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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Health, social and legal supports for migrant agricultural workers in France, Italy, Spain, Germany, Canada, Australia and New Zealand: a scoping review

Introduction

We carried out a scoping review to examine what previous literature can teach us about practices and possibilities for support services for migrant agricultural workers.

Methods

Following guidelines for scoping reviews as outlined by Arksey and O'Malley (2005) and further refined by Levac et. al (2010) we conducted searches of several databases and two additional searches to capture regions of focus and more current literature. We used a thematic analysis to generate our themes.

Results

Our analysis yielded four key themes: (1) political, economic and legal factors; (2) living and working conditions; (3) facilitators/barriers to navigating services and supports and; (4) potential and existing strategies for social support for migrant agricultural workers. The first two themes pointed more to structural and material conditions that both posed barriers for this population to access supports, but also illustrated vulnerabilities that pointed to the need for a variety of services and protections. Under the third, we highlighted the ways that the design of services and supports, or their degree of accessibility, could shape the level of help available to this population. Lastly, potential and existing strategies for social support discussed in the literature included an emphasis on mental health and wellbeing, occupational health and safety training and documentation, and policy reforms to secure the status and address the precarity of this workforce.

Discussion

While research on social support and service provision for migrant agricultural workers is still in its infancy, a strength of this body of work is its attention to macro-level issues that advocate for strategies that address root factors that shape this group's health. Further research is required to expand our understanding of social support roles and possibilities across other domains and sectors for this population.

Participant perspectives of an online co-design process to develop a prevention-focused mental health and well-being platform for primary producers

OBJECTIVE

To explore participant experiences of an online co-design process to develop a web-based preventative mental health and well-being intervention targeting primary producers in rural Australia.

SETTING

Rural Victoria, Australia.

PARTICIPANTS

Participants from a primary producer background, including horticulture, fisheries, animal cultivation and farm consultancy, were eligible for the study if they had participated in both the co-design and beta testing processes for a primary producer platform.

DESIGN

A qualitative study using semi-structured phone-based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes.

RESULTS

Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant diversity, (2) impact of online delivery on co-design participation, (3) experiences of the co-design process, (4) maintaining a shared vision and goals and (5) acting on the co-design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co-design using face-to-face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face-to-face.

CONCLUSIONS

Using an online co-design method to develop a preventative mental health and well-being web-based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co-design process and identify opportunities to improve participant engagement and experience with the online format.

Farmer Mental Health Interventions: A Systematic Review

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

Exploring men's use of mental health support offered by an Australian Employee Assistance Program (EAP): perspectives from a focus-group study with males working in blue- and white-collar industries

Background

Men continue to be overrepresented in the Australian suicide statistics despite wide scale public health initiatives to improve men’s mental health literacy and to increase their help-seeking behaviour. Employee Assistance Programs (EAP) deliver free and confidential mental health support; however, their services are underutilised by men. In the absence of contemporary literature that explores end-user experiences of EAPs, we asked men from blue- and white-collar employment settings about the barriers and enablers to using EAP services and explored differences between employment settings.

Methods

Forty-four men participated in this qualitative study: 32 from one white-collar employer and 12 from one blue-collar employer. Two qualified mental health professionals facilitated five first-round and three second-round focus groups and one interview with white-collar workers, and two focus groups and three interviews with blue-collar workers. Data were thematically analysed using a framework approach.

Results

Four of the six main themes were barriers: no need for EAP—alternative supports; uncertainty of EAP services; scepticism and distrust of EAP; and societal and workplace cultures. Elements of enduring barriers to EAP use were contained within sub-themes. These included lack of knowledge about EAPs, issues of trustworthiness and confidentiality, and fear of stigma and career jeopardy. Enablers comprised the need for attractive, reliable messaging and proactive connections and service delivery. Differences within sub-themes for white-collar and blue-collar groups reflected the corporate nature of work and workplace culture for white-collar participants, and workers’ communication and practical problem resolution preferences for blue-collar workers.

Conclusion

Some elements identified in the barriers to EAP use are more entrenched than were previously estimated and these need to be a priority for action to increase confidence in EAP services by end-users. EAPs that have a visible and proactive presence in the workplace, that tailor their marketing and service delivery to different workgroups, that provide a competitive advantage to its service users, and more confidently conveys independence from its client organisations may help to increase men’s interest in accessing EAP support services. Further initiatives that reduce the stigma surrounding mental health and help-seeking both in society and the workplace are needed.

