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1. Mental Health in Ontario Agriculture

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A look at the state of mental health in Ontario agriculture and strategies to address the epidemic. Briana Hagen, University of Guelph

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1. Mental Health in Ontario Agriculture

  1. 1. MENTAL HEALTH ON THE FARM Briana Hagen, MSc, PhD Candidate, Epidemiology Population Medicine OntarioVeterinary College University of Guelph
  2. 2. OUTLINE What do we know? • Scoping review of mental wellness in farming What have we done? What are we doing? • Producer Stress and Resilience Survey (2015-2016) • Qualitative interviews with producers Where are we headed? • Development of a mental health literacy program
  3. 3. WHAT DO WE KNOW?
  4. 4. SCOPING REVIEW OF MENTAL HEALTH IN AGRICULTURE
  5. 5. Is the article about a mental health outcome? Does the article examine target population (farmers)? INCLUDE EXCLUDE Two phases: 1) Title, abstract, keyword review 2) Full-text review Two reviewers must agree to include or exclude. Disagreements resolved by consensus. No No Yes Yes Figure 1. Process of inclusion or exclusion from the scoping review of mental health in farming populations.
  6. 6. SCOPING REVIEW: SCREENING THE STUDIES n=6974 -all articles identified
  7. 7. SCOPING REVIEW: SCREENING THE STUDIES n=6974 n=4770 -after duplicates removed
  8. 8. SCOPING REVIEW: SCREENING THE STUDIES n=6974 n=4770 n=483 -for full screening
  9. 9. SCOPING REVIEW: SCREENING THE STUDIES n=6974 n=4770 n=483 n=327 -final number of studies included in analysis
  10. 10. Figure 3.
  11. 11. Figure 4. The number of studies conducted worldwide by year.
  12. 12. Primary outcome(s) studied n Proportion of total (n=327) Stress 138 42.2% Suicide 109 33.3% Depression 103 31.5% Anxiety 47 14.4% Resilience 20 6.1% Mortality 7 2.1% Burnout 2 0.6% Non-specified mental health outcome 49 14.9% Table 1. Primary outcome(s) studied and other factors of interest explored among 327 studies included in data extraction.
  13. 13. Primary outcome(s) studied n Proportion of total (n=16) Stress 11* 68.8% Suicide 5 31.3% Depression 2* 12.5% Anxiety 2* 12.5% Resilience 2* 12.5% Mortality - - Burnout 1* 6.3% Non-specified mental health outcome - - Table 2. Primary outcome(s) studied in Canada and other factors of interest explored among 16 studies included in data extraction. * Jones-Bitton et al., National Farmer Survey of Mental Health contributes one study here
  14. 14. RESOURCES: PEER-REVIEWED • 20/327 studies in the scoping review (6.1%) • US (4):AgriAbility (2011), Farm Partners (1998), Sowing the Seeds of Hope (2001), music therapy • Canada (1): Qualitative overview of mental health service development in SK (2000)
  15. 15. WHAT CAN WE LEARN?
  16. 16. SUCCESSES • Linking health and mental health works • National Centre approaches with state/provincial execution • Partnering university, private sector, and government • Communication between agencies and representation from all sectors on a governing board • Long term funding commitments lead to farmer buy-in
  17. 17. FAILURES • Failing to tailor services to farming populations • Having small pockets of funding for similar projects with great overlap • Top down approaches to improving health and wellness • No peer-reviewed evaluations of programming
  18. 18. SCOPING REVIEW: TAKE HOME MESSAGES ▪ Agriculture is a large part of Canadian culture and economy, but there is little data examining mental health and wellness of Canadian producers ▪ Mental health outcomes beyond stress have been overlooked in the current Canadian literature and warrant examination ▪ A national approach to exploring mental health outcomes of agricultural producers is needed to inform whether intervention is needed and where it would be most effective.
  19. 19. WHAT HAVE WE DONE?
