JMIR Publications

ABSTRACT

Background:

Farmers have higher rates of depression than non-farmers and higher rates of suicide than the general population. A number of barriers to help-seeking have been identified in farmers, which may be overcome by offering mental health support online. Computerised Cognitive Behaviour Therapy (cCBT) is a recommended treatment for mild-moderate depression, but has not be evaluated in the farming community.

Objective:

This study explored the feasibility of delivering a cCBT life skills course tailored to farmers, using a mixed methods approach.

Methods:

Farmers (aged 18+) with no/minimal to moderately severe depressive symptoms (PHQ-9 score < 20) were recruited using online and offline adverts and given access to a cCBT course consisting of 5 core modules and automated and personalised email support. Depression (PHQ-9), anxiety (GAD-7) and social functioning (WSAS) were measured at baseline and 8-week follow-up. Mann-Whitney U tests assessed changes in scores over time. Telephone interviews focusing on participant use and satisfaction with the course and analysed using thematic analysis.

Results:

56 participants were recruited; 48% through social media. In total, 35 (63%) participants logged onto the course. At baseline, almost half of the participants reported experiencing minimal depressive symptoms (n=25; 45%) and mild anxiety (n=25; 45%) and just over half reported mild to moderate functional impairment (n=30; 54%). Post-treatment data was available for 26.8% (n=15) of participants; an attrition rate of 73%. On average, participants experienced fewer depressive symptoms and less functional impairment at 8-week follow-up; as expected, these results did not reach statistical significance. Participants experienced significantly fewer symptoms of anxiety at 8-week follow-up (P = .02). Most participants found the online course helpful, easy to access and the email support helpful. Qualitative interviews identified heavy workloads and mental health stigma within the farming community as barriers to help-seeking. Participants thought that online support would be helpful; it is convenient and anonymous. There were concerns that older farmers and those with limited internet connection may have difficulty accessing the course. A number of improvements regarding the layout and content of the course were suggested. To improve retention providing dedicated support from someone with farming knowledge is recommended.

Conclusions:

cCBT may be an effective and convenient way of supporting mental health for some within the farming community. However, challenges in recruiting and retaining farmers may indicate that cCBT supported only by email may not be an acceptable mode of mental health delivery for many, however it was valued by the responding sample. Involving farming organisations in planning, recruitment and support may address these issues. Mental health awareness campaigns targeting the farming community may also help reduce stigma and improve recruitment and retention.