Suicide in the farming community: methods used and contact with health services

Suicide in the Construction Industry: A Targeted Meta-analysis

OBJECTIVE

With research suggesting an increased risk of suicide for those employed in the construction industry the present review aimed to provide an updated, targeted, and rigorous estimate of the relative risk of suicide for this population.

METHOD

Comprehensive searches of Medline, Psycinfo, Embase, Emcare, Web of Science, and Scopus databases, as well as grey literature and reference lists, were undertaken to identify studies which reported the rate or risk of construction industry workers' suicide. Only samples that did not incorporate other industries and utilized reference groups deemed representative of the general or employed populations, were included.

RESULTS

Eleven studies were included in the review. Primary analysis was undertaken on seven studies deemed to have wholly samples wholly representative of the construction industry. Despite a high level of heterogeneity (I2 = 98%), results suggest increased risk of construction worker suicide compared to the wider population. Random effect meta-analysis indicated a pooled relative suicide risk = 1.25 (95% CI 1.03-1.52), reported. A sensitivity analysis using less stringent inclusion criteria, demonstrated the robustness of these findings.

CONCLUSION

Despite limitations, this paper suggests that construction industry employees may have an elevated risk of suicide. Additionally, this review highlights the need for further research, using standardized methodologies, to generate more robust understandings. Future research will benefit by accounting for locale-specific cultural and socio-political factors and attempting to quantify more specific drivers of suicide risk for this population.

Suicide and suicidality in people exposed to pesticides: A systematic review and meta-analysis

Exposure to pesticides has been proposed to be a positive association in suicide and suicidality. Many studies have explored this topic, but have reported inconsistent findings. We carried out a systematic review and meta-analysis of the now existing evidence on the association between pesticide exposure and the risk of suicide and suicidality. We searched PubMed, EMBASE and Web of Science databases for studies published up to February 1, 2023. For studies that provided detailed data, we applied quantitative meta-analysis to calculate Odds ratio (OR) with 95% Confidence Intervals (CIs) to evaluate the results. Heterogeneity among the included studies was assessed using Cochran's Q test, I² statistic and tau-squared (τ²). Publication bias was evaluated by funnel plots, Egger's test, and Begg's test. In addition, subgroup analyses according to pesticides category and geographical area were performed. 2906 studies were initially identified, and 20 studies were eventually included. Fifteen of the studies were on suicide deaths and suicide attempts, and five were on suicidal ideation. Pesticide exposure was positively related to suicide deaths and suicide attempts (pooled OR = 1.31; 95%CI: 1.04-1.64, p < 0.001) and suicidal ideation (pooled OR = 2.43; 95%CI: 1.51-3.91, p = 0.015). In the subgroup analysis, mixed pesticide type (pooled OR = 1.55; 95%CI: 1.39-1.74) increased the risk of suicide deaths and suicide attempts. The results of the analysis by geographic area showed that the risk of suicide deaths and suicide attempts with pesticide exposure was 2.27 (95%CI = 1.36-3.78), and 1.33 (95%CI = 1.14-1.56) in Asia and Europe, respectively. The risk of suicidal ideation caused by pesticide exposure in Asia and America were 2.19 (95%CI = 1.08-4.42) and 2.99 (95%CI = 1.76-5.06). In conclusion, pesticide exposure may increase the risk of suicide and suicidality based on the current evidence.

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.

An exploration of the relationship between adverse events on the farm and suicidal ideation in farmers

BACKGROUND

The risk of suicide for agricultural workers in parts of the United Kingdom (UK) is almost twice the national average. Existing literature has suggested that adverse farming events, where failure is determined by uncontrollable and unpredictable forces, may be to blame. Yet, the impact of such events on farmer suicidality has not been explicitly explored.

AIMS

The present paper therefore aimed to investigate the relationship between adverse farming events and suicidal ideation in farmers.

METHODS

A cross-sectional questionnaire battery was disseminated between July 2018 and February 2019, and completed by 170 adult farmers.

RESULTS

Over a 12-month period, 88.8% reported that they had experienced an adverse farming event and 32.9% said that they had experienced suicidal thoughts. Correlational analysis revealed a relationship between these variables.

CONCLUSIONS

The high prevalence of suicidal ideation within farmers demonstrates a critical need for intervention. Likewise, the prevalence of adverse farming events suggests that interventions need to be appropriately tailored, with greater understanding about the impact of such events on the mental wellbeing of farmers.

People Who Die by Suicide Without Receiving Mental Health Services: A Systematic Review

Introduction

The majority of people who die by suicide have never seen a mental health professional or been diagnosed with a mental illness. To date, this majority group has largely been ignored, with most existing research focusing on predictors of suicide such as past suicide attempts. Identifying the characteristics of people who die by suicide without receiving services, often with a fatal first attempt, is crucial to reduce suicide rates through guiding improvements to service pathways and “just in time” interventions.

Methods

In this systematic review, PsycInfo, PubMed, CINAHL, and Web of Science were searched for peer-reviewed articles published from 1980 to 1st March 2021. Included studies examined predictors of non-receipt of formal mental health services among people who died by suicide. Data were extracted from published reports and the quality of included studies was assessed using a modified version of the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies. This review was registered with PROSPERO, CRD 42021226543.

