1.
MENTAL HEALTH ON THE FARM
Briana Hagen, MSc, PhD Candidate, Epidemiology
Population Medicine
OntarioVeterinary College
University of Guelph

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.
WHAT DO WE KNOW?

4.
SCOPING REVIEW OF MENTAL
HEALTH IN AGRICULTURE

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.
SCOPING REVIEW: SCREENING THE
STUDIES
n=6974
-all articles
identified

7.
SCOPING REVIEW: SCREENING THE
STUDIES
n=6974
n=4770
-after
duplicates
removed

8.
SCOPING REVIEW: SCREENING THE
STUDIES
n=6974 n=4770
n=483
-for full
screening

9.
SCOPING REVIEW: SCREENING THE
STUDIES
n=6974 n=4770 n=483
n=327
-final number
of studies
included in
analysis

10.
Figure 3.

11.
Figure 4. The number of studies conducted
worldwide by year.

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.
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.
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.
WHAT CAN WE LEARN?

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.
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.
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.
WHAT HAVE WE DONE?

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.
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.
PRODUCER STRESS & RESILIENCE
SURVEY: 2016

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.
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.
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.
WE HAVE A PROBLEM.
HERE, AT HOME.
: 45%
Survey of >1100 Canadian producers, September 2015 to January 2016

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.
WHAT IMPACTS STRESS
www.menti.com
https://www.menti.com/72a540f5
Code: 49 33 84

29.
FACTORS ASSOCIATED WITH
PERCEIVED STRESS

30.
FACTORS ASSOCIATED WITH STRESS
Survey of >1100 Canadian producers, September 2015 to January 2016

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.
“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.
“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.
“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.
FACTORS ASSOCIATED WITH STRESS
Survey of >1100 Canadian producers, September 2015 to January 2016

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.
: 38%
: 43%
: 18%
Survey of >1100 Canadian producers, September 2015 to January 2016
AND, THERE’S BURNOUT

38.
RESILIENCE

39.
WHAT IF THERE WERE SKILLS
THAT COULD HELP?
Resilience = a state of being that
and

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.
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.
FACTORS ASSOCIATED WITH
RESILIENCE

43.
WHAT IMPACTS RESILIENCE?
www.menti.com
https://www.menti.com/05b2da6f
Code: 29 26 33

44.
FACTORS ASSOCIATED WITH RESILIENCE
Survey of >1100 Canadian producers, September 2015 to January 2016

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.
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.
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.
WHAT ARE WE DOING?

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.
STEP TWO (QUALITATIVE):
IN-DEPTH INTERVIEWS

51.
WHERE ARE WE GOING?

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.
Producers
Government
Veterinarians
Industry
Mental Health
Professionals &
Researchers

54.
*Graphic notes curtesy of Alex Sawatzky

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.
PHASE TWO FUNDERS

57.
THANK YOU!
Briana Hagen, MSc, PhD Candidate
Department of Population Medicine
University of Guelph
bhagen@uoguelph.ca

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