behavioral health issues of the aging agricultural population by: michael r. rosmann, ph.d. a...

BEHAVIORAL HEALTH ISSUES OF BEHAVIORAL HEALTH ISSUES OF THE AGING AGRICULTURAL THE AGING AGRICULTURAL

POPULATIONPOPULATIONBy: Michael R. Rosmann, Ph.DBy: Michael R. Rosmann, Ph.D..

A Conference on the Aging FarmA Conference on the Aging Farm Community: Using Current HealthCommunity: Using Current Health

and Safety Status to Map Future Action.and Safety Status to Map Future Action.

Airport Holiday Inn SelectAirport Holiday Inn SelectIndianapolis, INIndianapolis, IN

Wednesday, March 7, 2007Wednesday, March 7, 2007

Produced by Michael R. Rosmann, Ph.D., March 2007

1210 71210 7thth Street, Suite C Street, Suite CHarlan, Iowa 51537Harlan, Iowa 51537

Telephone: 712-235-6100Telephone: 712-235-6100Fax: 712-235-6105Fax: 712-235-6105

Email: Email: [email protected]@agriwellness.org

Web site: Web site: www.agriwellness.orgwww.agriwellness.org

Building hope and health in Building hope and health in

the rural agricultural the rural agricultural communitycommunity


““The Health United States 2001, Urban andThe Health United States 2001, Urban andRural Health Chart Book presents a patternRural Health Chart Book presents a patternrisky health behaviors among ruralrisky health behaviors among ruralpopulations that suggest a ‘rural culture’ populations that suggest a ‘rural culture’ health determinant. This pattern suggestshealth determinant. This pattern suggeststhat there may be environmental and cultural that there may be environmental and cultural factors unique to towns, regions, or United factors unique to towns, regions, or United States Department of Agriculture economic States Department of Agriculture economic types that affect health behavior and health. types that affect health behavior and health. Responding to regionally diverse behavioral riskResponding to regionally diverse behavioral riskfactors is a challenge for the maturing field of rural factors is a challenge for the maturing field of rural health” (Hartley, 2004).health” (Hartley, 2004).


To farmers, “the land is everything.”

Ownership of a family farm is the

triumphant result of the struggles of

multiple generations. Losing the family

farm is the ultimate loss – bringing

shame to the generation that has let

down their forbearers and dashing the

hopes for successors.


Exiting Farms and FarmersExiting Farms and Farmers

Older farmers are exiting at a much slower rate Older farmers are exiting at a much slower rate than in previous years (Gale, 2002).than in previous years (Gale, 2002).

Farming no longer dominates the rural economy. Farming no longer dominates the rural economy. Farm policy will continue to be critical to many Farm policy will continue to be critical to many areas but agriculture is not the only issue of areas but agriculture is not the only issue of importance to many rural communities. High importance to many rural communities. High poverty rates in rural areas, poor access to poverty rates in rural areas, poor access to health care, especially behavioral health care health care, especially behavioral health care and a rapid influx of people and businesses into and a rapid influx of people and businesses into many rural areas are major issues facing policy many rural areas are major issues facing policy makers (Johnson, 2005).makers (Johnson, 2005).


Stress and Injuries Linked with Stress and Injuries Linked with Agriculture as a Occupation:Agriculture as a Occupation:

Stress caused by financial difficulties increases Stress caused by financial difficulties increases the risk of farming-related injuries and fatalities the risk of farming-related injuries and fatalities (Geller, Ludtke and Stratton, 1990; Thu, Lasley, (Geller, Ludtke and Stratton, 1990; Thu, Lasley, Whitten, Lewis, Donham, Zwerling and Scarth, Whitten, Lewis, Donham, Zwerling and Scarth, 1997; Kidd, Scharf and Veazie, 1996; Hagel et 1997; Kidd, Scharf and Veazie, 1996; Hagel et al, 2004; Alpass et al, 2004).al, 2004; Alpass et al, 2004).