Results

Sixty-seven studies met inclusion criteria, with sample sizes ranging from 39 to 193,152 individuals. Male sex, younger or older age, and rural location were consistently associated with non-receipt of mental health services. People not receiving mental health services were also less likely to have a psychiatric diagnosis, past suicidal behavior or contact with general health services, and more likely to use violent means of suicide. There was some evidence that minority ethnicity and psychosocial stressors were associated with service non-receipt.

Conclusion

People who die by suicide without receiving mental health services are likely to have diverse profiles, indicating the need for multifaceted approaches to effectively support people at risk of suicide. Identifying the needs and preferences of individuals who are at risk of suicide is crucial in developing new support pathways and services, and improving the quality of existing services.

Systematic Review Registration

http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021226543.

Prevalence of Low Back Pain and Associated Risk Factors among Farmers in Jeju

Background

We aimed to investigate the prevalence of low back pain (LBP) and its associated agricultural work-related, biomechanical factors among this population.

Methods

We analyzed initial survey data from the Safety for Agricultural Injury of Farmers cohort study involving adult farmers in Jeju Island. The prevalence of LBP was calculated with associated factors.

Results

In total, 1,209 participants were included in the analysis. The overall prevalence of LBP was 23.7%. Significant associations for LBP were the type of farming activity, length of farming career, prior agricultural injury within 1 year, and stress levels. Multivariate logistic regression analysis revealed three biomechanical factors significantly related to LBP: repetitive use of particular body parts; the inappropriate posture of the lower back and neck.

Conclusions

Some occupational, and biomechanical risk factors contribute to LBP. Therefore, postural education, injury prevention education, and psychological support will be needed to prevent LBP.

Suicide mortality rates in farm-related occupations and the agriculture industry in the United States

BACKGROUND

Studies suggest that agricultural workers and rural residents may have an elevated suicide risk. However, suicide is relatively rare, and rural and farming populations have significantly declined, limiting their representation in national surveys. Many studies have inadequate samples for meaningful analysis.

METHODS

We pooled 29 years of data from the Mortality-Linked National Health Interview Survey, 1986-2014, then measured suicide mortality in groups including agriculture workers, and variation in suicide across rural and urban areas. Exposure variables indicated whether participants worked in a farm-related occupation or industry, or lived in a rural area. We used survey-weighted Poisson regression to estimate suicide mortality rates and rate ratios.

RESULTS

Age-adjusted suicide mortality rate per 100,000 was: 22.3 for farmers and farm managers; 21.6 for farmworkers; 28.7 in farming, forestry, and fishing; 15.3 across all other occupations; 16.1 among rural residents. Among farmworkers, age-adjusted rates were 28.3 in rural areas, 17.1 in urban areas (not significantly different). The age-adjusted suicide mortality rate ratio (RR) comparing workers in the agriculture, forestry, and fishery industries to those in all other industries was 1.34 (95% confidence interval, [CI]: 1.05-1.72) (not statistically significant after further adjustment for demographic characteristics). Age-adjusted results were consistent with a higher suicide risk for workers in forestry and fishing than in all other occupations (RR: 1.88, 95% CI: 0.79-4.46).

CONCLUSION

Workers in agriculture, forestry, and fishing may have an elevated suicide risk. National surveys should consider oversampling of rural residents, who have increased morbidity and mortality risks.

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.].

Suicidal Ideation and Pesticide Exposure in Rural Communities of Central India

Background  This study aims to evaluate association between suicidal ideation and pesticide exposure in rural communities of Wardha district of Central rural India compared with villagers who are not exposed to it. Method  It was a cross-sectional study done in rural community of Wardha district in Central India. About 100 farmers who were exposed to pesticides and 100 controls who were not exposed to pesticides were included. A Semistructured proforma to record sociodemographic variables and Indian version of the Self Reporting Questionnaire-20 was used. Results  Of these 200 subjects, data were available for 85 farmers in study group and 74 in control group. In the farmers group, 31% of farmers had suicidal ideas, while 8% of controls felt like ending their life. Conclusion  Measures must be taken to store pesticides at a safer place thus reducing long-term exposure. Organic farming is a better choice to avoid suicidal ideas.

Economic Stress, Family Distress, and Work-Family Conflict among Farm Couples

Despite recognition that farming has substantial economic uncertainty, few recent studies have investigated how economic stress may impact the family dynamic among family farmers. This study sought to address this gap in the literature by examining both personal and global economic stress as a predictor of family distress and work-family conflict among a sample of farm couples. Participating in the study were 217 husband-wife dyads (434 individuals) in which farming was the primary occupation of the husband. A cross-sectional survey design was used to assess economic stress, family distress, and work-family conflict. Spouses completed separate online surveys to ensure independent responding. Both individual (spillover) and dyadic (crossover) effects were examined. Results demonstrated farmers' personal economic stress was positively related to individual and spousal family distress. Furthermore, family distress was a mediator of the relationship between personal economic stress and work-family conflict for both farmers and their spouses. In sum, economic stress is an important variable to consider when examining the work-family interface of farm couples. Moreover, personal economic stress had a larger impact on family distress and work-family conflict than global economic stress. By providing a better understanding of the family mechanisms by which economic stress may impact farm couples, it is hoped the current results can be used to assist in the development and application of mental health resources for farm families.

