Sowing seeds of awareness: a cross-sectional analysis of mental health literacy and help-seeking in Irish farmers

Malone S.M., Firnhaber J., O'Hagan A.D., O'Keeffe S., McNamara J., O'Connor S.

Hammersley C., Richardson N., Meredith D., McNamara J., Carroll P., Jenkins P.

Roche E., Richardson N., Sweeney J., O’Donnell S.

Mental ill-health and suicide represent a significant proportion of the burden of global disease among men. Connell’s relational theory of masculinities provides a useful framework to explore how mental health literacy, mental health stigma, and delayed help-seeking and help-offering behaviors are associated with mental ill-health among men, particularly within male-dominated industries. To address the high incidences of mental ill-health in male-dominated industries, several workplace interventions targeting these outcomes have been implemented. No review to date has examined the current state of evidence for these interventions or identified the behavior change techniques used. This review was restricted to empirical, quantitative research reporting on psychosocial interventions targeting mental health literacy, stigma, and help-seeking and help-offering behaviors in male-dominated industries. Quality appraisal was completed using the Effective Public Health Practice Project and a narrative synthesis was conducted. Twelve articles were included for review which reported on four distinct interventions. The methodological quality of two articles was strong, three moderate and seven weak. The strongest evidence of intervention effects related to mental health literacy and help-seeking intentions. There was less evidence relating to help-offering and help-seeking behaviors and mental health stigma. Sixteen behavior change techniques were identified across interventions that are discussed in relation to the wider men’s health literature. The evidence on psychosocial interventions in male-dominated industries is limited due to methodological and conceptual issues. Recommendations for future research include standardized reporting of intervention descriptions, the use of theory to guide intervention development, and utilizing validated and reliable outcome measures.

O'Connor S., O'Hagan A.D., Malone S.M., O'Shaughnessy B.R., McNamara J., Firnhaber J.

Farming can be a demanding, solitary, and unpredictable occupation. As a result, farmers may be more susceptible to sleep issues and burnout than workers in other occupations. However, economic and social pressures that may cause burnout and sleep issues in farmers vary greatly between nationalities. There is a lack of research on sleep and burnout in European, and specifically Irish, farmers using reliable psychometric tests. Therefore, we conducted a cross-sectional prevalence assessment of sleep issues and burnout with a population sample of 351 Irish farmers. Using the Pittsburgh Sleep Quality Index (PSQI), a subscale of the Maslach Burnout Inventory (MBI), and the Short Form Health Survey-12 (SFHS), we identified how farmers’ sleep and burnout were correlated with their mental and physical health and identified the role of individual differences such as socioeconomic status, age, and gender. Irish farmers reported frequent burnout (23.6%) and widespread sleep issues (50.1%), with burnt out farmers reporting especially poor sleep. This has serious implications for farmers’ health, as burnt out farmers and farmers with poor sleep both reported worse mental and physical health. We identified age and parenthood as risk factors for burnout but identified no gender differences. While these exploratory findings are constrained by our cross-sectional design, they extend literature on occupational health risks in European agriculture to cover poor sleep and burnout. Irish farmers as a population need health intervention targeting sleep and burnout; especially in older and parent populations.

O'Connor S., Malone S.M., Firnhaber J., O’ Shaughnessy B.R., McNamara J.G., O'Hagan D.

AbstractPurposeFarming is a high‐pressure occupation. Populations of farmers face significant health risks, including injury, mental illness, and in some cases, heavy alcohol use. However, there is little research on farmers’ use of substances beyond alcohol. This study examines factors relating to Irish farmers’ disordered alcohol and substance use.MethodsIn accordance with STROBE guidelines for cross‐sectional research and reporting, we examined disordered alcohol and substance use in 351 Irish farmers using the Alcohol Use Disorders Identification Tool (AUDIT) and Drug Use Disorders Identification Tool (DUDIT).FindingsWhile 28% of farmers did not drink, 40% of those who did drink exceeded the AUDIT threshold for disordered use. Similarly, while 95% of farmers did not use substances, 78% of farmers who did use substances exceeded the DUDIT threshold for disordered use. Age was the most important risk factor for disordered alcohol and substance use and correlated with other main risk factors: lower income, no children, part‐time farmer, and full‐time off‐farm roles. Disordered drinking was highest in farmers engaged in full‐time education.ConclusionsThis population of Irish farmers report broadly healthy alcohol and substance use behaviors. Irish farmers may serve as a model group whose strengths can be utilized in interventions within and beyond the Irish farming community. Our results confirm the importance of analyzing demographic factors in farmers’ drinking and identify younger farmers as especially at‐risk for harmful alcohol and substance use.

