Managing Mental Health
Challenges Among Farmers
Peggy Mack, Ph.D., APRN, BC
Farmer Stress Webinar
for
California Dairy Quality Assurance Program and USDA NRCS
November 30, 2007
Email: Peggymack02@aol.com
copyrighted 2007
Overview – Discussion Points
1. Mental health (emotional health) and physical
health are equally important.
2. Stress effects an individual’s mental health and
physical health.
3. Mental health problems, mental illnesses, are
identifiable and manageable.
4. Precursors for mental health issues are
recognizable and require preventive measures.
5. Farmers with high stress are at risk for
depression and suicide.
Suicide Among Farmers –
A Global Problem
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Australia - “One farmer takes his life every 4
days” (10/19/06)
India (Southern) – “thousands…farmers kill
themselves by drinking pesticide” 4/22/04; Or a
yearly average of 17,627 farm suicides, (2001)
Scotland – Suicide is committed by farmers
using firearms or by hanging with the rate of 31
per 100,000 (2006)
National Institute of Mental Health
Current Suicide Rates in U.S.
http://www.nimh.nih.gov/suicideresearch/suichart.cfm
USA Farmers and Suicide
Although firm numbers are difficult to confirm, suicide among farmers is
occurring. Depression is a forerunner.
In 2002, in rural Iowa, a survey (n = 1617) was conducted in which
16.4% of the responders had suicidal ideation. Middle aged participants
had the higher rates for thinking seriously about suicide. Methods
planned varied with gender. Suicide ideas were correlated with
depression, alcohol-related problems, financial
difficulties, decreased family and social contacts.
What are we not understanding
about farmers?
In what ways is the occupation, farming,
affecting farmers’ health and their quality of
life (QOL) ?
Health - Physical and Mental –
Integral Connections
Genetics
Stress
Perceptions
Learned
Coping
Physical and Mental Health
Relationships - Example
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Arthritis – disability, health problem
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Pain - associated with arthritis
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Intermeshing of pain & arthritis –
When pain is not alleviated, there is a mental
health issue (such as depression).
Citation: Neugebauer, V., & Li, W., & Bird, G.C., & Han, J.S. (2004). The amygdale and persistent pain. The Neuroscientist. Vol.10, no.3, 221234.Wang, P.S. & Beck, A.L.& Berglund, P.& McKenas, D.K. & Pronk, N.P. & Simon, G.E. & Kessler, R.C. (2004). Effects of Major
Depression on Moment-in-Time Work Performance. American Journal of Psychiatry.161: 1885-1891.
What’s Mental Health?
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Mental Health = Emotional Health
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Emotions –
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Reactions to some positive or negative stress event
(ex: love, pleasure, dislike, anxiety, etc).).
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Originate in the brain – influenced by genetics (DNA).
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Interface with physical health (ex: high blood pressure)
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Give meaning to life – influenced by prior learning
experiences, impact present and future perceptions.
Its’ a Team Effort!
Mental health
Physical health
Challenges to Health and Quality of Life
Stress
Genetics
Learned
Behaviors
Perceptions:
values, beliefs,
morals
Balancing Domains of Health
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Mental Health and Physical Health are
connected, equally important.
The mental health and physical health
domains are connected.
Connecting Domains of Health by
Science and Technology
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Emotions are tracked as signals in the brain.
There are links between emotions (mental health) and
physiological pathways (physical health) in the brain.
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Connections demonstrated by technology (MRI, PET scans)
Citation: National Institute of Mental Health. Seeing Our Feelings: Imaging Emotion in the Brain.
Publications. NIMH Publication No. 01-4601. Bethesda (MD): National Institute of Mental Health, National
Institutes of Health, US Department of Health and Human Services; 2001 (updated 2005,
September 9). Available from http://www.mental-health-matters.com/articles/article.php?artID=333,
accessed November 20, 2007
Science, Brain, & Health: The Amygdala Connection
The Brain’s Amygdala – a physiological
connection with a psychological response.
http://pubs.niaaa.nih.gov/publications/arh284/images/tapert.gif and
teens.drugabuse.gov/images/mom_brain2_tn.gif
Mental Health Challenges (Stresses)
Have an Impact on the Brain
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The brain changes structure and function
with mental health challenges.
i.e. stress and its ineffective management
impacts the brain.
