Evaluating Mental Health First Aid for Illinois Agricultural Communities.

Introduction. Mental Health First Aid (MHFA) was created to teach individuals how to identify, understand, and respond to signs of mental illnesses and substance use disorders. Programs like this may be essential for agricultural communities where suicide rates have increased, and mental health stigma has been a barrier to this population. This study evaluated how effective MHFA and Youth MHFA were for participants from agricultural communities. Methods. Participants completed the MHFA (N = 38) and Youth MHFA (N = 66) programs in 2021-2022, and Extension educators offered both programs as a part of outreach efforts within agricultural contexts. Participants completed pre-, post-, and post-only evaluations as standardized by the National Council for Mental Wellbeing. Results. After completing the MHFA and Youth MHFA training, participants increased their knowledge, confidence, and skills in various mental health topics. This includes early indicators of mental health challenges, the ability to have supportive conversations, and how to provide resources to others. For example, most participants felt they became more knowledgeable about MHFA (69%) and the ability to recognize the signs and symptoms of mental health or substance use challenges (65%). Conclusion. This research has implications for supporting agricultural workers through additional mental health training, managing farm stress, and understanding mental health stigma within this community.

A Comparison between Farm-Related Stress, Mental Health, and Social Support between Men and Women Farmers.

Agricultural producers have worse mental health than the general population; however, recent research has not considered differences in stressors and mental health conditions by gender. A survey was mailed to a random sample of farmers in Illinois to screen for symptoms of anxiety and depression and identify sources of stress and social support. Men experienced more stress related to environmental and economic conditions than women, while women tended to have slightly higher levels of geographic isolation stress than men. Overall, there were no significant differences by gender in the proportion meeting the criteria for depression or anxiety; however, the results are higher than what is observed in the general population. Among those farmers who experience higher levels of stress about geographic isolation, the odds for women farmers to experience depressive symptoms are four times more than men farmers (OR 4.46 (0.91, 21.8); p = 0.06). Additional research should examine the relationship between social support and mental health. Interventions to reduce stress by gender should be considered.

Mental Health Among LGBTQ+ Farmers in the United States.

OBJECTIVES: The objective of the current study is to describe mental health among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people who work in agriculture in the U.S. METHODS: This study uses a survey of LGBTQ+ adults who work in agriculture in the U.S. (N = 148), including questions about LGBTQ+ identity, farming background, depression symptoms (PHQ-8) and diagnosis, anxiety symptoms (GAD-7) and diagnosis, suicide risk, and stress. Data were analyzed using SPSS, including descriptive statistics, chi-square tests, and Mann-Whitney U tests. RESULTS: Over one-third (36.1%) had probable depression (PHQ-8 ≥ 10), and 71.9% were experiencing mild to severe depression symptoms. Nearly half (46.2%) had probable anxiety disorder (GAD-7 ≥ 8), and 69.7% experienced mild to severe anxiety symptoms. Over half (51.7%) were at significant risk for suicide. Greater proportions of men had probable anxiety disorder, probable depression, and suicide risk compared to non-men. Greater proportions gay participants had probable depression, as did beef producers. Perceived stress was higher for men, lesbian and gay participants, transgender participants, and those in beef production. Resilient coping was highest among participants who were genderqueer or genderfluid, bisexual, and those in field crop production. CONCLUSION: LGBTQ+ farmers in the current sample experienced depression and anxiety at higher rates than general farming or general LGBTQ+ samples, although suicide risk was lower than for general LGBTQ+ samples. Future research should explore how working in agriculture may be protective against suicide risk for LGBTQ+ farmers, as well as how specific farm stressors are related to LGBTQ+ farmer mental health.

Rural US residents recognize anxiety better than urbanites and suburbanites but hold similar stigma.

