Examination of mental health of agricultural workers in the United States shows that the agricultural workforce suffering from mental illnesses and disorders is widespread. A 2018 report highlighted the fact that male farmers, ranchers, and agricultural managers were nearly twice as likely to die by suicide as the general working population (32.2 suicides per 100,000 people compared to 17.3 suicides per 100,000 people, respectively). Note, in 2020 male suicide rates are 3.88 times higher than female rates.
Background Farming is defined as "the science and art of cultivating plants and livestock." Thus, the agricultural workforce includes farmers, ranchers, and workers engaged in agriculture. In addition to the workforce, the agricultural community also includes family members of workers, in particular, spouses and children.
Mental health, or mental well-being, is defined by the World Health Organization (WHO) as "a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community." On the other hand, the terms mental illness and mental disorder refer to a broad range of illnesses that often include "some combination of disturbed thoughts, emotions, behavior and relationships with others."
While sometimes used interchangeably with mental health, the term behavioral health, or behavioral well-being, specifically refers to the connection between individual behaviors and health. Behavioral disorders include conditions that have a genetic or biological component (e.g. Attention Deficit Hyperactivity Disorder, ADHD) as well as behaviors, such as drug and alcohol abuse, gambling addictions, or other behaviors that can have negative consequences on an individual health and quality of life. The latter category of behavioral disorders often develop as a result of mental illness, and are therefore often considered together.
The fields of mental and behavioral health focus on 1) promoting, supporting, and sustaining mental and behavioral well-being and 2) reducing the presence, severity, and impact of mental and behavioral disorders.
Epidemiology Mental illnesses often stem from multiple sources but as an occupation, agriculture ranks as one of the most stressful occupations and one that experiences high suicide rates.
For example, in a 2019 international review article, 71% of studies that compared farming to non-farming populations found that farmers showed worse mental health. In the US, a 2019 study among young Midwestern farmers found that 53% and 71% of study participants met criteria for Major Depressive Disorder and Generalized Anxiety Disorder, respectively. This is compared to the general population, where 2.7% of US adults suffer from Generalized Anxiety Disorder and another 7.1% suffer from Major Depressive Disorder.
Each of these conditions has the potential to lead to suicide. As previously indicated, 2015 data from the U.S. National Violent Death Registry System (NVDRS), maintained by the Centers for Disease Control and Prevention (CDC) reported a suicide rate of 32.2 per 100,000 farmers, ranchers, and agricultural managers. This report also highlights a suicide rate of 17.3 per 100,000 people for both agriculture employees and the general working-age population, indicating a much higher risk to farmers compared to the general population.
Although assessments of mental health in rural regions have been sparse over time, studies indicate that there has been no noteworthy progress in the past four decades. This stagnation is particularly striking given that scholars initially brought attention to mental health and well-being challenges in rural communities during the late twentieth century.
Risk factors A wide range of factors affect the mental health of agricultural populations, particularly farm families. Some of these factors are similar to the general population and have in recent years been summarized within the social determinants of mental health framework with consideration of both individual and structural level factors. Others are specific to the agricultural sector.
Family farming as a lifestyle/culture (not just occupation) Family farming is a family business where the family members are the employees, their workplace is their home, and success is a function of the capabilities of the family members. The intermixing of family roles with economic roles means that stressed farms are stressed families and the needs of the farm, not the individual family members, come first and foremost.
Often, the operators of family farms are caretakers of a piece of earth that has been maintained by generations of farmers before them. If they lose the farm, they lose their home, their identity, and their legacy. They hope their children will choose the farming life and continue this legacy for generations to come. Farming is a family activity in an environment with strong cultural values. Children work before and after school to contribute to the farm's success. As a farm family ages, the stresses of transitioning the farm to the next generation become a source of stress with legal implications and role conflicts as intergenerational opinions differ as to how to manage the future of the farm.
Farm characteristics Farm characteristics shape mental health in a variety of ways, including seasonality of the work, type of work, and workplace environment. Farmers work long days alone in an isolated environment during the growing season. They spend the "off-season" making repairs and getting caught up on the work not done during the busy season while preparing for spring planting. For livestock farmers, there is no "off-season" since the animals require daily attention.
