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BEHAVIORAL HEALTH ISSUES OF THE AGING AGRICULTURAL POPULATION

BEHAVIORAL HEALTH ISSUES OF THE AGING AGRICULTURAL POPULATION. By: Michael R. Rosmann, Ph.D . A Conference on the Aging Farm Community: Using Current Health and Safety Status to Map Future Action. Airport Holiday Inn Select Indianapolis, IN Wednesday, March 7, 2007.

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BEHAVIORAL HEALTH ISSUES OF THE AGING AGRICULTURAL POPULATION

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  1. BEHAVIORAL HEALTH ISSUES OF THE AGING AGRICULTURAL POPULATION By: Michael R. Rosmann, Ph.D. A Conference on the Aging Farm Community: Using Current Health and Safety Status to Map Future Action. Airport Holiday Inn Select Indianapolis, IN Wednesday, March 7, 2007 Produced by Michael R. Rosmann, Ph.D., March 2007

  2. 1210 7th Street, Suite C Harlan, Iowa 51537 Telephone: 712-235-6100 Fax: 712-235-6105 Email: info@agriwellness.org Web site: www.agriwellness.org Building hope and health in the rural agricultural community Produced by Michael R. Rosmann, Ph.D., March 2007

  3. “The Health United States 2001, Urban and Rural Health Chart Book presents a pattern risky health behaviors among rural populations that suggest a ‘rural culture’ health determinant. This pattern suggests that there may be environmental and cultural factors unique to towns, regions, or United States Department of Agriculture economic types that affect health behavior and health. Responding to regionally diverse behavioral risk factors is a challenge for the maturing field of rural health” (Hartley, 2004). Produced by Michael R. Rosmann, Ph.D., March 2007

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

  5. Exiting Farms and Farmers • Older farmers are exiting at a much slower rate than in previous years (Gale, 2002). • Farming no longer dominates the rural economy. Farm policy will continue to be critical to many areas but agriculture is not the only issue of importance to many rural communities. High poverty rates in rural areas, poor access to health care, especially behavioral health care and a rapid influx of people and businesses into many rural areas are major issues facing policy makers (Johnson, 2005). Produced by Michael R. Rosmann, Ph.D., March 2007

  6. Stress and Injuries Linked with Agriculture as a Occupation: • Stress caused by financial difficulties increases the risk of farming-related injuries and fatalities (Geller, Ludtke and Stratton, 1990; Thu, Lasley, Whitten, Lewis, Donham, Zwerling and Scarth, 1997; Kidd, Scharf and Veazie, 1996; Hagel et al, 2004; Alpass et al, 2004). • There is a tendency for health and financial stressors to affect older farmers and families more than they affect younger farmers and families (May, 1998). Produced by Michael R. Rosmann, Ph.D., March 2007

  7. National Stress and Mental Survey of 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: • Extreme stress factors included poor harvests, unfavorable • government policies and troubled farm finances. • High stress factors included weather, the BSE Crisis and the • pressure to maintain the family farm. • Medium stress factors included physical health concerns, • balancing farm and off-farm work, personal family relationship • difficulties and concerns about mental health. • Lower stress factors included loneliness, lack of affordable • childcare and substance abuse. * Canadian Agricultural Safety Association, 2005 Produced by Michael R. Rosmann, Ph.D., March 2007

  8. Serious Psychological Distress in Rural Areas: • Health, United States, 2005 (U.S. Department of Health and Human Services, 2005) indicated that serious psychological distress is linked with poverty: • 8.7% of persons who are very poor reported serious psychological • distress in 2002 – 2003. • 5.4% of near poor persons reported serious psychological distress • in 2002 -2003. • 1.8% of the nonpoor reported serious psychological distress • in 2002 – 2003. • 2.9% of persons within metropolitan service areas reported serious psychological disturbance in 2002 – 2003. • 3.9% of person living outside metropolitan service areas reported serious psychological distress in 2002 – 2003. Produced by Michael R. Rosmann, Ph.D., March 2007

  9. Age and the Agricultural Population: • Serious psychological maladjustment decreases with age: • 2.9% of 18 – 44 year olds reported serious • psychological disturbance in 2002 – 2003. • 4.0% of 45 – 64 year olds reported serious • psychological distress in 2002 – 2003. • 2.3% of 65+ year olds reported serious • psychological disturbance in 2002 – 2003. (U.S. • Department of Health and Human Services, 2005). • Roy’s (2001) survey of 717 northwest Iowa farmers found that farmers over 65 years of age reported fewer mental health symptoms, possibly because they were more financially secure than younger farmers. Produced by Michael R. Rosmann, Ph.D., March 2007

