FARMERS’ COMMON BEHAVIORAL HEALTH ISSUES OFTEN ARE OCCUPATION-RELATED

By Dr. Mike Rosmann

February 1, 2016

How the behavioral health of the agricultural population (farmers, ranchers, farm laborers, seasonal farm workers, fishers and lumber harvesters) differs from the U.S. population in general provides important information for farmers and their healthcare providers. Today’s article examines common behavioral health problemsof both populations, and follows last week’s discussion of chronic mental illnesses and personality disorders.

The agricultural population has fewer people with severe behavioral health disorders because they usually--but occasionally do not--disrupt personal, social and occupational functioning to the degree that they hinder the symptom-bearers from being able to handle the challenges of farming successfully.

The more common behavioral health disorders that affect the agricultural and general populations include these: adjustment disorders, relationship problems, anxiety, depression and alcohol/drug abuse. For farmers, their disorders tend to be occupation-related.

Several studies have looked at common behavioral health issues reported by the agricultural population in the U.S. One large longitudinal study, for which I was the primary investigator, entailed 43,852 callers to statewide farm crisis telephone hotlines in seven Upper Midwestern states from September 2005 through October 2007.

Only people in the agricultural population were included in the study. The callers gave the following reasons for contacting the hotlines: difficulty coping with daily roles/activities-28%, feeling depressed-28%, marital or family concerns-25%, stress over finances-14%, alcohol/drug abuse-5%, and gambling-<1%.

With the callers’ permission, the hotline responders gathered information about their demographic characteristics and reasons for contacting the hotlines. The trained responders offered prepaid vouchers to callers who asked for, or appeared to need, professional behavioral health services. Of 10,647 referrals for professional behavioral healthcare, 7,238 persons accepted assistance.

The diagnosis most frequently reported by the professional behavioral healthcare providers to the 7,238 service recipients was adjustment disorder-44.5%, which often includes difficulties coping with daily roles/activities and in relationships. Adjustment disorders are acute stress-related maladjustments that usually remit through counseling.

Forms of depression (major depression or bipolar disorder) followed-32.5%, along with anxiety disorders (generalized anxiety, phobias and PTSD)-10.7%, alcohol/drug misuse-6.5%, spousal, child and parent abuse-3.6%, personality disorder-1.5%, psychotic disorder (schizophrenia and any disorder entailing delusions, hallucinations or disturbed thinking/speech)-.6% and pathological gambling-.1%.

These diagnoses somewhat parallel the diagnoses of 122 farm residents who sought counseling or psychiatric care in a study I directed at Southwest Iowa Mental Health Center during a three-year period (1984-1986) of the 1980s’ Farm Crisis.

Relationship problems were most frequent-40%, followed by adjustment disorders-24%, depressive illnesses-18%, anxiety disorders-11%, substance misuse-5%, schizophrenia and other psychotic disorders-2%.

How do serious behavioral health problems of the agricultural population compare to the general U.S. population? National Institute of Mental Health (NIMH) data for 2014 indicate that about 4.2% of all U.S. adults suffered a chronic mental illness, personality disorder or other debilitating behavioral health condition that temporarily or permanently disabled them from working.

U.S. Department of Labor statistics indicate that about 18% of employed people reported missing one or more work days due to other serious behavioral health conditions in 2014; about 10% of these cases faked their claims. The general population has a higher prevalence of persons with serious behavioral health conditions than the agricultural population.

It’s difficult to compare the most common behavioral health issues, the relational problems and adjustment disorders, for the agricultural and general populations. The criteria for these diagnoses changed when the newest Diagnostic and Statistical Manual of Mental Disorders (DSM 5) went into effect in 2013.

Relationship problems are now defined as forms of physical, psychological or sexual violence, abuse, or neglect. Adjustment disorders are now diagnosed as forms of anxiety, depression, or other behavioral health disorders.

Valid comparisons across populations don’t exist. Insurers indicate both problems are among the most commonly reported diagnoses.

The federal Substance Abuse and Mental Health Services Administration has useful information pertaining toother common mental illnesses. For 2014 the following prevalence data were available for the U.S. general population: 18.1% had some form of mental illness; 8.4% had a substance use disorder; and about a quarter of the persons were diagnosed with both disorders concurrently.

The NIMH provided the following estimates of the prevalence of major behavioral health disorders among the general U.S. population in 2014: depressive disorders-6.6%, bipolar disorder-2.6%, and any anxiety disorder-18.1%. It appears the agricultural population, in comparison to the general population, is more likely to experience depressive disorders, but the comparisons of anxiety disorders, relational problems and adjustment disorders are more complex.

Multiple simultaneous stressors, especially economic uncertainty and threats of the possible loss of their land to farm gainfully, are the major contributing factors to the behavioral health problems experienced by the agricultural population. Studies in the U.S. and other agricultural countries have shown the behavioral health difficulties of most farm people wax and wane in response to the amount of stress they experience.

The next two columns will look at how people involved in agriculture can manage their behavioral health problems to remain optimally functional. Dr. Rosmann is a clinical psychologist/farmer at Harlan, Iowa. Contact him at: mike@agbehavioralhealth.com.

Read more at: www.agbehavioralhealth.com.