Spengler E.S., Tierney D., Elledge L.C., Grzanka P.R.

Sexual minorities report more psychological distress, unmet mental health needs, and barriers to mental health care compared with heterosexuals, yet little is known about their barriers to seeking out mental health care. The present study reports the factors that influence intentions to seek out mental health care of a national survey of 398 sexual minorities. Structural equation modeling identified structural barriers, such as cost, time, and knowing how to access services, as the strongest predictor of sexual minorities' help-seeking intentions. Latent moderators indicated sexual minorities' help-seeking intentions varied depending upon their degree of psychological distress. This revealed a pattern where the most vulnerable participants (i.e., those with high structural barriers and negative help-seeking attitudes) were willing to pursue mental health care only when they were experiencing significant distress. Furthermore, nearly 40% of participants reported unmet mental health needs, and structural barriers were the primary reasons for this deficit. Findings from this study contrast with previous mental health help-seeking research by emphasizing the importance of structural vulnerability, which refers to the external forces that frame and constrain choices, thereby impeding decision-making and limiting life options for those who are in systemically disadvantaged social positions. These findings are discussed in terms of counseling psychology training, practice, social justice advocacy, and future health care research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Riethmuller M.L., Dzidic P.L., McEvoy P.M., Newnham E.A.

Western Australia is a geographically diverse area and major contributor to Australia's agricultural production, however the specific challenges and resources associated with farmers' mental health have not been examined. Farmers face significant challenges such as variability in weather, unpredictable commodity markets, and increasing isolation as rural community populations decline. This qualitative research study adopted a social constructionist epistemology to explore the main risk and protective factors for the mental health of farmers in Western Australia. Sixteen farmers (37% female; 28–64 years old, M = 41.75 years) and thirteen service providers (38% female, 27–64 years of age M = 47.23) participated in semi-structured interviews. Through inductive thematic analysis the findings suggest that the main risk factors contributing to poor mental health of farmers included rate of change, family business, declining communities, drinking culture and weather variability. Our findings indicate that communication and connection with others and taking time away from farming were important protective factors for farmers' mental health. However, different aspects of some factors comprised both mental health risks and protections. These findings highlight mental health as a significant concern in rural areas and that building community awareness and initiatives around mental health are vital to support farming communities.

Roberts T., Murray A.

van Doorn D., Richardson N., Meredith D., Blake C., McNamara J.

Premature cardiovascular disease (CVD) mortality among men represents a public health concern worldwide. In Ireland, male farmers are a 'high-risk' group for CVD mortality compared to normative values for Irish males. Despite this, they are perceived to be a 'hard-to-reach' (HTR) group to engage with health interventions. Primary prevention measures, including health screening and health behavior change interventions, are key strategies in addressing CVD yet often do not reach HTR groups such as male farmers. The Farmers Have Hearts - Cardiovascular Health Program (FHH-CHP) is a unique large-scale (n = 868) workplace health intervention specifically targeted at Irish male livestock farmers. It included a baseline and Week 52 health check and a health behavior change intervention with three delivery methods: 'health coach by phone' and/or mobile (M)-health by text message. The program adopted gender-specific and strengths-based methods to maximize participant engagement. It integrated a multi-actor approach and was trialed in a 'real world' practice outside of confined health care settings. Data collection comprised health check results (baseline, Week 52) and self-report measures (baseline, Week 26, Week 52). The FHH-CHP is the first targeted health intervention adopting gender-specific methods to reach and engage male livestock farmers in their cardiovascular health. Documenting the FHH-CHP study protocol is important therefore and will benefit practitioners attempting to apply gender-specific approaches to engage at-risk and HTR groups of men with targeted health interventions. Meeting men outside of clinical health settings and adopting gender competency standards are needed to address inequities in health outcomes experienced by men.

Nye C., Winter M., Lobley M.