"Farmers Aren't into the Emotions and Things, Right?": A Qualitative Exploration of Motivations and Barriers for Mental Health Help-Seeking among Canadian Farmers

Working in agriculture has been associated with an increased prevalence of psychological distress and mental health concerns. Farmers are also less likely than non-farmers to seek-help for their mental health. Previous research examining help-seeking among farmers has focused predominantly on male farmers, and has not included many of the Canadian agricultural commodity groups or provinces. The goal of this study was to explore perceptions of farmer help-seeking for mental health amongst farmers and people who work with farmers. The study objectives were to characterize the motivations and barriers to help-seeking behaviours. Semi-structured interviews were conducted with 75 farmers and individuals who work with farmers in Ontario, Canada, between 2017 and 2018. Interviews were conducted in person, and by telephone when needed. Topics of discussion included farming stresses and their impacts; personal well-being; agricultural crises and mental health help-seeking; use of mental health supports; motivators and barriers to help-seeking; and perceived ideals for mental health supports. Thematic analysis was conducted collaboratively by three authors using inductive and deductive coding. Our analysis resulted in five themes around help-seeking motivations and barriers: 1) Accessibility of mental health supports and services; 2) Stigma around mental health in the agricultural community; 3) Anonymity and/or lack of anonymity in seeking support; 4) Farm credibility; and 5) Recommendations for implementing mental health services for the agricultural community. This study provides insights around how farming culture and the accessibility and delivery of services may influence help-seeking for mental health, and proposes strategies to break down barriers to help-seeking in this population.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Data-informed targets for suicide prevention: a small-area analysis of high-risk suicide regions in Australia

PURPOSE

To investigate small-area variation in risks associated with suicide deaths across four regional communities in New South Wales, Australia, and to determine whether these areas have unique demographic and socioeconomic risk profiles that could inform targeted means restriction suicide prevention efforts.

METHODS

Archival data on suicide mortality for all deaths in New South Wales, Australia, over the period 2006-2015 were geospatially attributed to four high-risk priority regions. Deaths in the four regions were compared to each other, and to NSW, on demographic factors, indicators of economic deprivation, and suicide means.

RESULTS

Priority means restriction targets were identified for all sites. In Murrumbidgee, suicide deaths were significantly more likely to involve firearms and older males (p < 0.001). The Central Coast had a greater proportion of overdose deaths (p < 0.001), which were associated with being female and unemployed. Suicide deaths in Newcastle were associated with being younger (p = 0.001) and involving 'jumping from a height' (p < 0.001), while economic deprivation was a major risk for suicide death in Illawarra Shoalhaven (p < 0.001).

CONCLUSIONS

Local regions were significantly differentiated from each other, and from the State, in terms of priority populations and means of suicide, demonstrating the need for locally based, targeted interventions. There were, however, also some risk constancies across all sites (males, hanging, economic deprivation), suggesting that prevention initiatives should, optimally, be delivered within multilevel models that target risk commonalities and provide tailored initiatives that address risk specific to a region.

The Mental Health of the Organic Farmer: Psychosocial and Contextual Actors

Despite the large body of research and literature on the health and mental health of farmers, we should not assume that research findings necessarily apply to the organic farmer. The limited literature on the mental health of the organic farmer points to potential differences. Research has found that workers on organic farms may be happier than their counterparts; others have identified added sources of stress related to the perceived need of organic farmers to embrace concepts linked to the organic movement. However, further research is needed to identify both risk and protective factors for mental health among organic farmers. The purpose of this qualitative descriptive study was to explore the psychosocial and contextual factors that may relate to the mental health of the organic farmer. Key informant interviews were conducted with 10 farm producers and 20 farm workers. The findings indicated that respondents recognized mental health as influential in the workplace and the future of organic practices (e.g., the mental, financial, physical stress). Some of the risk factors mentioned by participants reflected those experienced by conventional, nonorganic farmers. Participants also reported contentment with farming as an occupation, the benefits of being connected to the land, feelings of social and environmental responsibility, and engagement in social activities that may promote human and social capital. These feelings and activities ultimately benefit the farmer, contribute to social cohesion, and may have positive implications for mental health. Results suggest that there may be protective mental health factors unique to the organic farmer.

Trends and Characteristics of Occupational Suicide and Homicide in Farmers and Agriculture Workers, 1992-2010

OBJECTIVE

We examined work-related homicides and suicides among farm operators/workers in the United States from 1992 to 2010.

METHODS

Work-related homicide and suicide cases from 1992 to 2010 were obtained from the Census of Fatal Occupational Injuries. To calculate rates, denominator data on the US working population were also obtained from 2003 to 2010 Current Population Survey. Logistic regression was used to identify factors that were differentially associated with homicide and suicide.

RESULTS

Over these 19 years, 171 farm operators/workers died from homicide and 230 died from suicide. When compared to rates of all workers, suicide rates were higher while homicide rates were lower among farm operators/workers. Males (OR = 6.1), whites (OR = 4.7), and 35- to 54-year-old (OR = 2.3) farm operators/workers had increased odds of suicide over homicide compared with their respective counterparts (ie, females, nonwhites, <35-year-olds). Those working in smaller farm operations with <11 employees had 1.7 times the odds of suicide over homicide.

CONCLUSIONS

Suicide and homicide are both present in the agricultural industry, with suicide being more common than homicide. Translation of suicide prevention programs should be explored for the agricultural industry.

Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017

Aim: To examine rates of contact with primary and mental health care prior to suicide in men and women and across a range of age categories. Method: The authors performed a systematic review of 44 studies from 2000 to 2017 of which 36 reported rates on contact with primary health care and 14 reported on contact with mental health care prior to suicide. Results: Contact with primary health care was highest in the year prior to suicide with an average contact rate of 80%. At one month, the average rate was 44%. The lifetime contact rate for mental health care was 57%, and 31% in the final 12 months. In general, women and those over 50 years of age had the highest rates of contact with health care prior to suicide. Conclusions: Contact with primary health care prior to suicide is common even in the final month before death. The findings presented in this study highlight the importance of placing suicide prevention strategies and interventions within the primary health care setting.

Risk Factors for Suicide and Suicidal Behavior Relevant to Emergency Health Care Settings: A Systematic Review of Post-2007 Reviews

Suicide is a global public health problem, and with recent economic and societal changes, there may be emerging risk factors unrecognized by health care professionals. The aim of this systematic review was to update existing suicide risk factor literature applicable to emergency health care settings. A total of 35 articles identified from PsycINFO, CINAHL, and Medline met the inclusion criteria. Results supported the significance of existing suicide risk factors and identified emerging risk factors. The review provides a high-quality update of risk factor literature that could be applied to emergency health care settings; however, further research is needed to confirm emerging risk factors.

Characteristics of suicidal attempts among farmers in rural South India

BACKGROUND

Globally, farming as an industry is considered a high-risk occupation for suicides. Certain states in India like Karnataka have a suicide rate higher than the national average, and this is generally attributed to the farmers' suicide.

AIMS

The aim is to study the characteristics of suicidal attempts among the farmer community in South India, with special emphasis on gender differences, modes used, and the immediate precipitant causes.

MATERIALS AND METHODS

Retrospective, case register-based, explorative-descriptive study of 426 consecutive medicolegal case files of patients whose stated occupation was farming and who were admitted as cases of deliberate self-harm or suicide attempt to a rural tertiary care hospital in rural South India.

RESULTS

Out of the 426 farmers who attempted suicide, majority were male (355, 83.3%), in the age group of 21-40 years (318, 75%), married (358, 84%), and belonging to lower socioeconomic status (268, 62.9%). About 54% of them had attempted suicide by consuming pesticides (230). Surprisingly, 183 (43%) and 86 (20.2%) reported the immediate precipitant as being relationship issues and marital conflict, respectively, and only 100 (23.5%) attributed it to financial reasons. Females were significantly associated with a past history of suicidal attempt while males tended to abuse alcohol before an attempt more frequently.

CONCLUSIONS

Pesticide poisoning was the most common mode for attempting suicide among the farmers. Contrary to public perception and other studies, relationship, and marital issues, not financial reasons were found to be the most common immediate precipitant for the attempters in our study.

The health and wellbeing of Australian farmers: a longitudinal cohort study

Background

Isolation, long work days, climate change and globalization are just some of the many pressures that make farming a vulnerable occupation for incurring mental health issues. The objective of this study was to determine whether farming in Australia is associated with poorer wellbeing, physical and mental health, and less health service use.

Methods

The Australian Rural Mental Health Study, a longitudinal cohort study was analysed over four time points comparing farmers with non-farming workers (n = 1184 at baseline). Participants were recruited from rural NSW, Australia. A number of physical, mental health, wellbeing, service use outcomes were assessed using generalised estimating equations including all waves in each model. Barriers to seeking help were also assessed.

Results

Farmers who lived remotely reported worse mental health (β −0.33, 95 % CI −0.53, −0.13) and wellbeing (β −0.21(95 % CI −0.35, −0.06) than remote non-farm workers regardless of financial hardship, rural specific factors eg drought worry, or recent adverse events. All farmers were no different to non-farming workers on physical health aspects except for chronic illnesses, where they reported fewer illnesses (OR 0.66, 95 % CI 0.44, 0.98). All farmers were half as likely to visit a general practitioner (GP) or a mental health professional in the last 12 months as compared to non-farm workers regardless of location (OR 0.59, 95 % CI 0.35, 0.97). Rural workers felt that they preferred to manage themselves rather than access help for physical health needs (50 %) or mental health needs (75 %) and there was little difference between farmers and non-farm workers in reasons for not seeking help.

Conclusions

Remoteness is a significant factor in the mental health and wellbeing of farmers, more so than financial stress, rural factors and recent adverse events. Creative programs and policies that improve access for farmers to GPs and mental health professionals should be supported.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3664-y) contains supplementary material, which is available to authorized users.

Family Dysfunction and Suicide Risk in a Community Corrections Sample

BACKGROUND

When comparted with the general population, the suicide rate in correctional populations is elevated. While predictors of suicide are well researched in jail and prison populations, much less work has been done to examine predictors of suicide in community corrections samples where 80% of the US correctional population is currently supervised.

AIMS

The goal of this study was to determine factors associated with suicide risk in a community corrections sample.

METHOD

Self-reported current ideation was examined in a sample of 512 individuals under supervision.

RESULTS

When univariate associations between current suicidal ideation and predictor variables were examined, current suicidal ideation was associated with being female, being White, reporting an increased level of stress, reporting an increased level of depression, meeting criteria for an anxiety disorder, an increased number of physical health complaints, and self-report of family dysfunction. In a multivariate analysis predicting suicide risk, only meeting criteria for an anxiety disorder, an increased number of physical health complaints, and self-report of family dysfunction were significant.

CONCLUSION

Mental and physical health complaints as well as self-report of family dysfunction are salient predictors of suicide risk in the community corrections population.

Symptoms of depression and all-cause mortality in farmers, a cohort study: the HUNT study, Norway

OBJECTIVES

To explore all-cause mortality and the association between symptoms of depression and all-cause mortality in farmers compared with other occupational groups, using a prospective cohort design.

