The mental health of farmers.
ABSTRACT Farmers are subject to a number of unique occupational stressors, many of which have been aggravated in recent years by changes in farming practice and by economic factors. These are probably part of the explanation for the high rates of suicide in farmers and farm workers, which in the UK account for the largest number of suicides in any occupational group. Suicide is usually associated with mental illness, which, in farming communities, appears to be particularly stigmatized and poorly understood. This affects health-seeking behaviour, which is compounded by the geographical isolation and inaccessibility of many services in rural areas. Our current understanding of these issues suggests a number of potentially valuable interventions.
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ABSTRACT: The occupation of farming has been reported to be associated with a high suicide rate, and suicidal ideation is an important risk factor for suicide. The objective of this study was to explore the association between occupational pesticide exposure or poisoning history and suicidal ideation among male farmers in South Korea. Through a nationwide sampling survey, a total of 1958 male farmers were interviewed in 2011 in South Korea. Detailed occupational pesticide exposure and pesticide poisoning information were obtained from face-to-face interviews. Suicidal ideation was defined as whether they had thought of harming themselves or trying to take their own lives over the preceding year. Logistic regression analyses were conducted to examine the effect of pesticide poisoning on suicidal ideation. Among all farmers, 8.7% (n=92) reported suicidal ideation in 2010. After controlling for potential confounders, lifetime hospitalization due to pesticide poisoning showed a 2.48-fold increase in risk (95% CI: 1.26, 4.91). Those with multiple poisonings showed more significant associations with suicidal ideation (OR=2.33 for once, OR=3.02 for more than once). Moderate- or severe-symptom severity of acute pesticide poisoning cases (OR=2.23; 95% CI: 1.21-4.11) also showed increased risks of suicidal ideation than the milder classes did. However, no significant association was identified with cumulative lifetime pesticide application and suicidal ideation. Our findings suggest that risk of suicidal ideation is related to occupational pesticide poisoning among male farmers.Environmental Research 11/2013; · 3.24 Impact Factor
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ABSTRACT: PurposeOlder farmers experience a high rate of suicide, and depression is closely aligned with suicide among agricultural workers. Depressive symptoms may be influenced by work patterns, work satisfaction, stress, and health status. In addition, members of a couple may affect each other's depressive symptoms. The purpose was to determine whether depressive symptoms score is predicted by hours worked on the farm, satisfaction with work, number of health conditions, perceived stress, and demographics in a sample of older farm couples, and to assess the degree of influence on depressive symptoms spouses have on each other. MethodsA total of 494 couples participated in the initial interview for a longitudinal study of farmers aged 50 and above. Data from husbands and wives were used together in a multilevel, dyad-based regression model to determine predictors of depressive symptoms. FindingsMen's depressive symptoms scores were predicted by their own number of health conditions and stress and by their wives’ stress and health conditions. Women's depressive symptoms scores were predicted by their own work satisfaction, stress, and number of health conditions and their husbands’ time spent working on the farm and stress. Conclusions Stress management may be particularly important in older farm couples, since perceived duress of 1 member of the dyad impacts both. Work factors and health conditions also affect depressive symptoms in older rural couples, but these may be less easily modified.The Journal of Rural Health 01/2014; 30(1). · 1.44 Impact Factor
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ABSTRACT: Exposure to pesticides has been associated with psychiatric problems among farm workers, although there is still controversy as to chemical types, intensity and forms of exposure that represent risk factors for neuropsychological problems. Furthermore, tobacco workers are exposed to dermal absorption of nicotine, although its effect on mental health has not yet been studied.NeuroToxicology 05/2014; · 2.65 Impact Factor
The mental health of farmers
Rural Mental Health Research,University of Southampton,Southampton,UK
Farmers are subject to a number of unique occupational stressors, many of which
have been aggravated in recent years by changes in farming practice and by
economic factors. These are probably part of the explanation for the high rates of
suicide in farmers and farm workers, which in the UK account for the largest number
of suicides in any occupational group. Suicide is usually associated with mental
illness, which, in farming communities, appears to be particularly stigmatized and
poorly understood. This affects health-seeking behaviour, which is compounded by
the geographical isolation and inaccessibility of many services in rural areas. Our
current understanding of these issues suggests a number of potentially valuable
Key words: Farmers; mental health; mental illness; rural; suicide.