There is a tendency for health and financial There is a tendency for health and financial stressors to affect older farmers and families stressors to affect older farmers and families more than they affect younger farmers and more than they affect younger farmers and families (May, 1998).families (May, 1998).


National Stress and Mental Survey ofNational Stress and Mental Survey of Canadian Farmers* Canadian Farmers*

Western Opinion Research, Inc. surveyed 1,100 agricultural producers across Canada.

20% described themselves as being “very stressed” and another 45% described themselves as being “somewhat stressed”.

Farm stress levels tended to decrease with age and income level. The levels of stress were similar to the general Canadian population

sampled in 2002 but the causes of stress for farmers are unique:

o Extreme stress factors included poor harvests, unfavorable government policies and troubled farm finances.o High stress factors included weather, the BSE Crisis and the pressure to maintain the family farm.o Medium stress factors included physical health concerns, balancing farm and off-farm work, personal family relationship difficulties and concerns about mental health.o Lower stress factors included loneliness, lack of affordable childcare and substance abuse.

* Canadian Agricultural Safety Association, 2005


Serious Psychological Distress in Serious Psychological Distress in Rural Areas: Rural Areas:

Health, United States, 2005 (U.S. Department of Health Health, United States, 2005 (U.S. Department of Health and Human Services, 2005) indicated that serious and Human Services, 2005) indicated that serious psychological distress is linked with poverty:psychological distress is linked with poverty:


o 8.7% of persons who are very poor reported serious psychological8.7% of persons who are very poor reported serious psychological distress in 2002 – 2003.distress in 2002 – 2003.o 5.4% of near poor persons reported serious psychological distress 5.4% of near poor persons reported serious psychological distress in 2002 -2003.in 2002 -2003.o 1.8% of the nonpoor reported serious psychological distress 1.8% of the nonpoor reported serious psychological distress in 2002 – 2003.in 2002 – 2003.

2.9% of persons within metropolitan service areas reported 2.9% of persons within metropolitan service areas reported serious psychological disturbance in 2002 – 2003. serious psychological disturbance in 2002 – 2003. 3.9% of person living outside metropolitan service areas 3.9% of person living outside metropolitan service areas reported serious psychological distress in 2002 – 2003.reported serious psychological distress in 2002 – 2003.

Age and the Agricultural Population:Age and the Agricultural Population: Serious psychological maladjustment decreases with Serious psychological maladjustment decreases with

age:age:


o 2.9% of 18 – 44 year olds reported serious 2.9% of 18 – 44 year olds reported serious psychological disturbance in 2002 – 2003.psychological disturbance in 2002 – 2003.o 4.0% of 45 – 64 year olds reported serious 4.0% of 45 – 64 year olds reported serious psychological distress in 2002 – 2003.psychological distress in 2002 – 2003.o 2.3% of 65+ year olds reported serious 2.3% of 65+ year olds reported serious psychological disturbance in 2002 – 2003. (U.S. psychological disturbance in 2002 – 2003. (U.S. Department of Health and Human Services, 2005).Department of Health and Human Services, 2005).

Roy’s (2001) survey of 717 northwest Iowa farmers Roy’s (2001) survey of 717 northwest Iowa farmers found that farmers over 65 years of age reported fewer found that farmers over 65 years of age reported fewer mental health symptoms, possibly because they were more mental health symptoms, possibly because they were more financially secure than younger farmers.financially secure than younger farmers.

Data from the National Health Interview Survey Data from the National Health Interview Survey from 1997 through 2002 were evaluated to from 1997 through 2002 were evaluated to determine urban-rural differences. The prevalence determine urban-rural differences. The prevalence of significant psychological distress was higher in of significant psychological distress was higher in nonmetropolitan than metropolitan areas, a finding nonmetropolitan than metropolitan areas, a finding that is at variance with past research that showed that is at variance with past research that showed no urban-rural difference in psychological distress. no urban-rural difference in psychological distress. Participants with significant psychological distress Participants with significant psychological distress from rural areas were less likely than their counterparts from rural areas were less likely than their counterparts from metropolitan areas to have contact with from metropolitan areas to have contact with mental health professionals and more likely to be mental health professionals and more likely to be unable to afford medications (Mojtabai, 2006).unable to afford medications (Mojtabai, 2006).


