability in a time of crisis has lethal consequences. However, suicide prevention programming that addresses access to lethal means must take the sociocultural context of rural America into consideration. These findings should also be considered as applied to health care providers that serve rural communities. Suicide risk assessment and management should consider stressors unique to farmers.

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.

Factors Associated with Suicidal Behavior in Farmers: A Systematic Review

This review aimed to investigate the factors associated with suicidal behavior in farmers in the scientific literature. Two researchers participated independently in searching databases, specifically PubMed/MEDLINE, LILACS, Web of Science, Scopus, PsycINFO, and SciELO. Only observational studies were included. The quality of the selected studies was assessed with a critical assessment checklist for cross-sectional analytical and case-control studies, prepared by the Joanna Briggs Institute. Data related to the publication were collected (author and year; city/country); methodological design; sample/population (gender; average age), outcome, measuring instrument and factors associated with suicidal behavior. A total of 14 studies were included in the systematic review, and factors associated with farmers' behavior in mental health (depression), seasonal impacts (drought), and work exposures (herbicides and insecticides) were identified. However, heterogeneity was found in terms of the method, measurement of suicidal behavior, and associated factors, which indicates the need for further studies.