Received 17 April 2002; revised 11 June 2002; accepted 11 September 2002
Recent figures released by international accountants
Deloitte & Touche , based on their client group
covering 250000 acres of farmland, reveal the depth of
the decline in farming income that has occurred in the
UK in recent years. The average income from a 500 ha
farm fell from £80000 in 1995/1996 to £2500 in
2000/2001. This dramatic drop was not just the result of
the BSE (bovine spongiform encephalopathy) and foot
and mouth crises, but applied across all sectors of the
farming industry as a result of the fall in the price of
wheat and other produce, as well as poor recent harvests.
This decline in income was seen despite a 10% increase
in efficiency, which resulted from farmers cutting down
overheads. These changes are not just of theoretical
interest to economists and accountants, but represent a
highly relevant increase in the economic stressor which
has consistently emerged as one of the important pre-
dictors of psychiatric morbidity and even suicide. This
review will examine the influence of this and other factors
on psychiatric morbidity and mortality in farmers, and
the potential for preventative interventions.
Farmers and agricultural workers, uniquely amongst
the main occupational groups, live and work almost
exclusively in rural areas. It is therefore important to
understand the nature of rural areas in the context of
health and health care. Although almost 90% of the land
in the UK is rural, <20% of the population lives in rural
areas. Rural areas have a similar mix of industry and
services to urban areas, but greater proportions of the
rural workforce are self-employed, employed in their own
homes or work part-time. Although the most dramatic
drop in income over the past few years has occurred
amongst farmers, the proportion of men and women in
rural areas who earn low wages is greater than in the rest
of the population of the UK . Rural areas have
less social housing than urban areas, and housing is a
particular concern to agricultural workers and tenant
farmers whose housing is frequently tied to their work,
which has become increasingly insecure as a result of the
mechanization of farming and the drop in farm incomes.
Access to all types of services, including health, is poor,
particularly in remote rural areas, and this particularly
disadvantages older people, the disabled and the rural
poor because of the dependency on cars as the main
means of transport.
Although the prevalence of most mental health prob-
lems in rural areas in the UK appears to be significantly
lower than in inner-city areas, the range of services that
people with mental health problems can access in rural
areas tends to be very limited . This relative inaccess-
ibility to services appears to be compounded by a greater
sensitivity to the stigma of mental health problems and
greater concerns about confidentiality in small rural
communities . This has been confirmed by a recent
study which showed that perceived stigma about mental
health interventions and services has a negative impact on
Occup. Med. Vol. 52 No. 8, pp. 471–476, 2002
Copyright © Society of Occupational Medicine. Printed in Great Britain. All rights reserved. 0962-7480/02
Correspondence to: Dr Alain Gregoire, Rural Mental Health Research,
University of Southampton, Tatchbury Mount, Calmore, Southampton,
UK.Fax: +44 23 8087 4360; e-mail: firstname.lastname@example.org
by guest on May 23, 2011
help-seeking behaviour in rural areas but not urban
The life of farmers
The lifestyle of farmers is inextricably linked with their
work, not only because of the long hours (>70% of
farmers work >10 h/day ), but also because the
majority live on their farms, which are relatively isolated.
In addition, few farmers take holidays, and their lives are
governed by often unpredictable forces such as weather,
disease and problems with animals and farm machinery.
Farmers are almost unique as a group whose work is so
intimately tied with every aspect of their lives and the lives
of their families, often across several generations.
The most important stresses in farmers’lives,identified
in several studies in the UK and abroad, appear to be
worries about finance [6–8].This is obviously particularly
relevant in the UK in the current economic climate.Time
pressures emerged as the second most important factor
associated with illness in the study by Eberhardt and
Pooyan . Time pressures are not only related to the
amount of work that farmers have to do, as illustrated by
long working hours, but are rendered particularly stress-
ful because of the unpredictability and the seasonal
variation in the workload. Furthermore, the burden of
paperwork and administration is very keenly felt by
farmers, particularly those on small farms who feel they
have benefited less from agricultural policies and often
have to shoulder the burden of complex administrative
work without any assistance. In a survey of farmers
attending an agricultural show , coping with paper-
work emerged as the highest ranked stressor. In addition,
the administrative demands on them often coincide with
particularly busy times on the farm.
