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Rural Mental Health: Promoting

Resilience in Farmers and Ranchers

Andrea Bjornestad

Courtney Cuthbertson

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North Central Regional Center for Rural Development

Andrea Bjornestad, Ph.D., LPC, NCCAssistant Professor

SDSU Extension Mental Health Specialist

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South Dakota State University

302 Wenona Hall (SWE)

Box 507

Brookings, SD 57007

Phone: 605-688-5125

Email: Andrea.Bjornestad@sdstate.edu

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Courtney Cuthbertson, Ph.D.

Community Behavioral Health Specialist

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Michigan State University Extension

446 W. Circle Drive, Room 251

Agriculture Hall

East Lansing, MI 48824

Phone: 517-884-8667

E-mail: cuthbe16@msu.edu

Objectives for Today

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Build awareness around potentially stressful

conditions affecting farmers

Build awareness around mental health

concerns for farmers and ranchers

Learn about preliminary findings from studies

about farmers and ranchers in the Midwest

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Agriculture: Current issues

• Farming is one of the most dangerous

occupations.1

• Agriculture sustains one of the highest mortality

rates from stress-related illnesses.2

• The impact of stress on the mental health of

farmers is an international concern.

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Farm stress3

• Long days

• Social isolation

• Heavy workload

• Technological

innovation

• Business

management

• Farm administration

• Disease outbreaks

• Natural disasters

• Government

regulations

• Climate changes

• Market fluctuations

• Family roles

• Health care costs

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Mental health concerns of farmers & ranchers

• Recent depression rates in agricultural workers have varied

from 7.4% to 24%.4, 5

• Suicide in agricultural workers is a global concern as farming

is an occupation with a higher suicide rate than the general

population.6

• Gender differences exist as rural males maintain higher

suicide rates than rural females in most countries.7

• Farmers may have a tendency to ignore both physical and

mental health symptoms unless their work productivity is

reduced.8

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Suicide crisis in farmersThe US farmer suicide crisis echoes a much larger farmer suicide crisis happening globally9:

• An Australian farmer dies by suicide every four days.

• One farmer per week takes his or her own life in the UK.

• One farmer dies by suicide every two days in France.

• More than 270,000 farmers have died by suicide since 1995 in India.

Possible contributors to the high suicide rate in farmers9

• Social isolation

• Potential for financial losses

• Most commodity prices remain below the cost

of production.

• Barriers to and unwillingness to seek mental

health services

• Access to lethal means

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Mental health stigma

• A negative stigma exists regarding mental health

issues, and to protect their family reputation,

farming families tend to view psychiatric

treatment as least desirable.10

• Farmers tend to disclose to family members or

friends rather than seeking professional help.

• Farm families may live in isolated geographic

locations in which access to mental health

services is limited.

Current survey

• Survey of farmers/ranchers from KS, MI, MO,

SD

• Survey sent to 1000 randomly selected

farmers/ranchers per state

• 14.8% response rate (n = 568)

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Current survey

• Items include:

• Demographics

• Farming characteristics and history

• Farm/Rancher Stress Inventory

• GAD-7 (anxiety)

• PHQ-9 (depression)

• SBQ-R (suicide history and ideation)

• Brief COPE (coping strategies)

• MSPSS (support from friends/family)

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Demographics

• Age: 20 to 94; mean 63

• Gender: 81.2% male

• Marital status: 82.8% married

• Race: 96.4% white

• Veteran status: 18.2%

• Education: 50.4% associates or higher

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Demographics

• Years farming: 0 to 80; mean 42

• Head of livestock: 1 to 63,000; mean 746

• Acres farmed: 10 to 200,000; mean 2326

• Farm role: 61.2% principle/primary

owner/operator

• Off-farm job: 17.6%

• All income from farming: 40.3%

• Use pesticides: 87.3%

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Demographics

• Generation: 22% first

• Primary commodity:

• 67.6% field crops

• 21.6% beef

• Experienced a disaster: 34.5%

• Experienced loss in net farm income: 9%

• $1000 to $681,000

• 50% lost $20,000 or less

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MSPSS

• 12 items about who a person can rely on in

difficult times

• 1 very strongly disagree to 7 very strongly agree

• 3 composite scores/areas:

• Significant other (mean: 5.6)

• Family (mean: 5.48)

• Friend (mean: 5.05)

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Preliminary Findings: Social support

• Who would you be willing to reach out to for

support?