Tailored Mental Health Literacy Training Improves Mental Health Knowledge and Confidence among Canadian Farmers

This study evaluated the impact of "In the Know" mental health literacy training for Canadian agriculture. We hypothesized that "In the Know" would significantly increase participants' knowledge around mental health, confidence in recognizing mental health struggles, confidence in speaking about mental health with others, and confidence in helping someone who may be struggling with mental health. "In the Know" was a 4-h, in-person program delivered by a mental health professional who also had experience in agriculture. Six sessions were offered in Ontario, Canada in 2018. Participants were farmers and/or worked primarily with farmers. A pre-training paper questionnaire was administered, followed by a post-training questionnaire at the end of the session and 3 and 6 month post-training questionnaires via email. Wilcoxon signed-rank tests were performed to compare participants' self-reported knowledge and confidence across four timepoints. "In the Know" significantly improved participants' self-reported mental health knowledge and confidence in recognizing mental health struggles, speaking to others, and helping others who are struggling immediately following training and often at 3 and 6 months post-training. This is the first study among farming populations to measure program impact with 3- and 6-month follow-ups. Given the reported associations between mental health literacy and increased help-seeking, disseminating "In the Know" more broadly across farming communities may help to increase mental health literacy and thus increase help-seeking among farmers.

Research trends in farmers' mental health: A scoping review of mental health outcomes and interventions among farming populations worldwide

Background

Mental health issues among farmers are identified population health concerns. While one systematic review focused on suicide in farming populations in the United States, there have been no scoping studies examining mental health in farming communities worldwide. The objectives of this scoping review were to: provide a descriptive analysis of the literature pertaining to mental health outcomes in farming populations; describe the international scope of the research; and highlight published mental health services and interventions that have been evaluated.

Methods

Following Arksey and O’Malley’s scoping review framework, five major health and science platforms were used to identify studies examining mental health outcomes in farming populations, worldwide. Studies that met a priori inclusion criteria that were published prior to December 31, 2017 were included in this review. Data synthesis and descriptive statistics were conducted using STATA 15® software; proportions were calculated by country.

Results

The initial literature search yielded 9,906 records. After title and abstract screening, 676 articles were reviewed in-full. Of these, 341 met a priori inclusion criteria. Studies included were conducted between 1979 and 2017; the majority (265; 77.7%) were published between 2002–2017. The most frequently measured outcomes were stress (41.9%), suicide (33.1%), and depression (32.6%). Over 70% of studies that examined stress described using quantitative research methods, most predominantly, cross-sectional designs (42.7%). Approximately 64% of studies that measured suicide reported using a quantitative approach; the largest proportion of included suicide studies (33.6%) described using cohort designs. Approximately 84% of studies that measured depression described using quantitative approaches; sixty percent of these studies reported using a cross-sectional study design. Twenty included studies described a mental health service or intervention (5.9%).

Conclusions

This scoping review provides a critical overview of the literature examining mental health outcomes in farming populations worldwide. Given the importance of farming and agriculture, this review can be used to ensure future research complements existing work, avoids unnecessary overlap, and begins to tackle the less-studied mental health outcomes amongst farmers. These results can guide researchers to identified gaps in research and services, leading to a more informed approach to future work, and ultimately, a more comprehensive understanding of mental health among farmers worldwide.

Meeting Farmers Where They Are - Rural Clinicians' Views on Farmers' Mental Health

Objective: To explore rural clinicians' understanding of farmers' mental health and well-being, current health services, and potential responses.Methods: Qualitative design, with semi-structured, taped interviews of five family physicians and four mental health nurses-counselors practicing in rural Grey-Bruce counties, Ontario. Transcripts analyzed with N-Vivo through iterative coding of emergent themes and mapping of relationships among themes.Results: Participating rural clinicians all expressed admiration for farmers. They shared insights around three main themes: 1) farming as a unique subculture; 2) farming involved both benefits and challenges for health; and 3) farmers rarely seek care. Clinicians need to take advantage of contact opportunities to ask about mental health. Several suggested ways to meet farmers where they are, e.g., through better funding for house-farm calls and community events.Conclusion: Clinician responses to farmers' mental health challenges include recognizing farmers' distinct context. Complementary health promotion in conjunction with farm organizations is needed to reach farmers.

Suicide and Accidental Death for Australia's Farming Families: How Context Influences Individual Response

This article presents qualitative data to explore the experience of farming family members faced with accidental or suicide death and understand how this is experienced within the farming context. Individual semistructured interviews were conducted with 25 members of Australian farming families bereaved by suicide or accidental death. Qualitative data was thematically analyzed. Three interconnected themes were identified: acceptance of risk, normalization of death, pragmatic behavior patterns and connection to place. Bereavement and reconstruction of meaning following suicide or accidental death for farming families is influenced by the cultural, social, geographical, and psychological contexts of farming families. This article challenges traditional conceptions of suicide and accidental death as necessarily experienced as "violent" or "traumatic," bereavement as experienced similarly across western cultures, and the reaction to suicide or accidental death as one that challenges people's understanding of their world and leaves them struggling to find a reason why the death occurred.

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.