METHODS

We included adult participants with a known occupation from the second wave of the Nord-Trøndelag Health Study (Helseundersøkelsen i Nord-Trøndelag 2 (HUNT2) 1995-1997), Norway. Complete information on emigration and death from all causes was obtained from the National Registries. We used the depression subscale of the Hospital Anxiety and Depression Scale (HADS) to measure symptoms of depression. We compared farmers to 4 other occupational groups. Our baseline study population comprised 32 618 participants. Statistical analyses were performed using the Cox proportional hazards models.

RESULTS

The estimated mortality risk in farmers was lower than in all other occupations combined, with a sex and age-adjusted HR (0.91, 95% CI 0.82 to 1.00). However, farmers had an 11% increased age-adjusted and sex-adjusted mortality risk compared with the highest ranked socioeconomic group (HR 1.11, 95% CI 0.98 to 1.25). In farmers, symptoms of depression were associated with a 13% increase in sex-adjusted and age-adjusted mortality risk (HR 1.13, 95% CI 0.88 to 1.45). Compared with other occupations this was the lowest HR, also after adjusting for education, marital status, long-lasting limiting somatic illness and lifestyle factors (HR 1.08, 95% CI 0.84 to 1.39).

CONCLUSIONS

Farmers had lower all-cause mortality compared with the other occupational groups combined. Symptoms of depression were associated with an increased mortality risk in farmers, but the risk increase was smaller compared with the other occupational groups.

Farmers’ contact with health care services prior to suicide: evidence for the role of general practitioners as an intervention point

Suicide in Australian rural communities has received significant attention from researchers, health practitioners and policymakers. Farmers and agricultural workers have been a focus of particular interest, especially in relation to levels of help seeking for mental health concerns. A less explored area, however, is the level of contact that Australian farming and agriculture workers who die by suicide have had with health providers for physical, rather than mental, health conditions. It is often assumed that farmers and agricultural workers have lower levels of contact with health care services than other rural residents, although this assumption has not been well tested. Using data from the Queensland Suicide Register, this paper describes levels of contact with health care providers in the 3 months before death by suicide among men in farming and agriculture occupations and other occupations in rural Queensland. No significant differences were found in farming and agricultural workers’ levels of contact with a general practitioner when compared with other rural men in Queensland. The current findings lend weight to the view that rural general practitioners represent an important intervention point for farming and agriculture workers at risk of suicide (whether or not those individuals exhibit accompanying psychiatric illness).

Male farmers with mental health disorders: a scoping review

The issue of male farmers' mental health raises many concerns including high rates of psychological distress and suicide amid the poor uptake of health services among this subgroup. Gender is an important social determinant of health, and this paper provides an overview of connections between farming and masculinities in the context of men's mental health disorders. This scoping review summarises findings drawn from 46 studies to discuss male farmers' mental health disorders, psychosocial interventions and barriers to help-seeking. In providing the review, recommendations are made including the need for an array of study and intervention approaches to advance the mental health and well-being of male farmers and their families.

Suicide by occupation: systematic review and meta-analysis

BACKGROUND

Previous research has shown that those employed in certain occupations, such as doctors and farmers, have an elevated risk of suicide, yet little research has sought to synthesise these findings across working-age populations.

AIMS

To summarise published research in this area through systematic review and meta-analysis.

METHOD

Random effects meta-analyses were used to calculate a pooled risk of suicide across occupational skill-level groups.

RESULTS

Thirty-four studies were included in the meta-analysis. Elementary professions (e.g. labourers and cleaners) were at elevated risk compared with the working-age population (rate ratio (RR) = 1.84, 95% CI 1.46-2.33), followed by machine operators and deck crew (RR = 1.78, 95% CI 1.22-2.60) and agricultural workers (RR = 1.64, 95% CI 1.19-2.28). Results suggested a stepwise gradient in risk, with the lowest skilled occupations being at greater risk of suicide than the highest skill-level group.

CONCLUSIONS

This is the first comprehensive meta-analytical review of suicide and occupation. There is a need for future studies to investigate explanations for the observed skill-level differences, particularly in people employed in lower skill-level groups.

Suicide and pesticide use among pesticide applicators and their spouses in the agricultural health study

BACKGROUND

An association may exist between pesticide exposure and suicide.

OBJECTIVE

We sought to evaluate the existence of an association between pesticide use and suicide using data from the Agricultural Health Study (AHS), a prospective cohort study of licensed pesticide applicators and their spouses in Iowa and North Carolina.

METHODS

Via linkage to state mortality files and the National Death Index, we identified 110 suicides occurring between enrollment in the AHS (from 1993 to 1997) and 31 May 2009, among 81,998 cohort members contributing 1,092,943 person-years of follow-up. The average length of follow-up was 13.3 years. AHS participants provided data on pesticide use and potential confounders via self-administered questionnaires at enrollment. We evaluated several measures of pesticide use: use of any pesticide, ever use of 50 specific pesticides, cumulative lifetime days of use and intensity-adjusted cumulative lifetime days of use of 22 specific pesticides, and ever use of 10 functional and chemical classes of pesticides. We used Cox proportional hazards regression models to estimate adjusted hazard ratios and 95% confidence intervals.

