Helping farmers avoid suicide

MOST Australian farmers who take their own life don’t tell anyone of their intentions, but events preceding the tragedy are strikingly similar between cases, new research shows.

Agricultural workers have been found to have the highest suicide rate compared to other occupational groups in Queensland, and are increasingly recognised as an important target group for suicide prevention efforts.

To help identify pathways to suicide, researchers at Griffith University interviewed the next-of-kin of 18 male farmers from Queensland and NSW who took their own life after 2006, using the psychological autopsy method to generate life charts.

In most cases (14/18), suicide was an acute act in response to one of two “salient situational stressors”, the study found: “romantic relationship breakdown for middle aged men, and for older men, financial difficulties pending retirement”. In most of these cases, the farmer had not communicated his intent to take his own life.

Men who killed themselves after separation or divorce were aged 30–58 years, and often had child custody or paternity problems and a background of mental illness and alcohol and/or cannabis misuse. Four of the nine men in this group had sought professional treatment for their mental health in the 2 weeks before death or had an appointment to be seen within the next week. More than half used firearms; none of the seven men who died by hanging owned or had access to a firearm.

Farmers whose suicide was preceded by financial stressors were aged 52–62 years and had experienced difficulties such as closure of a mill, deregulation of milk, and crop diseases in the years before their death. All five men in this group had been diagnosed with depression and prescribed antidepressants in the weeks before death, but had no previous history of depression. The study found all of these men also appeared to be experiencing an anxiety disorder which had not been formally diagnosed.

For a minority of cases (4/18), the pathway to suicide was not “situational” but “protracted”, characterised by longstanding established mental health issues, with intermittent periods of hospitalisation. All four men who fell into this category had experienced the suicide death of at least three close people in their lifetime.

Writing in the International Journal of Environmental Research and Public Health, the authors wrote that their findings suggested that farmers required targeted suicide prevention, assessment and treatment strategies across their lifespan.

Such strategies, they suggested, could include restricting access to means such as firearms on presentation to a health professional; relationship and family counselling; financial counselling – particularly retirement preparation; and public health and stigma reduction campaigns regarding the symptoms of depression and anxiety and the association between physical and mental health.

“There is a need also for national policies, which could provide financial advice and support dignified financial exit, especially for older farmers, but also support training and new businesses,” they added.

The findings complement the results of focus group research which found that community members were often able to identify multiple risk factors for a person’s suicide in hindsight, despite remarking that nobody saw it coming.

The researchers conducted focus groups and interviews with 30 men and 33 women from six farming communities across Queensland and NSW to better understand risk and protective factors for farmer suicide.

Participants described how the Australian male farming identity was inseparable from the industry, so that financial pressures, relationship breakdown and physical injury or illness could all be interpreted by the farming male as personal failures.

The authors reported that: “Participants described a ‘culture’ of not seeking help for fear of being seen as ‘weak’ or it only being for ‘sissies’.”

“Across all groups, the fact that men find it difficult to communicate, do not communicate a lot or do not have the opportunity or avenues to facilitate talking was raised and identified as a risk for suicide,” the authors wrote.

Being “private people” was also seen as an important part of the rural identity, especially for the older and male farmers, the authors reported.

The communities studied varied in size and remoteness, with larger towns having better access to services. Nevertheless, the authors reported that “asking for help” rather than access to services “seemed to be the major barrier to receiving it consistently across sites”.

The authors concluded that education and training programs may equip farmers and their communities with more knowledge about suicide warning signs and how to address them.

Study co-author, Meg Perceval, a PhD candidate working in rural mental health and suicide prevention in Inverell, northern NSW, said suicide was not the result of one factor but the complex interplay of different individual, social and environmental stressors.

“Diet, alcohol intake, sleep, exercise, social support and having a sense of meaning and purpose are all important contributing factors to a person’s overall wellbeing, and inversely can sometimes lead to pointers about their suicide risk,” she said.

“Just as you want to prevent heart disease before the patient starts getting chest pains, ideally, we want to tackle risk factors and enhance protective factors for suicide as early as we can, and so GPs need to be regularly asking brief screening questions such as ‘how’s your family’ or ‘how are you sleeping’,” she said.

Associate Professor Ruth Stewart, president of the Australian College of Rural and Remote Medicine said that suicide was “one of the biggest challenges in rural health at the moment”.

Screening questions could be useful – particularly when a GP did not already know a patient – she said. However, she added, “in rural and remote medicine you often know patients well enough to recognise unusual behaviour in them, or else you hear it from their family”.

“Often patients are offered treatment but decline it,” she said. “I think it’s to do with the kind of personality that makes someone choose to be a farmer and continue to work as a farmer; such a strong emphasis on independence and not a lot of experience working with other people and sharing their problems.”

Associate Professor Stewart said that the new research suggested a need for public campaigns and education to “reach out to younger males about what to do when a relationship breaks down and how to seek help, and to older males about financial planning and coping with financial uncertainty”.

There was also a challenge for GPs, she added. “A lot of our training as GPs is in how to relate to people who are comfortable to talk about feelings. We need to develop advanced skills in engaging with people who want to be independent,” she said.

beyondblue has recently funded The Ripple Effect, a research project led by the National Centre for Farmer Health, which aims to reduce suicide stigma in rural and regional communities across Australia. The findings are yet to be made public.

If this article has raised issues for you, help is available at:

Doctors’ Health Advisory Service:

NSW and ACT … 02 9437 6552
NT and SA … 08 8366 0250
Queensland … 07 3833 4352
Tasmania and Victoria … 03 9495 6011
WA … 08 9321 3098
New Zealand … 0800 471 2654

Lifeline on 13 11 14
beyondblue on 1300 224 636

To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.