A thematic analysis of the personal factors influencing mental health help-seeking in farmers

PURPOSE

It is crucial to understand the micro-level personal factors that impact farmer mental health help-seeking, given that farmers are at increased risk of suicide yet show reduced mental health help-seeking behaviors.

METHODS

Ten farmers, 10 farmers' partners, and 8 general practitioners (ie, family physicians) from Australia completed qualitative semi-structured interviews. Braun and Clarke's method of thematic analysis was used to analyze the data.

FINDINGS

The analysis resulted in 4 themes: "mental health literacy," "stigma of mental illness and help-seeking," "support, the partners' role in help-seeking," and "the intersectionality between being a farmer, age, and gender." Farmers' knowledge and understanding of mental health and treatments was varied. Stigma was reported to be reducing, but still present toward both mental illness and mental health help-seeking. Support from a partner was reported to facilitate help-seeking if delivered tactfully. Lastly, being older and male were reported to negatively impact farmer mental health help-seeking.

CONCLUSION

The findings contribute to understanding farmer mental health help-seeking and could inform quantitative research and the development and implementation of interventions to promote mental health help-seeking in this group.

Disadvantaged by More Than Distance: A Systematic Literature Review of Injury in Rural Australia

Rural populations experience injury-related mortality and morbidity rates 1.5 times greater than metropolitan residents. Motivated by a call for stronger epidemiological evidence around rural injuries to inform prevention, a systematic review of peer-reviewed literature published between January 2010 and March 2021 was undertaken to explore the epidemiology of rural injury and associated risk factors in Australia. A subsequent aim was to explore definitions of rurality used in injury prevention studies. There were 151 papers included in the review, utilizing 23 unique definitions to describe rurality. People living in rural areas were more likely to be injured, for injuries to be more severe, and for injuries to have greater resulting morbidity than people in metropolitan areas. The increase in severity reflects the mechanism of rural injury, with rural injury events more likely to involve a higher energy exchange. Risk-taking behavior and alcohol consumption were significant risk factors for rural injury, along with rural cluster demographics such as age, sex, high socio-economic disadvantage, and health-related comorbidities. As injury in rural populations is multifactorial and nonhomogeneous, a wide variety of evidence-based strategies are needed. This requires funding, political leadership for policy formation and development, and implementation of evidence-based prevention interventions.

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

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

"Don't … Break Down on Tuesday Because the Mental Health Services are Only in Town on Thursday": A Qualitative Study of Service Provision Related Barriers to, and Facilitators of Farmers' Mental Health Help-Seeking

The suicide rate of farmers is approximately double that of the general Australian population, yet farmers employ fewer help-seeking behaviours (Arnautovska et al. in Soc Psychiatry Psychiatr Epidemiol 49:593-599, 2014; Brew et al. in BMC Public Health 16:1-11, 2016). Therefore, it is crucial to understand if, and how health services and system might influence farmer help-seeking. To shed light on this, the current study employed qualitative semi-structured interviews with 10 farmers, 10 farmers' partners and 8 medical practitioners. Thematic analysis, guided by Braun and Clarke's (Qual Res Psychol 3:77-101, 2006) techniques, was used to analyse the data. Three themes were devised concerning the interaction between farmers and health services, including 'health service interactions', 'services are provided within a complex system' and 'emerging technologies: the users, practitioners, and systems'. The findings underscore the importance of interactions between a farmer and a service provider, with farmers wanting their provider to have an understanding of farming life. Help-seeking was also shaped by access, availability, and practitioner constancy. Lastly, a complex relationship between digital mental health services and farmer help-seeking was reported, with factors related to the farmers, the practitioners and the infrastructure/systems discussed. The outcomes have implications for health service and policy reform, developing and providing interventions for farmers to promote health services interaction as a way of mental health help-seeking.

[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.

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.

Suicide Mortality Across Broad Occupational Groups in Greece: A Descriptive Study

Background

Several studies have investigated the relationship between specific occupations and suicide mortality, as suicide rates differ by profession. The aim of this study was to investigate suicide mortality ratios across broad occupational groups in Greece for both sexes in the period 2000–2009.

Methods

Data of suicide deaths were retrieved from the Hellenic Statistical Authority and comparative mortality ratios were calculated. Occupational classification was based on the International Classification of Occupations (ISCO-88) and the coding for Intentional self-harm (X60–X84) was based on the international classification of diseases (ICD-10).

Results

Male dominant occupations, mainly armed forces, skilled farmers and elementary workers, and female high-skilled occupations were seen as high risk groups for suicide in a period of 10 years. The age-productive group of 30–39 years in Greek male elementary workers and the 50–59 age-productive group of Greek professional women proved to have the most elevated number of suicide deaths.

Conclusion

Further research is needed into the work-related stressors of occupations with high suicide mortality risk and focused suicide prevention strategies should be applied within vulnerable working age populations.