RESULTS

After adjusting for age at enrollment, sex, number of children in family, frequency of alcohol consumption during the past 12 months, and smoking status, we found no association between prior pesticide use and suicide in applicators and their spouses. Results were the same for applicators and spouses together or for applicators alone and were consistent across several measures of pesticide use.

CONCLUSIONS

Our findings do not support an association between moderate pesticide use and suicide.

Firearm suicide decedents in the Republic of Ireland, 1980-2005

OBJECTIVES

To compare the sociodemographic characteristics of firearms suicide decedents and other suicide decedents in the Republic of Ireland between 1980 and 2005.

STUDY DESIGN

A cross-sectional study of sociodemographic characteristics of those who committed suicide with a firearm and those who committed suicide by an alternative method.

METHODS

Suicide data from 1980 to 2005 inclusive, provided by the Central Statistics Office of Ireland, were analysed. For the purpose of this paper, suicide method was collapsed into two groups: firearm-assisted suicide (FAS) and non-firearm-assisted suicide (n-FAS). Differences in gender, marital status (married vs not married), area of residence (urban vs rural), agri-employment (agri-employed vs not agri-employed) and age were examined between the two groups. A logistic regression is presented using suicide method (FAS vs n-FAS) as the criterion variable and individual factors as predictors.

RESULTS

In total, 9674 suicides were recorded from 1 January 1980 to 31 December 2005. Seven hundred and ninety-three of these were FAS and 8881 were n-FAS. For both suicide profiles, the deceased were predominantly male, living in a rural setting and not married. However, this profile was more salient in the FAS group. In comparison with the n-FAS group, a greater proportion of the FAS decedents were male [chi(2)(1)=152.5, P< or =0.0001, odds ratio (OR)=4.5, 95% confidence interval (CI) 3.4-6.1], from a rural setting [chi(2)(1)=153.5, P< or =0.0001, OR=4.4, 95%CI 3.2-5.6) and agri-employed [chi(2)(1)=21.3, P< or =0.0001, OR=1.5, 95%CI 1.3-1.8). FAS decedents were significantly younger than n-FAS victims, although the size of this effect was small (z=-8.4, P<0.0005, r=-0.1). There was no difference in marital status between the two groups.

CONCLUSIONS

Risk factors for FAS should inform policy-making in this area, with particular attention paid to protecting young males resident in rural settings. Consideration should be given to targeting agri-employed individuals as a specific at-risk group.

Who uses firearms as a means of suicide? A population study exploring firearm accessibility and method choice

BACKGROUND

The 1996 Australian National Firearms Agreement introduced strict access limitations. However, reports on the effectiveness of the new legislation are conflicting. This study, accessing all cases of suicide 1997-2004, explores factors which may impact on the choice of firearms as a suicide method, including current licence possession and previous history of legal access.

METHODS

Detailed information on all Queensland suicides (1997-2004) was obtained from the Queensland Suicide Register, with additional details of firearm licence history accessed from the Firearm Registry (Queensland Police Service). Cases were compared against licence history and method choice (firearms or other method). Odds ratios (OR) assessed the risk of firearms suicide and suicide by any method against licence history. A logistic regression was undertaken identifying factors significant in those most likely to use firearms in suicide.

RESULTS

The rate of suicide using firearms in those with a current license (10.92 per 100,000) far exceeded the rate in those with no license history (1.03 per 100,000). Those with a license history had a far higher rate of suicide (30.41 per 100,000) compared to that of all suicides (15.39 per 100,000). Additionally, a history of firearms licence (current or present) was found to more than double the risk of suicide by any means (OR = 2.09, P < 0.001). The group with the highest risk of selecting firearms to suicide were older males from rural locations.

CONCLUSION

Accessibility and familiarity with firearms represent critical elements in determining the choice of method. Further licensing restrictions and the implementation of more stringent secure storage requirements are likely to reduce the overall familiarity with firearms in the community and contribute to reductions in rates of suicide.

Dissemination and implementation of suicide prevention training in one Scottish region

BACKGROUND

As part of a national co-ordinated and multifaceted response to the excess suicide rate, the Choose Life initiative, the Highland Choose Life Group launched an ambitious programme of training for National Health Service (NHS), Council and voluntary organisation staff. In this study of the dissemination and implementation of STORM (Skills-based Training On Risk Management), we set out to explore not only the outcomes of training, but key factors involved in the processes of diffusion, dissemination and implementation of the educational intervention.

METHODS

Participants attending STORM training in Highland Region provided by 12 trained facilitators during the period March 2004 to February 2005 were recruited. Quantitative data collection from participants took place at three time points; immediately before training, immediately post-training and six months after training. Semi-structured telephone interviews were carried out with the training facilitators and with a sample of course participants 6 months after they had been trained. We have utilized the conceptual model described by Greenhalgh and colleagues in a Framework analysis of the data, for considering the determinants of diffusion, dissemination and implementation of interventions in health service delivery and organization.

RESULTS

Some 203 individuals completed a series of questionnaire measures immediately pre (time 1) and immediately post (time 2) training and there were significant improvements in attitudes and confidence of participants. Key factors in the diffusion, dissemination and implementation process were the presence of a champion or local opinion leader who supported and directed the intervention, local adaptation of the materials, commissioning of a group of facilitators who were provided with financial and administrative support, dedicated time to provide the training and regular peer-support.

CONCLUSION

Features that contributed to the success of STORM were related to both the context (the multi-dimensional support provided from the host organisation and the favourable policy environment) and the intervention (openness to local adaptation, clinical relevance and utility), and the dynamic interaction between context and the intervention.