Geographical and social isolation are frequently cited
as major psychosocial risk factors affecting the health of
farmers. There is some evidence that the social networks
of farmers are shrinking , and it is clear that
increasing mechanization and efficiency savings on farms
have led to more isolated patterns of work, with fewer
shared tasks. Spouses increasingly have jobs outside the
farm to maintain family incomes. However, a UK survey
of farmers indicated that very few lack daily contact with
other people, with 90% stating that they had a confidant
and two-thirds having two or three close friends . In
a survey of 203 Northumberland farmers, farm workers
and farmers’wives ,87% reported having a confidant
and two-thirds saw a family member or friend at least
once a week. Interestingly, more men than women
described having a confidant at home and men described
having a greater number of close friends than female
respondents.A more selective survey of farmers attending
a national agricultural show  revealed that they con-
sidered social isolation to be the least important stressful
factor in their lives. Despite these findings of apparently
low rates of social isolation amongst farmers, the import-
ance of social contact, social support and confiding
relationships to their mental health emerges clearly from
a number of studies of both psychological morbidity and
suicide (see below).
In a survey conducted by Hawton et al. ,one-third of
the farmers were found to have physical health problems
that interfered with their work. Not surprisingly, physical
health was more likely to be a problem in older farmers,
but it also affected a quarter of farmers under the age
of 50. The most common problems described were back
pain and arthritis. Physical health is an area of particular
concern to farmers, both because of their high risk of
occupationally related accidents and ill-health , and
because of the impact that disabling physical symptoms
can have on their livelihood and the future of their farm
A recent postal survey of 203 farmers in Northumberland
used a standardized self-rating scale (Hospital Anxiety
and Depression Scale; HADS) to measure levels of
depression and anxiety . The results, using two
commonly applied cut-off levels to define severity of
disorder,are shown in Table 1.The study found that rates
of morbidity were generally higher in women than in
men, as would be expected from findings in the general
Men appeared to be relatively protected by being
married or by having a confidant at home but, inter-
estingly, married women were at higher risk, possibly
because they are the main source of support for their
husbands. This is in contrast to the findings of a study
conducted in Iowa by Lorenz et al. , who found that
support from the spouse protected male and female
farmers from stress. Other protective factors identified in
the Northumberland study included for men, frequent
leisure activities and having close friends,and for women,
having a confidant and having had a recent holiday. Good
physical health was a protective factor for both men and
This association between physical health and depres-
sive symptoms is consistent with findings of other studies.
For example, Linn and Husaini  found that chronic
Table 1. HADS scores amongst a community sample of farmers
(from , with permission)
by guest on May 23, 2011
physical symptoms were the main predictors of depres-
sion and a rare prospective study found that back pain
was an important predictor of suicide on follow-up over a
13 year period . It may, of course, be that physical
symptoms are, at least in part, a symptom of stress and
psychiatric disorder, rather than just aetiological factors.
This is suggested by the findings of Walker and Walker
, who described a higher rate of stress symptoms in
Canadian farmers compared with non-farmers, including
not only psychological symptoms such as tension, poor
sleep and irritability, but also higher rates of physical
symptoms, in particular tiredness and back pain. It may
be that farmers are more likely to present with somatic
rather than psychological symptoms of depression and
anxiety, as suggested by Booth et al. .
Although the assumption is sometimes made that
farmers are at higher risk of suffering from alcohol
problems, research findings suggest the opposite. Studies
in the UK, Canada, Sweden and the USA have all found
relatively low levels of alcohol abuse amongst farmers
[11,17,19,20]. Some caution should be used when inter-
preting such findings, because most of these studies do
not include farmers who have stopped working or retired.
Given the nature of the work and the impact of alcohol
abuse, it may be that these studies suffered from a
response bias, as farmers who had to cease work because
of alcohol problems might have been excluded from the
sample.Whatever the prevalence of alcohol problems,it is
clinically important to note that the presence of alcohol
abuse amongst farmers has been associated, in a pro-
spective study, with a greatly increased risk of accidental
death (odds ratio 10.9) and an even greater increase in the
risk of suicide (odds ratio 13.2) .
Apart from the psychosocial risk factors discussed
earlier, which form part of the normal life of farmers,
recent attention has been given to the possibility of neuro-
psychological effects from organophosphate exposure.