  20. 20. RESEARCH OBJECTIVES 1. Identify factors associated with mental health outcomes; 2. Characterize the lived experience of mental health and wellness among Canadian farmers; and 3. Examine how an agriculture-specific mental health intervention can help facilitate mental health and wellness among Canadian farmers
  21. 21. RESEARCH OBJECTIVES 1. Identify factors associated with mental health outcomes; 2. Characterize the lived experience of mental health and wellness among Canadian farmers; and 3. Examine how an agriculture-specific mental health intervention can help facilitate mental health and wellness among Canadian farmers Quantitative
  22. 22. PRODUCER STRESS & RESILIENCE SURVEY: 2016
  23. 23. NATIONAL SURVEY • To determine prevalence of, and risk factors associated with: • Perceived stress • Depression • Anxiety • Burnout • Resilience • Explore help-seeking behaviours & industry support • Sept 2015 – Jan 2016
  24. 24. Perceived Stress Scale • Perceived Stress (Cohen et al.,1983) Maslach Burnout Inventory – Human Services Survey • Emotional Exhaustion • Depersonalization • Personal accomplishment (Maslach et al., 1996) Hospital Anxiety and Depression Scale • Anxiety • Depression (Zigmond & Snaith,1983) Connor-Davidson Resilience Scale • Resilience (Connor & Davidson,2003)
  25. 25. WHY WE NEED TO HAVE THESE CONVERSATIONS NOW… • 45% of producers were classified as having high stress • 58% of producers met the criteria for anxiety classification • 35% of producers met the criteria for depression classification • 40% of producers across Canada reported that they would feel uneasy about seeking professional help due to what people may think Jones-Bitton et al., National Farmer Survey of Mental Health
  26. 26. WE HAVE A PROBLEM. HERE, AT HOME. : 45% Survey of >1100 Canadian producers, September 2015 to January 2016
  27. 27. Op timal p erformance PERFORMANCE STRESS Energiz ed Focused Motivated Inactive Bored Fatigued Exhausted Panic, anxiety, and/or anger Burnout STRESS CURVE 45%
  28. 28. WHAT IMPACTS STRESS www.menti.com https://www.menti.com/72a540f5 Code: 49 33 84
  29. 29. FACTORS ASSOCIATED WITH PERCEIVED STRESS
  30. 30. FACTORS ASSOCIATED WITH STRESS Survey of >1100 Canadian producers, September 2015 to January 2016
  31. 31. “Commodity prices are always a concern. The unknown risks associated with experimenting. Financial investment and the return on investment can sometimes be stressful too.” “Your decisions dictate success or failure.”
  32. 32. “When being innovative you try new things. As much as you try to mitigate the risks you can’t help but have a few failures. These failures cost money. Sometimes a lot. You tend to look around you, especially after a failure, and witness other farmers who are seemingly more successful than you.”
  33. 33. “Everyone’s watching, no one wants to fall behind, everyone wants to out-pace the competition. A man who decides to visit the local coffee shop and is inundated with ridicule and laughter can go home destroyed, questioning his very existence.”
  34. 34. “There can also be a bit of resentment in the community. And I’m not sure if it’s real or imagined, but you get the sense sometimes that other farmers nearby want you to fail.“
  35. 35. FACTORS ASSOCIATED WITH STRESS Survey of >1100 Canadian producers, September 2015 to January 2016
  36. 36. WE HAVE A PROBLEM : 35% - 20% ‘mild’ - 12% ‘moderate’ - 3% ‘severe’ : 58% - 25% ‘mild’ - 25% ‘moderate’ - 8% ‘severe’ Survey of >1100 Canadian producers, September 2015 to January 2016
  37. 37. : 38% : 43% : 18% Survey of >1100 Canadian producers, September 2015 to January 2016 AND, THERE’S BURNOUT
  38. 38. RESILIENCE
  39. 39. WHAT IF THERE WERE SKILLS THAT COULD HELP? Resilience = a state of being that and
  40. 40. PRODUCER STRESS AND RESILIENCE SURVEY 2/3 of our producers scored lower in resilience than the US general population US general populationOur producers 2/3 of our producers scored lower in resilience than the US general population Survey of >1100 Canadian producers, September 2015 to February 2016
  41. 41. WE NEED TO INCREASE RESILIENCE. “We are not invincible, but feel we must be.” “I was incredibly upset with myself that day for not being on top of things...” “[I’m] destroying myself to make sure others are cared for.” “I’m pulled in multiple directions and unable to maintain work-life balance, being exhausted but unable to take a break .”