Suicide rates in the State of Rio Grande do Sul, Brazil: association with socioeconomic, cultural, and agricultural factors

Rio Grande do Sul State has the highest suicide rates in Brazil. Previous studies have suggested a possible role of agricultural activities, especially tobacco farming, where pesticide use is intensive. An ecological study was designed to assess associations between age-adjusted suicide rates based on death certificates and socioeconomic and agricultural factors. Suicide rates in males and females were inversely associated with schooling level and directly associated with divorce/marital separation. Rates for men were higher in areas where traditional Protestant religious were more prevalent, and rates for women were lower in areas with a higher proportion of single-inhabitant households. Multivariate analyses showed no associations between increased suicide rates and any of the agricultural variables. These results confirm the role of socioeconomic determinants of suicide, but do not support the hypothesis of a specific role of agricultural practices.

The interrelation between organophosphate toxicity and the epidemiology of depression and suicide

The literature on an association between organophosphate (OP) toxicity and depression or suicide is scarce. An interrelation exists among populations exposed to OPs, acute OP toxicity, neurobehavioral effects, depression, suicide, and fatality. Acute OP toxicity is characterized by the cholinergic syndrome with systemic and central nervous system effects. Organophosphate-induced neurobehavioral effects result in depression. A potential risk of depression and suicide exists in farm workers exposed to OPs. The sociodemographics of depression include age, gender, race, geographic region, social factors, economics, psychiatric disorders, medical conditions, and hereditary factors. Suicide is a major consequence of depression, with multiple sociodemographic risk factors. Developing countries have a higher incidence of OP toxicity, with limited information on the prevalence of depression. In these countries, the incidence of suicide is high, affecting more females. Suicide is more prevalent in rural areas, and in farming communities, commonly with ingestion of OPs. In industrialized countries, the incidence of OP toxicity is lower, but the prevalence of depression is higher. Suicide rates are lower in industrialized countries, affecting more males, the urban population, and farming communities. Other lethal methods of suicide, such as hanging, firearms, electrocution, and drug overdose are more common in industrialized countries. A potential risk of depression or suicide certainly exists from OP toxicity, largely depending on the epidemiology or sociodemographics of these disorders. Scientific evidence shows that the association between environmental toxicology and psychiatry has important public health implications.

Changes in Scottish suicide rates during the Second World War

Background

It is believed that total reported suicide rates tend to decrease during wartime. However, analysis of suicide rates during recent conflicts suggests a more complex picture, with increases in some age groups and changes in method choice. As few age and gender specific analyses of more distant conflicts have been conducted, it is not clear if these findings reflect a change in the epidemiology of suicide in wartime. Therefore, we examined suicide rates in Scotland before, during and after the Second World War to see if similar features were present.

Methods

Data on deaths in Scotland recorded as suicide during the period 1931 – 1952, and population estimates for each of these years, were obtained from the General Register Office for Scotland. Using computer spreadsheets, suicide rates by gender, age and method were calculated. Forward stepwise logistic regression was used to assess the effect of gender, war and year on suicide rates using SAS V8.2.

Results

The all-age suicide rate among both men and women declined during the period studied. However, when this long-term decline is taken into account, the likelihood of suicide during the Second World War was higher than during both the pre-War and post-War periods. Suicide rates among men aged 15–24 years rose during the Second World War, peaking at 148 per million (41 deaths) during 1942 before declining to 39 per million (10 deaths) by 1945, while the rate among men aged 25–34 years reached 199 per million (43 deaths) during 1943 before falling to 66 per million (23 deaths) by 1946. This was accompanied by an increase in male suicides attributable to firearms and explosives during the War years which decreased following its conclusion.

Conclusion

All age male and female suicide rates decreased in Scotland during World War II. However, once the general background decrease in suicide rates over the whole period is accounted for, the likelihood of suicide among the entire Scottish population during the Second World War was elevated. The overall decrease in suicide rates concealed large increases in younger male age groups during the War years, and an increase in male suicides recorded as due to the use of firearms. We conclude that the effects of war on younger people, reported in recent conflicts in Central Europe, were also seen in Scotland during the Second World War. The results support the findings of studies of recent conflicts which have found a heterogeneous picture with respect to age specific suicide rates during wartime.

Understanding suicide in Australian farmers

OBJECTIVE

Male farmers in Australia have an elevated risk of suicide. The aims of this study were to investigate the rate of mental health problems amongst farmers compared with non-farmer rural residents and to investigate what additional factors might contribute to an increased risk of suicide amongst farmers.

METHOD

This study used a combination of quantitative and qualitative approaches. First, using self-report questionnaire data, we compared rates of mental health problems (a common correlate of suicide) and a number of personality measures between farmers (n=371) and non-farming rural residents (n=380). In addition, semi-structured interviews with farmers (n=32) were used to gain a richer understanding of how the context of farming and mental health interact.

RESULTS

Five key findings emerged from the study. First, in the quantitative study, we found no support for the proposition that farmers experience higher rates of mental health problems than do non-farmer rural residents, but we identified potentially important personality differences between farmers and non-farmers, with levels of conscientiousness being significantly higher amongst farmers and levels of neuroticism being significantly lower. A strong association between maleness and farming was also found. In the qualitative study, participants indicated that farming is an environment in which individuals experienced a range of stressors but have limited capacity to acknowledge or express these. In addition, there appeared to be significant attitudinal barriers to seeking help for those who may have mental health problems, particularly male farmers.