PURPOSE: Recognizing signs of psychological distress is a critical first step in assisting people who are struggling with poor mental health to access help. However, community-level factors that impact recognition and stigma are underexplored. The purpose of this study is to investigate the relationship between rurality, other community-level variables, and individual variables with regard to the recognition and stigma of anxiety. METHODS: We use a survey of US adults (N = 627), including a rural oversample, and a cloaked vignette approach. We assess the ability to identify anxiety and measure associated stigma. The analysis applies an ecological model in multinomial logistic regressions. FINDINGS: About half of the respondents recognize anxiety from a list of possibilities when provided with a vignette detailing common anxiety symptoms. Respondents living in rural areas are nearly twice as likely to correctly identify anxiety than nonrural respondents. About one-fifth of respondents agree with a statement designed to measure stigma: that exhibiting the symptoms is a sign of personal weakness. Respondents able to identify anxiety show less stigma. Respondents from counties with high mental health provider access were less likely to endorse the stigma statement. CONCLUSIONS: Rural areas seem poised to reduce the stigma associated with anxiety, because residents are more adept at identifying anxiety than people living elsewhere. Future work could focus on effective mechanisms for reducing stigma associated with anxiety in rural areas, and whether anxiety recognition and stigma are changing.

An Effective Mental Health Literacy Program for Farm Financial Service Providers.

OBJECTIVES: Mental health literacy programs related to agriculture can help enhance skills among agricultural community members and service providers to assist farmers and producers who are experiencing distress. The aim of the current article is to describe an agricultural mental health literacy education-based intervention program offered to USDA Farm Service Agency farm financial service providers. The program was implemented as a self-paced, online training through USDA's AgLearn platform to N = 500 FSA staff. METHODS: Pre-/post-evaluations were used to measure objective and self-rated knowledge and skills. Correlations, paired-samples t-tests, ANOVA, and content analysis were used to analyze data. RESULTS: The training resulted in significant improvements in objective and self-rated knowledge. While there were no gender differences in objective knowledge, men's self-rated knowledge and skills were significantly higher than that of women at pre-test; at post-test, there were no significant gender differences in self-rated knowledge and skills. CONCLUSION: Evaluations of this agricultural mental health literacy program demonstrate its effectiveness for farm financial service providers. Expanding access to such trainings among agricultural service providers who interact with producers regularly can help improve agricultural communities' skills to initiate and engage in critical conversations about mental health.

From believers to skeptics: Latent class analysis of COVID-19 protective practices and perceptions among agricultural community members.

PURPOSE: This cross-sectional study aimed to identify homogenous groups of agricultural producers and stakeholders based on their perceptions of effectiveness and use of COVID-19 protective behaviors. METHODS: We conducted an online survey of agricultural producers and stakeholders through Qualtrics. Participants responded to 7 statements about COVID-19 protective behavior effectiveness and 7 statements about participation in COVID-19 protective behaviors in the previous 2 weeks. These statements included handwashing, disinfecting, refraining from touching one's face, covering one's face when coughing/sneezing, staying at home, social distancing, and wearing a face mask. Additional survey sections included demographics and health history. We performed separate latent class analysis (LCA) to identify clusters of agricultural producers' and stakeholders' perceptions and participation in COVID-19-related protective behaviors based on their pattern of responses. FINDINGS: Based on LCA, participants were distributed as universal believers (33%), social believers (16%), personal believers (26%), moderate believers (17%), and social skeptics (85%) of effectiveness and as low (15%), moderate (40%), and high (45%) adherents of COVID-19 protective behaviors. Those who were female, older, or had underlying health conditions were more likely to be universal believers and highly adherent. High adherence was also more likely among those who lived in urban areas or were not self-employed. CONCLUSIONS: Results suggest that groups of agricultural producers and stakeholders based on perception of effectiveness and participation in COVID-19 protective behaviors are associated with demographic and health characteristics. Public health campaigns that increase or maintain motivation to comply with protective behaviors should be developed and implemented specific for agricultural populations.

Agricultural Producers' and Stakeholders' Perceived Effectiveness and Participation in COVID-19 Protective Behaviors.