Age-Adjusted U.S. Suicide Rates by

Urban-Rural, 1970 – 1997*

Source: Singh, G. K., & Siahpush, M. (2002). The increasing rural-urban gradients in U.S. suicide mortality, 1970 – 1997. American Journal of Public Health, 92(7), 1161-1167.


Rural-Urban Continuum*Rural-Urban Continuum*1.1. Central counties in metropolitan areas with 1 million people or more.Central counties in metropolitan areas with 1 million people or more.2.2. Fringe counties in metro areas with 1 million people or more.Fringe counties in metro areas with 1 million people or more.3.3. Counties in metro areas with 250,000 – 1million people.Counties in metro areas with 250,000 – 1million people.4.4. Counties in metro areas with fewer than 250,000 people.Counties in metro areas with fewer than 250,000 people.5.5. Urban counties with a population of 20,000 or more, adjacent to a metro Urban counties with a population of 20,000 or more, adjacent to a metro

area.area.6.6. Urban counties with a population of 20,000 or more, not adjacent to a Urban counties with a population of 20,000 or more, not adjacent to a

metro area.metro area.7.7. Urban counties with a population of 2,500 to 19,999, adjacent to a metro Urban counties with a population of 2,500 to 19,999, adjacent to a metro

area.area.8.8. Urban counties with a population of 2,500 to 19,999, not adjacent to a Urban counties with a population of 2,500 to 19,999, not adjacent to a

metro area.metro area.9.9. Rural counties with a population of less than 2,500, adjacent to a metro Rural counties with a population of less than 2,500, adjacent to a metro

area.area.10.10. Rural counties with a population of less than 2,500, not adjacent to a metro Rural counties with a population of less than 2,500, not adjacent to a metro

area.area.


*Source: Butler, M. A., & Beale, C. L. (1994). Rural-urban continuum codes for metro and non-metro counties, 1993. Washington, D.C.: Economic Research Service, USDA Staff Report 9425.

Rural-Urban Continuum Characteristics*Rural-Urban Continuum Characteristics*Rural-Urban Rural-Urban

VariableVariableNumber of Number of CountiesCounties

Percent of Total U.S. Percent of Total U.S. Population in 1990Population in 1990

11 169169 45.545.5

22 132132 3.63.6

33 323323 22.322.3

44 203203 7.97.9

55 137137 4.04.0

66 110110 2.52.5

77 616616 6.56.5

88 643643 5.15.1

99 247247 1.01.0

1010 523523 1.41.4*Source: Singh, G. K., & Siahpush, M. (2002). The increasing rural-urban gradients in U.S. suicide mortality, 1970 – 1997. American Journal of Public Health, 92(7), 1161-1167.


Age-Adjusted Suicide Mortality for U.S. Men and Age-Adjusted Suicide Mortality for U.S. Men and

Women by Rural-Urban Continuum, 1995-1997Women by Rural-Urban Continuum, 1995-1997**Rural-Urban VariableRural-Urban Variable MenMen WomenWomen

11 17.4517.45 4.054.05

22 19.8519.85 3.883.88

33 20.7420.74 4.624.62

44 21.2221.22 4.474.47

55 22.0022.00 4.484.48

66 25.6425.64 4.734.73

77 23.1823.18 4.424.42

88 25.5925.59 4.604.60

99 24.4024.40 4.294.29

1010 26.8826.88 4.014.01

*Source: Singh, G. K., & Siahpush, M. (2002). The increasing rural-urban gradients in U.S. suicide mortality, 1970 – 1997. American Journal of Public Health, 92(7), 1161-1167.


The suicide rate among The suicide rate among farmers and ranchers is twice farmers and ranchers is twice the national average. During the national average. During downturns in the farm downturns in the farm economy, it rises three to four economy, it rises three to four times the national average.times the national average.

