Health Issues and Mental Distress in French Active Farmers: A Quantitative and Qualitative Study
Abstract
Purpose: Despite a particularly high suicide -related death rate observed in French farmers, data regarding this population’s perception of health and their potential difficulties in accessing health care remains scarce.
Methods : We conducted a quantitative study involving 161 randomly selected farmers in three rural localities. Precarious conditions w ere assessed based on farmers’ EPICES scores, their quality of life using the SF12 score, and their psychological distress by means of the GHQ -12. At the same time, a qualitative study was performed consisting in 16 in - depth interviews.
Findings: In total , 112 farmers (70% of persons contacted), most of them working as breeders for the meat -processing industry, participated in the study. Amongst them, 14.3% had forgone doctor consultation within the last 12 months, and 19.6% had abstained from consulting a dentist. They expressed trust in their general practitioners but frequently resorted to alternative medicine or marginal practitioners when they considered their disease to be benign. The general physical health status measured using the SF12 was good in 84.5% of cases. However, 29.7% of respondents experienced psychological distress that seemed to originate primarily from the conflicting rhythms of agricultural timescales (seasonal calendar; local weather conditions; social rhythms, including administrati ve work; community rhythms) . Factor analysis of mixed data showed that s ingle farmers exhibiting social deprivation, who had inherited their farm, tended to be affected by psychological distress.
Conclusion: The consideration of mental distress in this identified population proves to be challenging issues that may help prevent suicide in farmers.
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Introduction
The French rural population has undergone a major shift over the last decades. According to the World Bank, although 21% of the French live in rural areas, the active farmer population has decreased from 8% in 1980 to 3.4% in 2007 (1,2) . Since the Second World War, agriculture has progressively shifted toward industrial processing, and the role of farmers increasingly resembles that of a mana ger, faced with an array of administrative tasks (3–5). Poverty has surged u pward from 13% in 2006 to 24% in 2010 in this population (2).
Farmers‘ health is still a subject of contention in France. In a pro spective cohort involving 180,060 active and retired farmers from different areas in France, Levêque -Morlais N et al. showed that overall mortality and cancer -related death rates were significantly lower than those observed in the general population during the study period (2005 -9)(6). The authors concluded that farmers allegedly were in better overall health than the general population. However, in a monitoring survey, the Institut de Veille Sanitaire (InVS), Sai nt-Maurice, France, demonstrated elevated suicide -related death rates, especially in male livestock farmers (56% higher suicide rate for dairy farmers and 127% higher rate for livestock farmers working for the meat -processing industry in 2008) (7). Suicide and stress in farmers have been well documented in the UK (8–17) and Australia(18–22). However, the mechanisms underlying suicide are still poorly understood, especially in France (23–28).
Given the scarcity of general practitioners in rural areas and the distance from rural residents‘ homes to secondary or terti ary health care facilities, access to health care may be hindered for persons l iving in rural areas. Since 2013, Médecins du Monde , (Doctors of the World), a well -known non -governmental organization, has been involved in a rural -area-based program (Combrailles, Auvergne, France) aiming to facilitate and coordinate access to health ca re and social rights. We observed nevertheless that only few farmers resorted to this program.
We conducted a qualitative and quantitative study designed to better understand this population‘s perception of their health, as well as potential difficulties experienced by farmers in accessing health care.