This study was designed to identify the perceived effectiveness of COVID-19 protective behaviors and participation in COVID-19 protective behaviors among agricultural producers and stakeholders in the Midwest, United States. A questionnaire was disseminated online to agricultural producers and stakeholders in April-July 2020. Respondents (N = 1,876) shared their perceptions of the effectiveness of COVID-19 protective behaviors and participation in those behaviors. Respondents were primarily agricultural producers (85.5%), aged 64 or younger (66.4%), male (81.2%), white (98.3%), and rural residents (88.7%). About three-quarters of respondents thought washing hands with soap and water and covering a cough or sneeze is very effective at preventing the spread of COVID-19, however, only 30% thought wearing a face mask when in contact with others or in public is very effective. Similarly, over 80% reported washing hands with soap regularly every day and covering their cough or sneeze every day in the past two weeks. In contrast, less than 40% reported staying home as much as possible and wearing a face mask when in public every day in the past two weeks. Rural residents were less likely than urban or suburban residents to report wearing a face mask when in public or with people outside their household. Agricultural producers and stakeholders were found to be at risk of getting COVID-19 due to the perceptions and practices, especially those related to protective social measures. Understanding engagement in protective behaviors and perceptions of their effectiveness is critical to developing effective public health interventions for agricultural communities.

Developing and Implementing Farm Stress Training to Address Agricultural Producer Mental Health.

Farmers and ranchers (agricultural producers) have higher psychological distress and suicide rates than the general population. Poorer mental health status and outcomes among producers are often attributed to the continuously challenging economic, social, and climate-related changes to agriculture as an occupation and industry. This article describes the development of a training program for agribusiness professionals from the U.S. Department of Agriculture Farm Service Agency (N = 500) who work with producers, as they regularly interact with producers and thus are in a position to readily offer helpful mental health resources. The goal of the program was for agribusiness professionals to build skills and confidence to identify and respond to distressed producers. The educational program was offered primarily online and included a 1-day in-person training to practice skills to communicate with distressed producers and refer them to appropriate mental health resources. Evaluation of the program demonstrated participants experienced gains in knowledge and skills related to identifying and helping distressed producers.

Social Status Influence on Stigma Towards Mental Illness and Substance Use Disorder in the United States.

We describe the relationship between socio-demographic membership and stigma towards any mental illness (AMI) and substance use disorder (SUD) in the United States using a national survey (N = 2512). We hypothesize that participants from higher status socio-demographic groups may be more likely to report stigmatizing attitudes than participants from lower status socio-demographic groups. We find support for our hypothesis using multiple linear regression. Participants who were college-educated, male, or had household incomes above the national median were more likely to report stigmatizing attitudes toward both AMI and SUD in comparison to participants that were not college-educated, were female, or had household incomes below the national median. In contrast to our hypothesis, we find that participants who identified as Hispanic were more likely to report stigmatizing attitudes toward AMI than non-Hispanic whites. Younger and urban participants were more likely to report stigmatizing attitudes than their older and non-urban counterparts.

Addressing Farm Stress through Extension Mental Health Literacy Programs.

Agricultural producers have worse mental health than the general population, and often have limited access to mental health providers. Educational programs can strengthen knowledge of mental health including warning signs of stress and suicide, as well as assist individuals in developing communication skills and help-seeking behaviors. Cooperative Extension, the nation's academic outreach unit provided by land-grant universities, has a long history of providing agricultural education programs in the United States; this article describes the expansion of such programs to include mental health education for farmers and agricultural stakeholders in Michigan. Evaluation results of two programs developed by Michigan State University Extension demonstrate the programs are effective in improving understanding of agricultural economic trends, impacts of stress on the body, and warning signs of suicide among agricultural producers and stakeholders. Community-based education increases the capacity for mental health literacy programs to reach distressed farmers.

An Analysis of Suicide Risk Factors among Farmers in the Midwestern United States.