Senator Charles E. GrassleySenator Charles E. GrassleySeptember 5, 2003September 5, 2003


Comparison of Suicide by Farmers vs Comparison of Suicide by Farmers vs Non-Farmers*Non-Farmers*

*Source: Gunderson, P., Donner, B., Nashold, R., Salkowicz, L., Sperry, S., & Wittman, B. (1993). The epidemiology of suicide among farm residents or workers in five north-central states, 1980 - 1988. American Journal of Preventive Medicine, 9, 26-32.


FarmersFarmers Non-FarmersNon-FarmersRate is twice the national average.Rate is twice the national average. Rate is slightly below average.Rate is slightly below average.

Likely to occur in spring and fall.Likely to occur in spring and fall. More likely to occur in summer.More likely to occur in summer.

More likely to occur on Sunday, More likely to occur on Sunday, Monday and Tuesday.Monday and Tuesday.

More likely to occur on Friday and More likely to occur on Friday and Saturday.Saturday.

More likely to occur between 6:00 More likely to occur between 6:00 and 11:59 a.m.and 11:59 a.m.

More likely to occur in late p.m., More likely to occur in late p.m., early a.m.early a.m.

Firearms are main method.Firearms are main method. Greater variety of methods.Greater variety of methods.

Few attempts precede suicide.Few attempts precede suicide. Many attempts precede suicide.Many attempts precede suicide.

There is a positive association between economic stress There is a positive association between economic stress (e.g., unemployment) and suicide (Ortega, Johnson, Beeson (e.g., unemployment) and suicide (Ortega, Johnson, Beeson and Kraft, 1994).and Kraft, 1994).

Depression and hopelessness often accompany Depression and hopelessness often accompany overwhelming stress (Davidson, 1996).overwhelming stress (Davidson, 1996).

Changes in farming practices (e.g., increasing isolation Changes in farming practices (e.g., increasing isolation because of fewer farmers and the need for family members because of fewer farmers and the need for family members to work off the farm) fit with the family stress model (Singh to work off the farm) fit with the family stress model (Singh and Siahpush, 2002);and Siahpush, 2002);

Suicide can be seen as a last ditch attempt to escape from Suicide can be seen as a last ditch attempt to escape from overwhelming stress and despair (Rosmann, 1999);overwhelming stress and despair (Rosmann, 1999);

Protective factors that reduce stress and its negative Protective factors that reduce stress and its negative consequences involve support from a web of connections consequences involve support from a web of connections among members of the extended family and the local among members of the extended family and the local community (Carson, Araquistain, Ide, Quoss, et al, 1994; community (Carson, Araquistain, Ide, Quoss, et al, 1994; Rettig, Danes and Bauer, 1991).Rettig, Danes and Bauer, 1991).

Produced by Michael R. Rosmann, Ph.D., March 2007Produced by Michael R. Rosmann, Ph.D., March 2007

Age and Alcohol Use:Age and Alcohol Use: Health, United States, 2006 (U.S. Department of Health and

Human Services, 2006) data indicate that alcohol consumption decreases with age:


o 58% of 18 – 24 year olds reported consumption of alcohol in 2004.o 68.3% of 25 – 44 year olds reported consumption of alcohol in 2004.o 57.9% of 45 – 54 year olds reported consumption of alcohol in 2004.o 43.6% of 55 – 64 year olds reported consumption of alcohol in 2004.o 49.5% of 65 – 74 year olds reported consumption of alcohol in 2004. o 37% of 75+ year olds reported consumption of alcohol in 2004.

Behavioral Health Conditions of Behavioral Health Conditions of the Agricultural Population:the Agricultural Population:

Recently completed research (McSparron, Recently completed research (McSparron, 2005; DeArmond, Stallones, Chen and 2005; DeArmond, Stallones, Chen and Sintek, 2006; Scarth, Zwerling, Lewis and Sintek, 2006; Scarth, Zwerling, Lewis and Burmeister, 1997; Fetch and Jacobson, Burmeister, 1997; Fetch and Jacobson, 2005) suggests higher incidences of 2005) suggests higher incidences of depression for the agricultural population depression for the agricultural population that are related to stress than for the that are related to stress than for the nonagricultural populationnonagricultural population


Incidence of Behavioral Health Conditions of the Aging Agricultural

Population: Marital/family problems are the first major Marital/family problems are the first major

breakdown (Mecham, 2002; Rosmann and breakdown (Mecham, 2002; Rosmann and Delworth, 1990; Rosmann, 2003).Delworth, 1990; Rosmann, 2003).

