Managing Mental Health Challenges Among

Farmers

Peggy Mack, Ph.D., APRN, BCFarmer 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

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 HealthCurrent Suicide Rates in U.S.

http://www.nimh.nih.gov/suicideresearch/suichart.cfm

USA Farmers and SuicideAlthough 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

Learned Coping

Perceptions

Stress

Physical and Mental Health Relationships - Example

Arthritis – disability, health problem

Pain - associated with arthritis

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, 221-234.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?

Mental Health = Emotional Health

Emotions – Reactions to some positive or negative stress event (ex: love, pleasure, dislike, anxiety, etc).).

Originate in the brain – influenced by genetics (DNA).

Interface with physical health (ex: high blood pressure)

Give meaning to life – influenced by prior learning experiences, impact present and future perceptions.

Its’ a Team Effort!

Mental health Physical health

Learned Behaviors

Perceptions: values, beliefs,

morals

Stress

Genetics

Challenges to Health and Quality of Life

Balancing Domains of Health

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

Emotions are tracked as signals in the brain.

There are links between emotions (mental health) and physiological pathways (physical health) in the brain. 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

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

Susceptible genes alter under stress and factor in the development of depression (Caspi et al 2003).

Persons may be predisposed to develop depression based on genetic makeup and their ability to cope effectively with stress (Garcia, 2002).

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

Stress, unchecked, not coped with effectively, leads to permanent structural changes in the brain (Hariri, et al. 2002; Saplosky, 2003).

Other citations: Caspi et al., 2003; Garcia, 2002; Hariri, et al., 2002; Prescott, Kuhn, Vittum, Riley, and Kendler, 2004; Saplosky, 2003; Science, 2003.

For farmers, unchecked stress seems to impact farmers who go from having no mental health problems to high numbers of suicide.

Recognize the presence and extent of stress.

Like a rubber band that is stretched out, 24/7.

Continual vigilance - flight or fight response

Health changes, the body changes

Farmers reported: “We idle in stress.”

Mental health problems, mental illnesses, are identifiable and manageable -

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 durationrequired 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

• 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.

Behavioral Responses

Psychological

Responses

Physiological Responses

Our actions Our emotions,

mental health

Our physical health

One approach to help the farming community –

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 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.

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.

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.

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?

Address: 10 Guyenne Road Wilmington, DE 19807 Phone: 302.427.0425

Email: PeggyMack02@aol.comThank you!