Certain physical and mental health issues are particularly prevalent in farming occupations, yet frequently, farmers, particularly males, are resistant to seeking help from primary care practitioners. A qualitative approach examined the perspective of stakeholders at livestock auction marts to identify the determinants for, or barriers to, seeking help, perceptions regarding basing primary care services on-site at livestock auction marts, and the role of a site-based approach, i.e. placing primary healthcare services within a traditional farmers’ meeting place, in facilitating changes in help-seeking beliefs and behaviors. Findings support previous studies regarding barriers to seeking help, but demonstrate that by deconstructing these barriers through specifically designed workplace/site-oriented support services, more positive behaviors are facilitated. The study highlights how collaboration between livestock auction marts and primary healthcare services allows access to a hard-to-reach demographic in terms of healthcare, and illustrates how such socially integrative opportunities can contribute to the improvement of the mental and physical health and wellbeing of the agricultural community.

Younker T., Radunovich H.L.

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.

Brennan M., Hennessy T., Meredith D., Dillon E.

The demands of modern farming can place substantial stress upon the farmer, adversely impacting their wellbeing. This study identifies both the prevalence of stress and assesses the demographic, farm, and social characteristics that impact the incidence of stress. We report the results of a survey of a nationally representative sample of farm enterprises in Ireland undertaken in association with the Teagasc National Farm Survey (NFS) in 2018, which saw 736 questionnaires completed by farm operators. Frequency analysis is used to report the primary sources and prevalence of stress. A probit model is developed identifying and quantifying the factors that impact the incidence of stress. There were 57% of farmers who reported experiencing stress resulting from their farm work. Key sources of stress included "poor weather", (47%), "workload" (32%) and "financial" concerns (28%). The results of the probit model establish that the effect of age on the incidence of stress is significant, positive, and non-linear, indicating as farmers get older they are more likely to experience stress but at a declining rate. Operating a sheep farm system, as opposed to any other type of farm system, reduces the probability of stress. Working off-farm also reduces the probability of stress by 0.097, other things being equal. The findings highlight variance in the levels of stress reported by farmers by age and farm system, and consequently, the need to develop targeted supports that take consideration of differences within the population of farmers and farm enterprises.

Cuthbertson C., Eschbach C., Shelle G.

Agricultural producers have worse mental health than the general population, and often have limited access to mental health providers. Educational programs can strengthen knowledge of mental health including warning signs of stress and suicide, as well as assist individuals in developing communication skills and help-seeking behaviors. Cooperative Extension, the nation's academic outreach unit provided by land-grant universities, has a long history of providing agricultural education programs in the United States; this article describes the expansion of such programs to include mental health education for farmers and agricultural stakeholders in Michigan. Evaluation results of two programs developed by Michigan State University Extension demonstrate the programs are effective in improving understanding of agricultural economic trends, impacts of stress on the body, and warning signs of suicide among agricultural producers and stakeholders. Community-based education increases the capacity for mental health literacy programs to reach distressed farmers.

Hammersley C., Richardson N., Meredith D., Carroll P., McNamara J.

Compared to other occupational groups, farmers in Ireland experience a disproportionate burden of health problems, which impact farmers’ livelihoods and farming sustainability. Internationally, farmers’ poor health outcomes are associated with intersecting economic, environmental, socio-cultural, and occupation-specific factors linked to changes in agricultural governance. This qualitative study explored the challenges and stressors facing farmers in Ireland and how changes in farming governance have impacted farmers’ identities, masculinities and health. Eleven focus groups ( n = 26 female, n = 35 male, age-range 20s–70s) were conducted with both male farmers ( n = 3 focus groups; n = 13) and key informants ( n = 8 focus groups; n = 48, 22 male, 26 female). Utilizing Thematic Content Analysis, transcripts were coded independently by the first and second author using open and comparative coding techniques, with emerging themes grouped into primary and subthemes. Theme memos and conceptual maps tracked evolving relationships between themes. The analysis identified three broad themes. “Wrestling with challenges to autonomy and control within farming” examines the impact of tighter regulatory frameworks associated with changes to farming governance and unpacks other challenges associated with scale and succession. “Farming masculinities and health” explores how farming masculinities were closely aligned with farming practices and health practices and were framed relationally. “Isolation and the demise of rural communities” considers the impact of reduced social interaction on loneliness among farmers, particularly among more “at risk” single and older farmers. Findings provide unique insights into contemporary challenges and stressors facing farmers and have important implications for informing the design and roll-out of a national farmers’ health training program.

Jung H., Lee S., Kim Y.