Adjustment disorders rank second (Rosmann, Adjustment disorders rank second (Rosmann, 2003).2003).

Depressive illnesses rank third (Mecham, 2002; Depressive illnesses rank third (Mecham, 2002; Rosmann, 2003).Rosmann, 2003).

Anxiety disorders rank fourth (Rosmann, 2003).Anxiety disorders rank fourth (Rosmann, 2003). Substance misuse ranks fifth (Mecham, 2002; Substance misuse ranks fifth (Mecham, 2002;

Rosmann, 2003).Rosmann, 2003).


Presenting Problems of Callers to the Nebraska Rural Response Hotline*

July, 2001 – August, 2002

Presenting Problems Percent Marital/Family Problems 33Problems Coping with Daily Role/Activities 18Depression or Mood Disorder 24Alcohol/Drug Misuse 3Stress Over Finances 17Other 5

*Source: Mecham, M. (2002). Counseling Outreach and Mental Health Therapy Project, Interchurch Ministries of Nebraska.


Behavioral Health Conditions of 122 Farm Residents Experiencing

Economic Stress

Primary Behavioral Health Condition Percent Marital and Partner Relationship Difficulties 21Parent-child Relational Problem 10Other Family Issues 9Adjustment Disorders of all Types 24Depressive Illnesses 18Anxiety Disorders 11Schizophrenia and Psychotic Disorders 2Substance Abuse* 5 *Substance abuse occurred as a secondary condition in 40% of the primary conditions.

Source: Rosmann, M. R. (1987). The rural revolution of the 1980’s: Where are we – where are we going? National Association of Counties Knowledge Transfer Workshop, Des Moines, IA.

40


Factors Contributing to Worsening Factors Contributing to Worsening Behavioral Health Issues of the Aging Behavioral Health Issues of the Aging

Agricultural Population:Agricultural Population: Physical and mental decline (Scheerer and Brandt, Physical and mental decline (Scheerer and Brandt,

2001).2001). Loss of family (Scheerer and Brandt, 2001).Loss of family (Scheerer and Brandt, 2001). Required use of high technology (Alpass et al, 2004).Required use of high technology (Alpass et al, 2004). Uncertainty about the future (Scheerer and Brandt, Uncertainty about the future (Scheerer and Brandt,

2001).2001). Unresolved farm succession (Sheerer and Brandt, Unresolved farm succession (Sheerer and Brandt,

2001).2001). Lack of emotional support (Berkowitz and Perkins, Lack of emotional support (Berkowitz and Perkins,

1985).1985). Financial distress (Bultena, Lasley and Geller, 1986; Financial distress (Bultena, Lasley and Geller, 1986;

Molnar, 1985; Rosmann and Delworth, 1990; Elder and Molnar, 1985; Rosmann and Delworth, 1990; Elder and Conger, 2000).Conger, 2000).


Factors that Protect Against Behavioral Factors that Protect Against Behavioral Health Conditions of Aging Agricultural Health Conditions of Aging Agricultural

People:People:

Support from remaining family, friends and Support from remaining family, friends and neighbors with decision-making and farming neighbors with decision-making and farming obligations when necessary (Scheerer and obligations when necessary (Scheerer and Brandt, 2001; Elder and Conger, 2000; Brandt, 2001; Elder and Conger, 2000; Rosmann and Delworth, 1990).Rosmann and Delworth, 1990).

Access to behavioral health supports (Canadian Access to behavioral health supports (Canadian Agricultural Safety Association, 2005; Lambert Agricultural Safety Association, 2005; Lambert and Hartley, 1998; National Rural Health and Hartley, 1998; National Rural Health Association, 2000).Association, 2000).


