Identifying individual and contextual determinants underpinning farmers’ help-seeking behaviors and their role in shaping mental health outcomes

Project Description

Photo credit: Govin’s Farm, WI

Dates: 2022-2027

Farmers and ranchers experience greater mental health challenges, like stress, anxiety, depression, and suicide, compared to other occupational groups. These can lead to broad health and economic issues including reduced quality of life, increased risk of occupational injuries, increased healthcare costs, and loss of productivity and income. This research project will assess farmers’ help-seeking behaviors, the factors that shape these, and factors associated with better mental health outcomes. The specific research questions include:

In 2016, 43.2 farm men per 100K died by suicide compared to 27.4 per 100K for all occupations (CDC).

  • What are the help-seeking behaviors of farmers? To what extent do farmers draw on informal vs. formal support?
  • How do these behaviors vary based on farmers’ demographics, farm operation characteristics, and contextual environments?
  • Which behaviors and which individual and contextual determinants are associated with better mental health outcomes?
This project's specific aims include:
  1. Map the contextual determinants of farmers’ help-seeking behaviors
  2. Describe farmers’ help-seeking behaviors and mental health challenges and the role played by individual and contextual determinants
  3. Compare and contrast farmers’ help-seeking behaviors and assess their effectiveness in reducing mental health burden across a diversity of farmers in the 12-state study region.
  4. Adapt the Andersen Behavioral Model of Health Services Use to Midwestern farmers.

Why is this important?

Many farmers, policymakers, and health and safety organizations have expressed a critical need to address farmer mental health, especially as agricultural communities face increasing stressors. Many have responded to this need; for example, the U.S. Department of Agriculture launched the Farm and Ranch Stress Assistance Network (FRSAN) in 2019. Still, we know little about how farmers seek help and how effective and accepted mental health interventions are for this population.

This project will be the first in the U.S. to conduct an in-depth regional assessment of farmers’ help-seeking behaviors and their connections to mental health outcomes.

Project Personnel



Photo of Florence Becot Ph.D., M.Sc.

Florence Becot, Ph.D., M.Sc.

Associate Professor, agricultural safety and health Pennsylvania State UniversityDepartment of Agricultural and Biological Engineering


Photo of Andrea Bjornestad PhD, LPC, NCC

Andrea Bjornestad, PhD, LPC, NCC

Associate Professor & Extension Mental Health Specialist South Dakota State University
Phone: 605-688-5125
Photo of Carrie Henning-Smith PhD, MPH, MSW

Carrie Henning-Smith, PhD, MPH, MSW

Associate Professor, Division of Health Policy and Management & Deputy Director Rural Health Research CenterSchool of Public Health, University of Minnesota
Phone: 612-626-4512


Photo of Sarah Ruszkowski MA

Sarah Ruszkowski, MA

Research Specialist Marshfield Clinic Research InstituteNational Farm Medicine Center

Publications Informing this Project

  • Becot, F., & Inwood, S. (2022). Medical economic vulnerability: a next step in expanding the farm resilience scholarship. Agriculture and Human Values, 39, 1097-1116. https://doi.org/10.1007/s10460-022-10307-4
  • Becot, F., & Inwood, S. (2022). Examining access to health insurance and health care along the life course to shed light on interactions between farm households’ social needs, social policy, and the farm business. Sociologia Ruralis, 62(3), 485-508. https://doi.org/10.1111/soru.12394
  • Bjornestad, A., Brown, L., & Weidauer, L. (2019). The relationship between social support and depressive symptoms in Midwestern farmers. Journal of Rural Mental Health, 43(4), 109-117. https://doi.org/10.1037/rmh0000121
  • Bjornestad, A., Cuthbertson, C., & Hendricks, J. (2021). An analysis of suicide risk factors among farmers in the midwestern United States. International journal of environmental research and public health, 18(7), 3563. https://doi:10.3390/ijerph18073563
  • Cuthbertson, C., Brennan, A., Shutske, J., Zierl, L., Bjornestad, A., Macy, K., . . . Leatherman, J. (2022). Developing and Implementing Farm Stress Training to Address Agricultural Producer Mental Health. Health Promotion Practice, 23(1), 8-10. https://doi.org/10.1177/1524839920931849
  • Cuthbertson, C., Brennan, A. L., Shutske, J., Leatherman, J., Bjornestad, A., Zierl, L., Macy, K., Skidmore, M., Schallhorn, P., … Lin, E. (2022). An effective mental health literacy program for farm financial service providers. Journal of Agromedicine. https://doi:10.1080/1059924X.2022.2058666
  • Henning-Smith, C., Evenson, A., Kozhimannil, K., & Moscovice, I. (2018). Geographic variation in transportation concerns and adaptations to travel-limiting health conditions in the United States. Journal of Transport & Health, 8, 137-145. doi:doi.org/10.1016/j.jth.2017.11.146
  • Henning‐Smith, C., Moscovice I, Kozhimannil K. (2019). Differences in social isolation and its relationship to health by rurality. Journal of Rural Health. 35(4):540-549. https://doi.org/10.1111/jrh.12344.
  • Henning-Smith, C. (2020). The public health case for addressing transportation-related barriers to care. American Journal of Public Health, 110(6), 763-764. https://doi:10.2105/AJPH.2020.305638
  • Henning-Smith, C., Alberth, A., Bjornestad, A., Becot, F., & Inwood, S. (2021). Farmer Mental Health in the U.S. Midwest: Key Informant Perspectives. Journal of Agromedicine, 27(1), 15-24. https://doi.org/10.1080/1059924X.2021.1893881
  • Inwood, S., Becot, F., Bjornestad, A., Henning-Smith, C., & Alberth, A. (2019). Responding to Crisis: Farmer Mental Health Programs in the Extension North Central Region. Journal of Extension, 57(6), 6RIB1. https://tigerprints.clemson.edu/joe/vol57/iss6/20