The trajectory - depression
Science shows us
Stress effects both physical and mental health
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Susceptible genes alter under stress and factor in the
development of depression (Caspi et al 2003).
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Persons may be predisposed to develop depression
based on genetic makeup and their ability to cope
effectively with stress (Garcia, 2002).
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Changes in specific hormones and stressful life events
with major depression, duplicated the work of Caspi, et
al., in a follow-up study with twins (Prescott, Kuhn,
Vittum, Riley, and Kendler,2004).
There is a consequence to unchecked stress
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Stress, unchecked, not coped with effectively, leads to
permanent structural changes in the brain (Hariri, et al.
2002; Saplosky, 2003).
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Other citations: Caspi et al., 2003; Garcia, 2002; Hariri, et
al., 2002; Prescott, Kuhn, Vittum, Riley, and Kendler, 2004;
Saplosky, 2003; Science, 2003.
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For farmers, unchecked stress seems to impact farmers who
go from having no mental health problems to high numbers
of suicide.
Mental health problems, mental illnesses,
are identifiable and manageable Recognize the presence and extent of stress.
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Like a rubber band that is stretched out, 24/7.
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Continual vigilance - flight or fight response
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Health changes, the body changes
Farmers reported: “We idle in stress.”
Mental health problems, mental illnesses,
are identifiable and manageable
Recognize the effects of stress on both mental
and physical health.
 Physical response from the body – fly or fight.
 Physical health problems: high blood pressure,
headaches, backaches, etc.
 At the same time - Emotional responses – fly/ fight.
 Emotional health problems: irritability, tearfulness,
etc. Can lead to depression, and suicide.
Mental health problems, mental illnesses,
are identifiable and manageable
Recognize to identify mental health problems there is a
benchmark.
The gold standard:
•
specific signs, symptoms; or
•
duration of specific signs, symptoms, as described in
the DSM-IV*
DSM-IV = Diagnostic Statistical Manual
Citation: American Psychiatric Association. (1994). Diagnostic and
Statistical Manual of Mental Disorders. Washington DC: Author.
Recognize how to identify mental health
problems - DSM
Depression
 based on # of symptoms and duration.
 different levels of severity.
 all documented in the DSM-IV.
Example:
Forms of depression described in DSM-IV:
minor depression, major depression, bipolar.
Recognize how to identify mental health
problems - one example, Major Depression
Major Depression signs, symptoms, and duration
required are:
 Five (or more) of the following symptoms have
been present during the same two-week period and
represent a change from previous functioning; at
least one of the symptoms is either (1) depressed
mood or (2) loss of interest or pleasure.”
Source: DSM-IV
Recognize how to identify mental health problems –
Signs of Major Depression, Correlated with Farmers
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Irritability
loss of interest/pleasure in activities
fatigue/loss of energy
feelings of worthlessness/guilt
diminished ability to think/concentrate
significant weight loss/gain (not due to dieting)
sleeping too much or too little
recurrent thoughts of death/suicide
(Examples: My family be better off without me; Life’s not
worth it.)
Source: DSM-IV
Mental health problems, mental illnesses, are
identifiable and manageable- Recognize the different
layers of stress responses.
One approach to help the farming community –
Behavioral
Responses
Our actions
Psychological
Responses
Our emotions,
mental health
Physiological
Responses
Our physical health
Mental health problems, mental illnesses, are
identifiable and manageable –Recognize the different
layers of stress responses (continued)
Behavioral
Responses
Psychological
Responses
Physiological
Responses
diminished ability to
think/concentrate;
irritability; loss of
interest/
loss of pleasure in
activities; feelings of
worthlessness/guilt;
recurrent thoughts of
death/suicide
significant weight loss/gain
(not associated with dieting);
sleeping too much or having
insomnia;
Mental health problems, mental illnesses, are identifiable and
manageable -Recognize how words reflect high levels of stress.