  10. Data from the National Health Interview Survey from 1997 through 2002 were evaluated to determine urban-rural differences. The prevalence of significant psychological distress was higher in nonmetropolitan than metropolitan areas, a finding that is at variance with past research that showed no urban-rural difference in psychological distress. Participants with significant psychological distress from rural areas were less likely than their counterparts from metropolitan areas to have contact with mental health professionals and more likely to be unable to afford medications (Mojtabai, 2006). Produced by Michael R. Rosmann, Ph.D., March 2007

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

  12. Rural-Urban Continuum* • Central counties in metropolitan areas with 1 million people or more. • Fringe counties in metro areas with 1 million people or more. • Counties in metro areas with 250,000 – 1million people. • Counties in metro areas with fewer than 250,000 people. • Urban counties with a population of 20,000 or more, adjacent to a metro area. • Urban counties with a population of 20,000 or more, not adjacent to a metro area. • Urban counties with a population of 2,500 to 19,999, adjacent to a metro area. • Urban counties with a population of 2,500 to 19,999, not adjacent to a metro area. • Rural counties with a population of less than 2,500, adjacent to a metro area. • Rural counties with a population of less than 2,500, not adjacent to a metro 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. Produced by Michael R. Rosmann, Ph.D., March 2007

  13. Rural-Urban Continuum Characteristics* *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. Produced by Michael R. Rosmann, Ph.D., March 2007

  14. Age-Adjusted Suicide Mortality for U.S. Men and Women by Rural-Urban Continuum, 1995-1997* *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. Produced by Michael R. Rosmann, Ph.D., March 2007

  15. The suicide rate among farmers and ranchers is twice the national average. During downturns in the farm economy, it rises three to four times the national average. Senator Charles E. GrassleySeptember 5, 2003 Produced by Michael R. Rosmann, Ph.D., March 2007

  16. Comparison of Suicide by Farmers vs 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. Produced by Michael R. Rosmann, Ph.D., March 2007

  17. There is a positive association between economic stress (e.g., unemployment) and suicide (Ortega, Johnson, Beeson and Kraft, 1994). • Depression and hopelessness often accompany overwhelming stress (Davidson, 1996). • Changes in farming practices (e.g., increasing isolation because of fewer farmers and the need for family members to work off the farm) fit with the family stress model (Singh and Siahpush, 2002); • Suicide can be seen as a last ditch attempt to escape from overwhelming stress and despair (Rosmann, 1999); • Protective factors that reduce stress and its negative consequences involve support from a web of connections among members of the extended family and the local community (Carson, Araquistain, Ide, Quoss, et al, 1994; Rettig, Danes and Bauer, 1991). Produced by Michael R. Rosmann, Ph.D., March 2007

  18. 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: • 58% of 18 – 24 year olds reported consumption of • alcohol in 2004. • 68.3% of 25 – 44 year olds reported consumption of • alcohol in 2004. • 57.9% of 45 – 54 year olds reported consumption of • alcohol in 2004. • 43.6% of 55 – 64 year olds reported consumption of • alcohol in 2004. • 49.5% of 65 – 74 year olds reported consumption of • alcohol in 2004. • o37% of 75+ year olds reported consumption of alcoholin • 2004. Produced by Michael R. Rosmann, Ph.D., March 2007

  19. Behavioral Health Conditions of the Agricultural Population: • Recently completed research (McSparron, 2005; DeArmond, Stallones, Chen and Sintek, 2006; Scarth, Zwerling, Lewis and Burmeister, 1997; Fetch and Jacobson, 2005) suggests higher incidences of depression for the agricultural population that are related to stress than for the nonagricultural population Produced by Michael R. Rosmann, Ph.D., March 2007

  20. Incidence of Behavioral Health Conditions of the Aging Agricultural Population: • Marital/family problems are the first major breakdown (Mecham, 2002; Rosmann and Delworth, 1990; Rosmann, 2003). • Adjustment disorders rank second (Rosmann, 2003). • Depressive illnesses rank third (Mecham, 2002; Rosmann, 2003). • Anxiety disorders rank fourth (Rosmann, 2003). • Substance misuse ranks fifth (Mecham, 2002; Rosmann, 2003). Produced by Michael R. Rosmann, Ph.D., March 2007