CONCLUSION

The elevated rate of suicide amongst farmers does not seem to be simply explained by an elevated rate of mental health problems. Individual personality, gender and community attitudes that limit a person's ability to acknowledge or express mental health problems and seek help for these may be significant risk factors for suicide in farmers.

Farming and mental health problems and mental illness

BACKGROUND

Farmers experience one of the highest rates of suicide of any industry and there is growing evidence that those involved in farming are at higher risk of developing mental health problems. This article provides an overview of the literature examining mental health issues experienced by farming populations in the United Kingdom, Europe, Australia, Canada and the United States and identifies areas for further research.

METHOD

A literature review (Medline, Science Direct, Ingenta, Proquest and PsychINFO) was carried out using the words 'farmers', 'agriculture', 'depression', 'mental health', 'mental illness', 'stress', and 'suicide', as well as a review of relevant papers and publications known to the authors. (Papers not written in English and those published prior to 1985 were excluded.)

RESULTS

Fifty-two papers were identified with the majority focusing on stress and coping styles in farmers (24). A number of studies also focused on neuropsychological functioning and agricultural chemical use (7), depression (7), suicide (9), general mental health (4) and injury and mental health (1). This body of research studied male farmers, female farmers, farm workers, farming families, and young people living on farms. Research to date indicates that farmers, farm workers and their respective families face an array of stressors related to the physical environment, structure of farming families and the economic difficulties and uncertainties associated with farming which may be detrimental to their mental health.

CONCLUSION

Whilst suicide rates in some groups of farmers are higher than the general population, conclusive data do not exist to indicate whether farmers and farming families experience higher rates of mental health problems compared with the non-farming community. It is clear, however, that farming is associated with a unique set of characteristics that is potentially hazardous to mental health and requires further research.

Gunshot suicides in England--a multicentre study based on coroners' records

BACKGROUND

Gunshot suicides account for 2.5% of suicides in England and Wales. This amounts to more than 100 deaths per year. Information about such deaths may assist in the development of suicide prevention strategies.

METHOD

We have examined coroners' inquest records for all gunshot suicides between 1st January 2000 and 31st December 2001 in 24 coroners' jurisdictions in England.

RESULTS

Fifty-eight gunshot suicides were identified, including one homicide-suicide. Ninety-three per cent of cases were male. Sport or occupational usage was the main reason for owning the gun. Ten per cent were farmers or farm-workers. In 20% of cases the gun did not belong to the individual who used it for suicide. This was more likely in younger suicides. Seven (12.1%) individuals used illegally owned handguns. Large amounts of alcohol had been consumed before the act in nine cases. Nearly three-quarters (72.9%) of individuals with diagnostic information had a probable diagnosis of depression. However, only 22.4% had ever had contact with psychiatric services. Two shotgun certificate holders were under the care of psychiatric services at the time of their death and two others had a history of previous self-harm.

CONCLUSIONS

Strategies to reduce the number of gunshot suicides need to focus on limiting access to guns. These include restricting access to guns by non-certificate holders and those who may be at increased risk of suicide, and holding regular gun amnesties.

Psychosocial investigation of individual and community responses to the experience of Ovine Johne's Disease in rural Victoria

OBJECTIVE

This paper explores the psychosocial outcomes for individuals and communities in rural Victoria who experienced the outbreak of Ovine Johne's Disease (OJD).

DESIGN

The study uses a qualitative methodology to analyse the minutes of evidence provided by the inquiry into the control of OJD to identify the psychosocial events, experiences and outcomes associated with the control of this outbreak. The inquiry was undertaken by the Environment and Natural Resources Committee of the Victorian State Government.

SETTING

Public hearings were undertaken by the committee across several rural Victorian communities and the state capital, Melbourne.

SUBJECTS

The transcripts detail 136 submissions from 98 individuals and 23 organisations.

OUTCOME MEASURES

The analysis aimed to provide insight into the impact of the disease on individuals and communities and also to explore the factors individuals perceived as associated with these outcomes.

RESULTS

While the paper identifies that aspects of stock loss associated with the outbreak caused substantial emotional and economic distress, for farmers the most significant finding was the impact of the government control program on individuals, families and rural communities. The control program was perceived as having very limited scientific credibility and its implementation was described as heartless, inflexible and authoritarian. Involvement with the program resulted in farmers reporting emotions, such as, trauma, shame, guilt and stigma. Families became discordant and the sense of community within rural townships fragmented. Psychological outcomes of grief, depression and anxiety emerged as prevalent themes within families and communities.

CONCLUSIONS

These data highlight the need for significant attention to the management of rural disasters, such as, the OJD program.

WHAT THIS PAPER ADDS

There is an acknowledgement in the literature that rural disasters have a significant impact on the well-being of individuals, families and communities. The major focus of the previous research has, however, been on the impact of economic losses with less recognition of the other psychosocial loss experiences that accompany the experience of rural disaster. This paper achieves a clear description of the experiences for individuals (trauma, stigma, sense of personal failure, loss of identity, diminished self esteem and family disruption) and communities (destroyed social cohesion, economic disharmony) caught up in the OJD disaster and explores the factors that individuals perceive as responsible for these outcomes. The mental health outcomes for individuals, such as, loss, grief and depression are also explored within this paper. This paper highlights the psychosocial complexity of the experience of rural disaster for individuals and communities significantly extending the current knowledge base in this area.