Summary of Behavioral Health Risks of Summary of Behavioral Health Risks of the Aging Agricultural Population:the Aging Agricultural Population:

““Farm and ranch owners and farm workers as a whole areFarm and ranch owners and farm workers as a whole aregenerally hardy, well functioning, well educated and aging. generally hardy, well functioning, well educated and aging. But within this group, specific types of farmers, especially But within this group, specific types of farmers, especially limited resource farmers and operators of small family limited resource farmers and operators of small family farms as their main occupation and which have low sales, farms as their main occupation and which have low sales, are more vulnerable to behavioral health symptoms. Many are more vulnerable to behavioral health symptoms. Many farm operators and hired laborers are experiencing serious farm operators and hired laborers are experiencing serious economic stress as they age and the strains of trying to fill economic stress as they age and the strains of trying to fill too many roles and expectations. Nearly all of the aging too many roles and expectations. Nearly all of the aging rural agricultural population, whether farm and ranch rural agricultural population, whether farm and ranch owners and operators, indigenous agricultural laborers or owners and operators, indigenous agricultural laborers or migrant farm workers, lead lives that are being impacted bymigrant farm workers, lead lives that are being impacted bysimultaneous exposure to multiple stressors.” simultaneous exposure to multiple stressors.”


Summary of Behavioral Health Risks of the Summary of Behavioral Health Risks of the Aging Agricultural Population:Aging Agricultural Population:

““Symptoms, if and when they occur, usually involveSymptoms, if and when they occur, usually involvemanifestations of interpersonal relationship breakdown, manifestations of interpersonal relationship breakdown, situational rather than permanent inadequacies of coping, situational rather than permanent inadequacies of coping, with build-up of depression and anxiety in persons with build-up of depression and anxiety in persons predisposed to these symptoms developments. Substance predisposed to these symptoms developments. Substance misuse often accompanies these and other symptoms. misuse often accompanies these and other symptoms. Specific ethnic minorities and persons who lack adequate Specific ethnic minorities and persons who lack adequate support networks are particularly likely to exhibit behavioral support networks are particularly likely to exhibit behavioral health conditions. While progress is being made in health conditions. While progress is being made in reducing physical health injuries and occupation-related reducing physical health injuries and occupation-related illnesses, less progress is being made in the reduction of illnesses, less progress is being made in the reduction of psychological injuries, especially suicide. The chances of psychological injuries, especially suicide. The chances of undesired physical health injuries and illnesses increase undesired physical health injuries and illnesses increase with age, economic stress and exposure to too many with age, economic stress and exposure to too many distressing events at once.”distressing events at once.”


Summary of Behavioral Health Risks of Summary of Behavioral Health Risks of the Aging Agricultural Population:the Aging Agricultural Population:

““These events include physical and mental decline, These events include physical and mental decline,

isolation, loss of family, uncertainty about the family, isolation, loss of family, uncertainty about the family,

unresolved farm succession and economic decline. Of unresolved farm succession and economic decline. Of

these factors, economic stress and loss of loved ones are these factors, economic stress and loss of loved ones are

particularly troubling for aging farm residents. Protective particularly troubling for aging farm residents. Protective

factors include support from remaining family, friends and factors include support from remaining family, friends and

neighbors with decision-making and farming obligations neighbors with decision-making and farming obligations

when necessary and access to affordable, accessible and when necessary and access to affordable, accessible and

culturally acceptable behavioral health services.” culturally acceptable behavioral health services.”

(Rosmann, 2007).(Rosmann, 2007).


Please send your thoughts and ideas to Mike RosmannAgriWellness, Inc.1210 – 7th Street, Suite CHarlan, IA 51537Phone: 712-235-6100Fax: 712-235-6105Email: [email protected]

Thank You.Produced by Michael R. Rosmann, Ph.D., March 2007

mailto:[email protected]

behavioral health issues of the aging agricultural population by: michael r. rosmann, ph.d. a...

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