Suicide: An Unrecognized Epidemic Among Farmers

Abstract

Stress and depression are prevalent among farmers, and suicide has reached epidemic status. Occupational health nurses are in key positions to recognize these mental health issues and use strategies to control this epidemic.

Farmers are bombarded with numerous uncontrollable stressors such as weather-related crop damage, volatile markets, changing governmental regulations, a shrinking labor force, increasing production costs, and changing international policies and markets.

Individual characteristics and changing agricultural environments compound farmers’ stress. Farmers often describe health as the ability to do work, and their stress level increases as aging farmers are no longer able to engage in the normal work routine on the farm (Reed, Rayens, Conley, Westneat, & Adkins, 2012). Multigenerational working relationships and the fear of losing the family farm creates stress for some farmers (Maciuba, Westneat, & Reed, 2013). Farmers who once enjoyed independence are now forced to complete documentation of their farming practices to demonstrate accountability to environmental and animal protection groups. Farmers are learning that local financial institutions are not as willing to extend loans or credit in these challenging economic times as they did in the past.

Farmers are faced with limited mental health resources in rural areas. If such services are available, farmers may be fearful of the stigma associated with accessing such care. Mental health issues associated with farming have been recognized and widely discussed in the literature. However, it was not until July 2016 that the Centers for Disease Control and Prevention (CDC) issued an alarming report on suicides by occupation, disclosing the suicide rate to be the highest (84.5 per 100,000) among the farming/fishing/forestry groups (McIntosh et al., 2016). The problem is most likely worse than documented as the number of suicide attempts is not reported.

Occupational health nurses are in key positions to recognize the signs and symptoms of stress and depression among the farming population as some of their organization’s employees may also farm full-time or part-time, providing occupational health nurses with the opportunity to intervene and prevent the spread of this suicide epidemic (Jones, Reed, & Hunt, 2017). Occupational health nurses should explore the role of the client in the farming operation. A follow-up question such as, “Tell me how things are going on the farm” gives farmers or their family members an opportunity to share emotions and discuss their stress. Occupational health nurses should be aware of local issues that potentially could increase stress on farmers. When farmers seek medical services for vague symptoms, nurses should be mindful that the symptoms may be the manifestation of stress. If stress is detected, a quick, reliable mental health screening tool such as the Patient Health Questionnaire 9 (PhQ-9) may be used to assess depression (Blackwell & McDermott, 2014). With limited mental health services available in rural communities, occupational health nurses must be cognizant of and refer farmers to Employee Assistance Programs and other resources in the community such as the clergy.

Occupational health nurses should learn more about the mental health issues of farmers and advocate for change to improve the care they need and deserve. Jones et al. (2017) share some excellent resources of information including a free online continuing education course. Nurses can also advocate for changes in policy to support access to nationwide mental health services for all rural populations including farmers. There is a need for telehealth crisis assistance for farm and rural populations with counseling services provided by individuals who understand the stress associated with farming. Collaborative efforts are needed to curtail and prevent this unrecognized epidemic.