“I’m not thinking suicide thoughts, but I think whatever
happens, happens…
Whatever happens, happens, you know, I feel like that a lot.
Whatever happens, because, you know, I see my wife have to
work so hard,….. and my children they have their own (lives)
…. So what’s the sense in living? But I can’t take my own
life. But sometimes I do wish that I wasn’t living…”
Mental health problems, mental illnesses, are identifiable
& manageable- Recognize the treatment options
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Antidepressants (SSRIs)
Talk therapy, with professionals.
Support groups
Listen to the physical c/o as gateways.
Farmers’ put their personal health second
and the health of the farm first.
Farmers keep on farming no matter what….
Precursors for mental health issues are
recognizable and require preventive measures
Recognize how key stress events landscape challenges
impact the farmer’s quality of life.
 Accidents, physical health changes.
 Changes in the marital relationship and/or in the
family unit.
 Financial losses, increase debt.
 Occupational challenges – more rules, pesticide
misuse, weather and time.
Awareness & Strategies for Working with
Farmers- Recognize how key stress events, risk
factors, can impact the farmer
Behavioral
Stress Responses
Psychological
Stress Responses
Physiological
Stress Responses
Ex: Farmers fix
things, no days off.
Ex: Farmers’ drive to
be self sufficient.
Ex: Body changes.
Stress Responses’ Ex:
can’t concentrate, big
wt loss or gain, loss of
energy, can’t sleep,
accident prone.
Stress Responses’ Ex:
irritability, sadness,
loss of pleasure in
activities, etc.
Depression
Stress Responses’ Ex:
co-morbidity health
prob (diabetes, high
blood pressure).
chronic health issues
lead to disabilities.
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Designed by Peggy Mack, January 2004.
Extrapolated from works: Caspi et al., 2003; Hariri, et al., 2002; Prescott, Kuhn, Vittum,
Riley, and Kendler, 2004;Saplosky, 2003; Science, 2003.
Farmers with high stress are at risk for
depression and suicide
Recognize that there are important implications in working
with farmers with high stress; action plans are needed.
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Explore with the farming community how they
respond to stressors now….patterns of behaviors.
Discuss positive behavioral alternatives.
Develop strategies for handling mental health
emergencies.
Teach agricultural community members signs and
symptoms of depression, suicide (vignettes, worksheets)
Worksheets: Depression Signs and Symptoms
Irritability
loss of interest/
pleasure in activities;
fatigue/loss of energy
feelings of
worthlessness/guilt
Worksheet – Depression Signs and Symptoms
diminished ability to
think/concentrate
significant weight
loss/gain (not
associated with
dieting)
sleeping too much or
having insomnia
recurrent thoughts of
death/suicide
Farmers with high stress are at risk for
depression and suicide – Other Implications
We need to:
 Listen to what farmers say
 Recognize the uniqueness of the farming culture
 Understand the qualitative and quantitative
research data on farmers and their health.
 Apply research findings to practice
 Partner and collaborate …Think outside the box!
Summary of Health Domains
 Mental health (emotional health) and physical
health are equally important.
 Science connects physical, mental health.
In fact, science shows emotional illnesses
effect physical illnesses and visa versa.
Summary of Stress and the Brain
Science shows that:
 Stress can cause structural brain changes.
 Structural changes in the brain leads to mental illnesses,
such as depression.
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Mental illnesses, emotional problems, such as depression
can be identified and can be successfully treated.
Summary - Farmers at Risk for
Depression and Suicide
 Farmers’ quality of life appears to be less than the US
population quality of life.
 Farmers are so stressed with the pressures of their
occupation and their lives, that farmers are experiencing
signs and symptoms of depression.
 This stress is spiraling farmers to feel out of control, with
heightened risk for suicide.
 Appropriate outreach to farmers is essential to not only
farmers’ survival, but society’s survival.
Additional Questions?
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Address: 10 Guyenne Road
Wilmington, DE 19807
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Phone: 302.427.0425
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Email: PeggyMack02@aol.com
Thank you!