  42. 42. FACTORS ASSOCIATED WITH RESILIENCE
  43. 43. WHAT IMPACTS RESILIENCE? www.menti.com https://www.menti.com/05b2da6f Code: 29 26 33
  44. 44. FACTORS ASSOCIATED WITH RESILIENCE Survey of >1100 Canadian producers, September 2015 to January 2016
  45. 45. RESILIENCE “Watching my father farm as a young man gave me my love and drive for innovation. He was always on the cutting edge, always changing, modifying and running the numbers. I guess first off, I love that I have the ability to continue that tradition and pass the never ceasing qualities to my [children].The ability to manipulate my farms success with my own ingenuity, my own two hands, my “level” of smarts, is a high only a business owner could experience. It provides satisfaction and above all a sense of purpose.“
  46. 46. SUPPORTS “It is still difficult for people to admit they need help.At the end of the day we can’t be the ‘all things to everyone’ all of the time. For most businesses they have a HR, Finance, Operations department, yet on many family farms the producer is all of those things. It is difficult to ask for help."
  47. 47. THERE’S SOME GOOD NEWS 76% said mental health professional = helpful 67% would seek professional help 63% said getting help ≠ weak Survey of >1100 Canadian producers, September 2015 to January 2016
  48. 48. WHAT ARE WE DOING?
  49. 49. RESEARCH OBJECTIVES 1. Identify risk and protective factors associated with mental health outcomes, including stress, resilience, depression, and anxiety; 2. Characterize the lived experience of mental health and wellness among Canadian farmers, its impacts, and how this influences the use of mental health services; 3. In partnership with agricultural stakeholders, examine how an agriculture-specific mental health intervention can assist in facilitating mental health and wellness among Canadian farmers Qualitative
  50. 50. STEP TWO (QUALITATIVE): IN-DEPTH INTERVIEWS
  51. 51. WHERE ARE WE GOING?
  52. 52. RESEARCH OBJECTIVES 1. Identify risk and protective factors associated with mental health outcomes, including stress, resilience, depression, and anxiety; 2. Characterize the lived experience of mental health and wellness among Canadian farmers, its impacts, and how this influences the use of mental health services; 3. In partnership with agricultural stakeholders, examine how an agriculture- specific mental health intervention can assist in facilitating mental health and wellness among Canadian farmers Research to Action
  53. 53. Producers Government Veterinarians Industry Mental Health Professionals & Researchers
  54. 54. *Graphic notes curtesy of Alex Sawatzky
  55. 55. CONCLUSIONS • Canadian farmers are experiencing high levels of stress, anxiety, depression, and burnout and are underrepresented in the literature • Agriculture is unique as an occupation and lifestyle → interventions should be ag-specific • Building capacity among farmers and those who work with farmers to address the current gap in mental health resources
  56. 56. PHASE TWO FUNDERS
  57. 57. THANK YOU! Briana Hagen, MSc, PhD Candidate Department of Population Medicine University of Guelph bhagen@uoguelph.ca
  58. 58. REFERENCES Jones-Bitton et al., National Farmer Survey of Mental Health (In prep) Cohen et al.,1983 Maslach et al., 1996 Zigmond & Snaith, 1983 Connor & Davidson, 2003 http://farmstrong.co.nz/about/ https://www.mensheds.org.au/mens-shed-story https://www.yanahelp.org/additional-help.html https://www.domore.ag/ http://www.nfu.ca/sites/www.nfu.ca/files/Farm%20Family%20Stress.pdf https://supportline.ca/ http://www.acfareseaux.qc.ca/fr/maison-acfa https://www.aqps.info/ https://www.princeedwardisland.ca/en/information/agriculture-and-fisheries/farmer-assistance-program https://farmsafetyns.ca/farm-family-support-center/ http://www.agrability.org/about/program/ https://www.farmerhealth.org.au https://www.farmerhealth.org.au/sustainable-farm-families/sff-programs

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