Research on the complex relationships of variables contributing to farmer suicide is limited. The purpose of the study was to examine factors associated with suicide risk through the use of standardized instruments measuring psychological (depression, anxiety), social (social support), and contextual factors. A questionnaire was completed by 600 farmers in the Midwestern United States. A multiple linear regression model was used to analyze associations with suicide risk (SBQ-R), including depression (PHQ-9), anxiety (GAD-7), Brief COPE subscales (BC), social support (MSPSS), and select demographic and farming characteristics. The only variable that emerged as having a significant relationship with the natural log-transformed suicide risk score was coping through self-blame. While suicidality is often considered the outcome of mental illness, our findings do not suggest that suicide risk among farmers is related to mental illness, and a further examination of self-blame as a coping strategy is warranted.

Connecting Primary Care to Community-Based Education: Michigan Physicians' Familiarity With Extension Programs.

Clinical-community linkages enhance health care delivery and enable physician-patient partnerships to achieve better health. The Michigan State University (MSU) Model of Health Extension includes a strategy for forming these linkages by focusing on increasing primary care patient referrals and enrollment in health programs. This article shares the results of a survey of Michigan internal medicine and family medicine physicians (n = 323) to better understand attitudes toward and familiarity with community-based education (CBE) programs and to assess the logistical requirements to make CBE referrals efficient and sustainable. Survey results showed that at most, 55% of respondents were aware of at least one CBE program implemented by Cooperative Extension. Of those who were aware, over 85% agreed that the programs have positive benefits for patients. Thirty-five percent reported at least one referral barrier, and familiarity with the CBE programs was a significant predictor for reporting all referral barriers. The results suggest that increasing physicians' familiarity of CBE health programs is a key first step in identifying ideal strategies to overcome referral barriers. Data from this study may help determine scalable state level models for increasing awareness of chronic disease prevention and other CBE programs in efforts to improve the health of the nation.

Forecasting state-level premature deaths from alcohol, drugs, and suicides using Google Trends data.

BACKGROUND: Vital statistics on the number of, alcohol-induced death (AICD) drug-induced death (DICD), and suicides at the local-level are only available after a substantial lag of up to two years after the events occur. We (1) investigate how well Google Trends search data explain variation in state-level rates in the US, and (2) use this method to forecast these rates of death for 2015 as official data are not yet available. METHODS: We tested the degree to which Google Trends data on 27 terms can be fit to CDC data using L1-regularization on AICD, DICD, and suicide. Using Google Trends data, we forecast 2015 AICD, DICD, and suicide rates. RESULTS: L1-regularization fit the pre-2015 data much better than the alternative model using state-level unemployment and income variables. Google Trends data account for substantial variation in growth of state-level rates of death: 30.9% for AICD, 23.9% for DICD, and 21.8% for suicide rates. Every state except Hawaii is forecasted to increase in all three of these rates in 2015. LIMITATIONS: The model predicts state, not local or individual behavior, and is dependent on continued availability of Google Trends data. CONCLUSIONS: The method predicts state-level AICD, DICD, and suicide rates better than the alternative model. The study findings suggest that this methodology can be developed into a public health surveillance system for behavioral health-related causes of death. State-level predictions could be used to inform state interventions aimed at reducing AICD, DICD, and suicide.

Angry, Scared, and Unsure: Mental Health Consequences of Contaminated Water in Flint, Michigan.

Natural and manmade crises impact community-level behavioral health, including mental health and substance use. This article shares findings from a larger project about community behavioral health, relevant to the ongoing water crisis in Flint, Michigan, using data from a larger study, involving monthly surveys of a panel of key informants from Genesee County. The data come from open-response questions and are analyzed as qualitative data using grounded theory techniques. Although respondents were not asked about the water issues in Flint, participants commented that the water situation was increasing stress, anxiety, and depression among the city's population. Participants thought these mental health issues would affect the entire community but would be worse among low-income, African American populations in the city. Mental health consequences were related not only to the water contamination but to distrust of public officials who are expected and have the authority to resolve the issues. The mental health effects of this public health crisis are significant and have received inadequate attention in the literature. Public health response to situations similar to the water issues in Flint should include sustained attention mental health.