Background:

Various studies indicated elevated rates of depression, anxiety, and suicide among farmers compared to the general population, with occupational stressors including financial uncertainty, social isolation, and regulatory pressures contributing to poor mental health outcomes. Despite Germany's significant agricultural sector (255,000 farms), farmers' mental health has been a neglected research topic. By identifying key stressors and understanding the barriers to mental health services, this proposed project can help improve the delivery of care and inform primary care and prevention strategies.

Research questions:

What is the prevalence of depression, anxiety, and suicide ideation among farmers in rural Germany? How are occupational sociodemographic, farm-structural, and occupation-specific factors associated with mental health?

Method:

Sequential explanatory mixed-methods study in Lower Saxony, Germany. Quantitative phase: Population-based cross-sectional survey of all commercial farm operators (n≈16,100) using validated instruments (PHQ-9, GAD-7, PSS-10, SBQ-R) plus newly developed agriculture-specific stressor questionnaire. Recruitment via Agricultural Social Insurance (SVLFG) database. Qualitative phase: 20-25 semi-structured interviews with purposively sampled farmers based on quantitative findings. Analysis includes descriptive statistics, multivariate logistic regression for risk factor identification, and thematic analysis of interview data with systematic integration of findings.

Results:

We anticipate identifying elevated prevalence rates of depression and anxiety symptoms compared to general population, with specific risk patterns related to farm type (particularly livestock operations), age groups (45-64 years), and gender differences. Qualitative findings will illuminate coping mechanisms, help-seeking behaviors, and healthcare access barriers, providing contextual understanding of quantitative patterns.

Conclusions:

This proposed study will provide first insights on German farmers' mental health, establish validated assessment tools, and inform evidence-based prevention strategies for this vulnerable occupational group.

Points for discussion:

What are your experiences with managing mental health among this population in your country? What specific challenges have you observed?

What is the GP's role in providing (mental health) care for the needs of farming populations?

What clinical interventions would come to your mind to better serve this population?