The barriers and facilitators of farmer mental health help-seeking: a mixed methods approach

The barriers and facilitators of farmer mental health help-seeking: a mixed methods approach

Farming as an occupation has many inherent stressors, and farmers demonstrate suicide rates twice that of the general population (Arnautovska, McPhedran, & De Leo, 2014). There are also reports that indicate farmers may show fewer help-seeking behaviours, although research to date has failed to uncover clear reasons for this (Brew, Inder, Allen, Thomas, & Kelly, 2016). If mental health help-seeking behaviours, such as seeking mental health support from health professionals, occurs promptly, then negative consequences may be minimised. There is an urgent need to identify factors specific to farmers that prevent and promote mental health help-seeking. To address this problem a two-phase program of research using mixed methods was conducted. The first phase was qualitative, using semi-structured interviews and thematic analysis as per Braun and Clarke’s (2006) recommendations to explore farmer mental health help-seeking with three samples: farmers, farmers’ partners, and General Practitioners (GPs). From the analysis, three superordinate themes were reported as part of Phase 1: ‘Farming life’, ‘Services’, and ‘Personal factors’. Farming life encompassed ‘Lifestyle and culture’, ‘Farming priorities’, and ‘The challenges of farming life’ themes. The services superordinate theme was comprised of three themes: ‘How the service is delivered’, ‘Services are provided within a complex system’, and ‘Emerging technologies: The users, practitioners, and systems’. Lastly, personal factors included the themes of ‘Mental health literacy’, ‘Stigma of mental illness and help-seeking’, ‘Support, the partners’ role in help-seeking’ and ‘The intersectionality between being a farmer, age, and gender’. The Phase 1 findings provided the basis for Phase 2 hypotheses generation. In Phase 2, correlational analyses and logistic regression demonstrated which of the factors identified in Phase 1 had bivariate and predictive relationships with intentions to seek mental health help. Further, the farmers’ intentions for seeking mental health help from a GP and a mental health professional were considered separately. With respect to intentions to seek mental health help from a GP, many factors demonstrated a bivariate relationship, and together these factors accounted for a large amount of the variance. One factor, comfort with mental health services, was a key predictor. There was a different pattern of relationships for intentions to seek help from a mental health professional, but many factors also demonstrated a bivariate relationship. Together, the factors accounted for a large amount of the variance in intentions to seek help from a mental health professional, and two factors were key predictors: comfort with mental health services and psychological openness. The findings from this research advance knowledge in a number of ways. Firstly, this research provides an understanding of the barriers and facilitators farmers experience with respect to mental health help-seeking. Additionally, Phase 2 provides information regarding the strength of these factors’ influence on farmer help-seeking intentions, and the importance of considering each health profession separately, because intentions to seek help from each were related to, and predicted by, different groups of factors. While further research is still needed, given the emerging state of the literature, this research has utility and highlights the complexity of preventive and promotive factors impacting on farmer mental health help-seeking.