• Family: 80.9%

• Friend: 47.0%

• Pastor/priest: 24.5%

• Medical provider: 13.7%

• Counselor/social worker: 5.6%

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Farm/Ranch Stress Inventory

• 28 items about various stressors for farmers and

ranchers

• 1 no stress to 4 very stressful

• 5 factors

• Government and external stress (mean: 2.49)

• Work (mean: 2.02)

• Finances (mean: 2.15)

• Operation (mean: 2.10)

• Isolation (mean: 1.39)

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Preliminary Findings: Percent Rating as Moderately/Very Stressful

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Preliminary Findings: Depression

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• Average score: 3.81 (range 0-19)

• Negatively associated with age (p<0.01)

• No significant differences

• Gender

• Military service

PHQ-9 N %

Minimal or none 381 70.7

Mild 99 18.4

Moderate 37 6.9

Moderately severe 11 2.0

Severe 11 2.0

Preliminary Findings: Anxiety

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• Average score: 3.31 (range 0-21)

• Higher among female than male (p<0.01)

• Higher among no military service (p<0.05)

• Negatively associated with age (p<0.001)

• Negatively associated with yrs farming (p<0.01)

GAD-7 N %

minimal 398 73.0

mild 97 17.8

moderate 27 5.0

severe 23 4.2

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Preliminary Findings: Suicide Risk

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• Average score: 3.83 (range 3-17)

• Negatively associated with years farming (p<0.05)

• Negatively associated with age (p<0.05)

• No significant differences

• Gender

• Military service

SBQ-R N %

No significant risk 494 92.3

Significant risk 41 7.7

Preliminary Findings: Mental Health

• Significant association between depression and

anxiety symptom experiences (p=0.000)

• 20.7% of sample experienced symptoms of both

• Significant associations:

• Anxiety and suicide risk (p=0.000)

• 16.9% with anxiety symptoms are at significant risk compared

to 4.5% without anxiety symptoms

• Depression and suicide risk (p=0.000)

• 20.8% with depression symptoms are at significant risk

compared to 2.8% without depression symptoms

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Preliminary Findings: Mental Health

• Association between depression and anxiety

diagnoses with current anxiety, depression

symptoms and suicide risk

• 26.5% with depressive symptoms not diagnosed

• 23.5% with anxiety symptoms not diagnosed

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GAD PHQ SBR

Ever diagnosed - depression 0.000 0.000 0.000

Ever diagnosed - anxiety 0.000 0.000 0.000

Preliminary Findings: Physical Health

• No significant relationships:

• Heart attack, stroke, skin cancer, other cancer, kidney

disease, diabetes, high cholesterol

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GAD PHQ SBR

coronary heart disease - 0.042 0.06

asthma 0.053 - -

COPD 0.026 0.008 -

arthritis 0.001 0.000 0.085

high blood pressure 0.048 0.056 -

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Relationship of MSPSS

r-squared p-value r-squared p-value r-squared p-value

Significant other -0.136 0.002 -0.124 0.005 -0.064 0.145

Family -0.186 0.000 -0.169 0.000 -0.085 0.053

Friend -0.257 0.000 -0.253 0.000 -0.215 0.000

GAD PHQ SBQMSPSS

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• Weak, negative associations between support and

mental health outcomes

• Strongest associations between:

• Friend support and anxiety, depression, suicide risk

Relationship of FRSI

r-squared p-value r-squared p-value r-squared p-value

Government and external stress 0.477 0.000 0.432 0.000 0.116 0.010

Work 0.492 0.000 0.451 0.000 0.172 0.000

Finances 0.498 0.000 0.459 0.000 0.137 0.002

Operation 0.457 0.000 0.409 0.000 0.102 0.024

Isolation 0.315 0.000 0.357 0.000 0.181 0.000

GAD PHQ SBQFarm/Ranch Stress Inventory

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• Moderate, positive associations between FRSI and

anxiety, depression

• Strongest associations between:

• Friend support and anxiety, depression, suicide risk

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Implications

• Importance of friendship

• Co-morbidity between anxiety and depression

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National Resources

• National Suicide Prevention Lifeline:

• 1-800-273-TALK (8255)

• National Suicide Prevention Lifeline Crisis Chat

• http://www.suicidepreventionlifeline.org/gethelp/lifelinechat.aspx

• Crisis Text Line: Text “GO” to 741741

• Veterans Crisis Line: 1-800-273-8255

• Press 1 (website also has a chat option)

• IOWA Concern 24-hour hotline: 1-800-447-1985

• https://www.extension.iastate.edu/iowaconcern/faq

• Farm Crisis Center

• https://farmcrisis.nfu.org/

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Cooperative Extension Resources

• MSU Extension Farm Stress Management

workshops

https://www.canr.msu.edu/managing_farm_stress/

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Cooperative Extension Resources

• SDSU: A Five-Step Approach to Alleviating Farm

Stress

https://extension.sdstate.edu/five-step-approach-

alleviating-farm-stress

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Cooperative Extension Resources

• NDSU – Responding to Distressed People

https://www.ag.ndsu.edu/casscountyextension/pdf

s/fs-1805-responding-to-distressed-people

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Questions?

Thank you!

andrea.bjornestad@sdstate.edu

cuthbe16@msu.edu

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References

1. Freeman, S. A., Schwab, C. V., & Jiang, Q. (2008). Quantifying stressors among

Iowa farmers. Journal of Agricultural Safety & Health, 14(4), 431-439.

doi:10.13031/2013.25280.

2. Fraser, C. E., Smith, K. B., Judd, F., Humpheys, J. S., Fragar, L. J., & Henderson, A.

(2005). Farming and mental health problems and mental illness. International Journal

of Social Psychiatry, 51(3), 340-349.

3. Hovey, J. D., & Seligman, L. D. (2006). The mental health of agricultural workers. In:

J.E. Lessenger (Ed.), Agricultural medicine (282-299). New York, NY: Springer.

4. Scarth, R. D., Stallones, L., Zwerling, C., & Burmeister, L. F. (2000). The prevalence

of depressive symptoms and risk factors among Iowa and Colorado farmers.

American Journal of Industrial Medicine, 37, 382-389.

5. Onwuameze, O., Paradiso, S., Peek-Asa, C., Donham, K. J., & Rautiainen, R. H.

(2013). Modifiable risk factors for depressed mood among farmers. Annals of Clinical

Psychiatry, 25:1.

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References

6. Behere, P. B., & Bhise, M. C. (2009). Farmers’ suicide: Across culture. Indian

Journal of Psychiatry, 51(4), 242-243. doi:10.4103/0019-4454.58286

7. Sauvaget, C., Ramadas, K., Fayette, J. M., Thomas, G., Thara, S., &

Sankaranayanan, R. (2009). Completed suicide in adults of rural Kerala: Rates and

determinants. The National Medical Journal of India, 22, 228-233.

8. Hull, M., Fennell, K., Vallury, K., Jones, M., & Dollman J. (2017). A comparison of

barriers to mental health support-seeking among farming and non-farming adults in

rural south Australia. Australian Journal of Rural Health, 25(6), 347-353.

doi:10.1111/ajr.12352.

9. Weingarten, D., & Mulkern, A. (2018). Why are farmers killing themselves in record

numbers? Retrieved from: http://www.theguardian.com/us-news/2017/dec/06/why-

are-americas-farmers-killing-themselves-in-record-numbers

10. DeArmond, S. E., Stallone, L., Chen, P. Y., & Sintek, E. E. (2006). Depression and

somatic symptoms within the farming community. Journal of Agricultural Safety and

Health,12(1), 5-15.

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Brief COPE

• 28 items about how someone copes with

stressors

• 14 constructs

• Self-distraction

• Active coping

• Denial

• Substance use

• Emotional support

• Instrumental support

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• Behavioral disengagement

• Venting

• Positive reframing

• Planning

• Humor

• Acceptance

• Religion

• Self-blame