The belief that organophosphate exposure has led to a
range of such symptoms is common amongst many in
the farming community and is a considerable source of
distress to those who suffer symptoms,because they often
feel that these are not being taken seriously. The evidence
on health effects of organophosphate exposure was
considered in a joint report by the Royal College of
Physicians and the Royal College of Psychiatrists  in
1998. This highlighted the inadequacy of the available
literature, and the authors were unable to reach clear
conclusions about any association between organo-
phosphates and neuropsychological symptoms. Although
there may be some evidence of cognitive disturbance
in association with organophosphate exposure , the
evidence on psychiatric morbidity and suicidal ideation
or behaviour is anecdotal. The toxic effects of organo-
phosphates are discussed elsewhere in this series .
Farmers account for the largest numbers of suicides
amongst any single occupational group in the UK.
Between 1991 and 1996, there were 190 suicides
amongst farmers in the UK. Suicide is the second most
important cause of death in young farmers after
accidents, and is an important cause of mortality in older
and retired farmers and amongst farmers’ wives. High
rates of suicide have also been described amongst farmers
in other parts of the world, including the USA [24,25],
Sweden , France  and India . Although 80%
of the population of India are farmers, there has been
little research into the factors associated with suicide,
which may be very different from those in the developed
world. The possibility of regional variation within
England and Wales has been examined both by county
and by type of farm, but no significant heterogeneity has
emerged . However, farm size does appear to have a
significant impact: in the study by Hawton et al. , of
the sample for whom farm size was known, 92% of
farmers who committed suicide had farms of <300 acres,
compared with 70% of farmers in the group who did not
commit suicide. This is consistent with the findings on
stress described above, which suggest that farmers with
smaller holdings suffer more stresses with fewer supports.
The methods of suicide used by farmers differ mark-
edly from the general population as they are much more
likely to use firearms (usually shotguns) and less likely to
take overdoses or use car exhaust [18,29]. However, in
1989, changes in the law in England and Wales covering
the registration, ownership and storage of shotguns led to
a marked decrease in the use of shotguns as a means of
suicide amongst farmers and this has now been overtaken
by hanging as the principal suicide method. This is a
further example of the influence that access to means has
on suicidal behaviour and suicide rates, which is well
documented in the literature [30–32]. In general, a
reduction in access to a particular means of suicide leads
to an increase in the use of alternative methods, but often
to an overall decrease in rates. Any fall in rate is obviously
proportionate to the prior frequency of the method used.
This exploration of the methods used for suicide is not
only relevant to potential interventions, but is also crucial
to understanding the link between the suicidal intent and
behaviour and the fatal outcome,as methods vary in their
lethality. Shotguns are a much more lethal method of
suicide than drug overdose,which may in part explain the
higher rate of suicide amongst farmers. This possibility
is also supported by the low rate of non-fatal deliberate
self-harm amongst farmers when compared with the
general population. This explanation would suggest that
suicide amongst farmers would be more likely to result
from impulsive acts than suicide in the general popu-
lation. There is some evidence to support this, e.g. the
A.Gregoire: The mental health of farmers 473
by guest on May 23, 2011
finding of Booth et al.  that only 21% of farmers who
killed themselves left a suicide note compared with 41%
of non-farmer controls. However, this is not consistent
with the findings of Hawton et al. , who stated that
‘nearly all [farmers] showed evidence of clear intent’. In
that study, half of the farmers had left a suicide note,
approximately half had declared suicidal intent to
someone and the proportion of suicides compared with
open verdicts was greater in farmers than that amongst
The factors associated with suicide in farmers in
England and Wales have been investigated in a psycho-
logical autopsy study conducted by Hawton et al. .
These included not having a confidant (>50% of suicides
compared with <10% of non-suicides), and stresses
associated with work finance, legal problems, physical
health and relationships. However, the most common
single factor was the presence of mental health problems,
which was found in 82% of farmer suicides. In most
cases, the evidence suggested the presence of depressive
illness, and one-third were receiving treatment with anti-
depressants. Two-thirds of the sample had seen their
general practitioner (GP) in the previous 3 months, but
often with physical symptoms, and it was noted that
farmers and their families often lacked knowledge about
mental health problems and the ways in which symptoms
might be expressed.
A number of interventions have been developed for
farmers which aim to deliver mental health promotion,
support, treatment and suicide reduction, and the
literature reviewed above suggests further opportunities.