  21. Presenting Problems of Callers to the Nebraska Rural Response Hotline*July, 2001 – August, 2002 Presenting ProblemsPercent Marital/Family Problems 33 Problems Coping with Daily Role/Activities 18 Depression or Mood Disorder 24 Alcohol/Drug Misuse 3 Stress Over Finances 17 Other 5 *Source: Mecham, M. (2002). Counseling Outreachand Mental Health Therapy Project, Interchurch Ministries of Nebraska. Produced by Michael R. Rosmann, Ph.D., March 2007

  22. Behavioral Health Conditions of 122 Farm Residents Experiencing Economic Stress Primary Behavioral Health ConditionPercent Marital and Partner Relationship Difficulties 21 Parent-child Relational Problem 10 Other Family Issues 9 Adjustment Disorders of all Types 24 Depressive Illnesses 18 Anxiety Disorders 11 Schizophrenia and Psychotic Disorders 2 Substance 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 Produced by Michael R. Rosmann, Ph.D., March 2007

  23. Factors Contributing to Worsening Behavioral Health Issues of the Aging Agricultural Population: • Physical and mental decline (Scheerer and Brandt, 2001). • Loss of family (Scheerer and Brandt, 2001). • Required use of high technology (Alpass et al, 2004). • Uncertainty about the future (Scheerer and Brandt, 2001). • Unresolved farm succession (Sheerer and Brandt, 2001). • Lack of emotional support (Berkowitz and Perkins, 1985). • Financial distress (Bultena, Lasley and Geller, 1986; Molnar, 1985; Rosmann and Delworth, 1990; Elder and Conger, 2000). Produced by Michael R. Rosmann, Ph.D., March 2007

  24. Factors that Protect Against Behavioral Health Conditions of Aging Agricultural People: • Support from remaining family, friends and neighbors with decision-making and farming obligations when necessary (Scheerer and Brandt, 2001; Elder and Conger, 2000; Rosmann and Delworth, 1990). • Access to behavioral health supports (Canadian Agricultural Safety Association, 2005; Lambert and Hartley, 1998; National Rural Health Association, 2000). Produced by Michael R. Rosmann, Ph.D., March 2007

  25. Summary of Behavioral Health Risks of the Aging Agricultural Population: “Farm and ranch owners and farm workers as a whole are generally hardy, well functioning, well educated and aging. But within this group, specific types of farmers, especially limited resource farmers and operators of small family farms as their main occupation and which have low sales, are more vulnerable to behavioral health symptoms. Many farm operators and hired laborers are experiencing serious economic stress as they age and the strains of trying to fill too many roles and expectations. Nearly all of the aging rural agricultural population, whether farm and ranch owners and operators, indigenous agricultural laborers or migrant farm workers, lead lives that are being impacted by simultaneous exposure to multiple stressors.” Produced by Michael R. Rosmann, Ph.D., March 2007

  26. Summary of Behavioral Health Risks of the Aging Agricultural Population: “Symptoms, if and when they occur, usually involve manifestations of interpersonal relationship breakdown, situational rather than permanent inadequacies of coping, with build-up of depression and anxiety in persons predisposed to these symptoms developments. Substance misuse often accompanies these and other symptoms. Specific ethnic minorities and persons who lack adequate support networks are particularly likely to exhibit behavioral health conditions. While progress is being made in reducing physical health injuries and occupation-related illnesses, less progress is being made in the reduction of psychological injuries, especially suicide. The chances of undesired physical health injuries and illnesses increase with age, economic stress and exposure to too many distressing events at once.” Produced by Michael R. Rosmann, Ph.D., March 2007

  27. Summary of Behavioral Health Risks of the Aging Agricultural Population: “These events include physical and mental decline, isolation, loss of family, uncertainty about the family, unresolved farm succession and economic decline. Of these factors, economic stress and loss of loved ones are particularly troubling for aging farm residents. Protective factors include support from remaining family, friends and neighbors with decision-making and farming obligations when necessary and access to affordable, accessible and culturally acceptable behavioral health services.” (Rosmann, 2007). Produced by Michael R. Rosmann, Ph.D., March 2007

  28. Please send your thoughts and ideas to Mike Rosmann AgriWellness, Inc. 1210 – 7th Street, Suite C Harlan, IA 51537 Phone: 712-235-6100 Fax: 712-235-6105 Email: info@agriwellness.org Thank You. Produced by Michael R. Rosmann, Ph.D., March 2007

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