Farmers are required to make important business decisions daily with inadequate information about the projected prices of inputs, future demand for their products, and market prices for their crops and animals. If any of these factors are unfavorable, they face increasing levels of debt and stress. Agricultural work is equivalent to being an entrepreneur without the access to capital and where the probability of showing a profit is not only uncertain, but unpredictable. Job satisfaction requires a balance between effort and reward, but economically this balance does not exist for most family farmers. For farmers, the reward is far more than economic because it is wrapped up in legacy and personal identity.
Macro-level stressors When facing economic challenges, farmers can choose to reduce the number of paid employees that they hire, which leads to longer workdays, or they may choose to diversify or change what they produce. Changes in production are limited to the equipment available to plant and harvest, and the climate that is required for crop production, reducing the flexibility that most businesses need to react to consumer behavior.
Even when farms are successful and can afford to hire workers, they cannot easily hire them. There is a shortage of U.S.-born workers willing to work in agricultural jobs. While U.S. farmers can use the H-2A Temporary Agricultural Worker program, the system has been called burdensome, as it requires legal assistance and extensive paperwork. Moreover, a farmer must initiate the process at least three months in advance with no knowledge of what the growing season will look like. Farmers must pay the travel and living expenses of those they hire to work their farms as well as pay a U.S. Department of Labor pre-determined hourly wage, often making the process more expensive than hiring a U.S.-based worker.
Workers in the United States agricultural sector have the highest rate of fatal and non-fatal injury of any sector. The working conditions involve direct contact with farm machinery and large animals. Machinery breaks down and needs repairing, resulting in costly delays. Handling animals requires training, experience, and a calm mental and physical presence. Aside from the physical demands of farm work, exposures to pesticides and other chemicals, viruses, bacteria, and other human health pathogens are also likely. Children living and working on the farm are frequently exposed to many of the same hazards as their parents.
Environmental stressors such as climate variability will make farming a greater challenge in the future as droughts and extreme weather events become more frequent. Climate has always been a challenge for the farming community, the Dust Bowl of the 1930s being the best example of the devastation that drought can cause. Extreme heat stress, made worse by climate change, will reduce product yields; increase the use of inputs such as pesticides and fertilizers; and impact the health of farmers and field workers. Policy directed at climate change mediation will become important to addressing food security and sustaining agricultural markets, but farmers have no control of these factors. Weather variability, especially related to drought, is one of the most important stressors being reported by farmers in developed countries.
Meso-level stressors The personal, interpersonal, and external challenges that farmers face cause extreme stress in an environment where healthcare is not affordable when it is accessible, mental healthcare is lacking, and stigmatization poses a barrier to help-seeking because confidentiality is lacking. Farmers often feel that traditional medical care professionals do not understand farm culture and healthcare workers do not communicate with them in a way that encourages honest discourse.
Individuals in rural farming communities are connected and there are social bonds between individuals within these communities. The cultural norms and expectations of rugged individualism regardless of the circumstances leads farmers to not seek the help they might need. Farmers expect to be capable of solving their own problems, not complaining, and being unwavering in their responsibilities to their families, even when strained beyond measure.
Diverse sub-populations A diversity of individuals are engaged in agriculture and previous research has shown that these sub-populations can be affected with a different range of stressors, which in turn may call for a range of interventions.
Farm men Compared to the general adult male population, the prevalence of depression is higher amongst male farmers (5.3% versus 9.8%, respectively). Agriculture Health Study reports show that 3.0% of the sample population has taken medication for their depression, compared to 13.2% in the general population. The reason for this difference in antidepressant usage is that male farmers have stigmatized attitudes towards mental health but are still just as likely to seek help from a doctor for mental health issues. However, they will seek help for the physical manifestations of stress like hair loss, back pain, headaches, and fatigue.
Farm women The U.S. Department of Agriculture's 2017 Census of Agriculture shows that 36% of producers are female. Most take on many different roles within the farm, including producer, homemaker, caregiver, and family supporter. In addition, many women take jobs off of the farm in order to access affordable health insurance. This can also lead to a greater need for childcare, thus creating more financial strain. Combining traditional responsibilities with their work as a farmer can also lead to increased work hours, greater challenges creating an appropriate work-life balance, and increased stress. Compared to non-agriculture Latina workers, Latina women in the field of agriculture displayed higher rates of stress, anxiety, and depression.