Mental health promotion
Because we know that farming is associated with high
levels of stress, that farmers and their families often
know little about mental health difficulties, and that the
stigma of mental health problems is often a barrier to
seeking help, there is clearly a role for targeted mental
health problem strategies. These should aim to increase
awareness,educate about problems and coping strategies,
and generally contribute to the de-stigmatization of both
the problems themselves and the seeking of help.Govern-
ment and non-government organizations associated
with both health and the farming community all have
contributions to make. Such promotion could take the
form of articles in the farming media, self-help materials
distributed to farmers and leaflets available in appropriate
locations, such as at auctions and in veterinary practices.
Educating the younger generation through programmes
in rural schools is particularly appropriate in view of
the transgenerational nature of farming. Good examples
of such activities already exist, principally from non-
government organizations such as the Samaritans ,
the Rural Stress Information Network and RuralMinds.
For example, the ‘Foot and Mouth First Aid Kit’, an
information card written and widely distributed by
RuralMinds, addressed the recognition of stress, offered
coping strategies and gave information on where to seek
help. The delivery of such initiatives by non-government
organizations rather than health services may be particu-
larly appropriate as farmers seem more likely to visit their
GPs for acute problems rather than for issues which may
respond to health promotion or prevention .
Recognition and effective management of mental
Several non-government organizations involved in health-
promotion activities targeted at rural communities also
provide various forms of support, advice and counselling.
These include the organizations mentioned above,as well
as the Farm Crisis Network, ‘Don’t Panic’ and a growing
number of local associations who provide telephone or
face-to-face contact with volunteers within the farming
community or with specially trained staff, as well as
helping farmers to access specialist advice.
The main challenges for primary care in this area are
to encourage farmers to seek help for mental health as
well as physical health problems, to recognize underlying
mental health problems even when they present as
somatic symptoms and to minimize the relative inaccess-
ibility of primary care, particularly in more remote rural
areas. An example of an outreach model designed to
deliver general health care to farmers in North Lancashire
and South Cumbria using nurse practitioners is currently
being evaluated by the University of Lancaster Institute
for Health Research .
A discussion of the strategies that can be employed for
suicide prevention in general is beyond the scope of this
review. Such strategies involve areas of law and policy,
public health, roles for various government and non-
governmental agencies, as well as raised awareness,
training and changes in practice in many areas of health
care . However, the literature on suicide in farmers
suggests a number of specific interventions which have
the potential for reducing the numbers of farmer suicides.
First, the close association between suicide and mental
health problems means that the range of actions that can
be taken to predict, prevent, detect and treat stress and
mental health problems in the farming community can
also have an indirect impact on suicide. Secondly, formal
or informal methods restricting access to firearms by
farmers in general, and particularly by farmers who are
thought to be at increased risk, are likely to impact on
by guest on May 23, 2011
suicide rates.The difficulty with such strategies is that the
farming community in general is very resistant to any
restrictions on their access to shotguns, which are
perceived by most farmers as essential tools for their
work and, indeed, by some as an inalienable right or
an essential part of their heritage. Thus, although there
have been frequent discussions about increasing formal
restrictions on ownership of shotguns by farmers, such
action has not been taken. There is probably a greater
potential for temporary voluntary restriction amongst
farmers who might be at risk. The findings of Hawton
et al.  suggest that access to shotguns amongst the
farmers who committed suicide had rarely been
restricted, even when the risk had been recognized by
family members and others.Thus,raised awareness about
this issue within the farming community, amongst formal
and informal support networks, and in primary health
care teams has the potential for reducing the number
of suicides amongst farmers at risk. Thirdly, specific
practical support for farmers, for example with financial
problems, retirement, housing, and retraining for those
who wish to leave farming but feel trapped, has the
potential for reducing the hopelessness which is known to
be associated with suicide risk and which is felt by so
many farmers. Finally, strategies for increasing the social
supports available, particularly in the more isolated areas,
could have a significant protective impact. Examples of
initiatives include support for self-help groups, befriend-
ing schemes and even an introduction service specifically
for farmers run by a national magazine with a rural focus.
The recent BSE and foot and mouth epidemics in the
UK were acute and extreme examples of farming crises
which received considerable public attention and some
sympathy for farmers. However, health professionals,
government agencies and non-governmental organiza-
tions were already becoming aware of the increasing
occupational stresses faced by farmers and the effects of
these on their mental health and, in particular, their
mortality through suicide. A number of initiatives have
now been established, principally by non-governmental
organizations, to provide health promotion and support
to farmers, but there is still considerable room for
improvement, including a need to increase awareness
amongst health professionals and to overcome barriers
that exist in the effective delivery of health care to this
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