Prevalence and predictors of mental health among farmworkers in Southeastern Anatolia of Turkey

Untreated mental disorders are widely recognized as a major contributor (13%) to the global burden of disease worldwide.1,2 According to the World Health Organization (WHO) estimates nearly 25% of individuals develop one or more mental or behavioral disorders at some stage in their life, and one-third of all years lived with disability worldwide can be attributed to neuropsychiatric conditions.3 The determinants of mental health are now recognized to include not only individual attributes, but social, cultural, economic, political and environmental factors such as living standards, working conditions, and social protection.1 

The International Labor Organization (ILO) states that agriculture is the second largest employment field in the world, with a total employment rate of about 32%, and the regional distribution of this rate is as follows: Sub-Saharan Africa 59%, South Asia 53.5%, Southeast Asia and Pacific 44.3%, East Asia 36.9%, North Africa 27.8%, Southeast Europe 20.2%, Latin America 16.3%, and developed economies and the European Union 3.7%.4 It is known that Turkey is in a similar situation with the rest of the world, where according to the 2013 data of the Turkish Statistics Institution (TurkStat), agriculture ranks second in terms of employment, and approximately 24.7% of workers are employed in agriculture.5 

Turkey’s Southestern Anatolia Region (SAR) including the nine administrative provinces of Adiyaman, Batman, Diyarbakir, Gaziantep, Kilis, Mardin, Siirt, Sanliurfa and Sirnak covers the lower Euphrates and Tigris river system also kown as upper Masopotamia. While the surface area of the region is 9.7% of Turkey, the irrigable land in Southeastern Anatolia constitutes 20% of the total region. Agriculture has the biggest share in public investments comprising 54.2%; it is expected that this expenditure will increase the employment rate by 58% in agriculture.6 

Agriculture preserves its importance in the world in terms of meeting food needs, providing input to industries, exports, and employment opportunities. The agricultural sector demonstrates differences compared to other sectors due to health issues and their causes arising from factors such as family members working together, work in the open field, an individual conducting more than one job at a time, dependence upon working times and periods based on seasonal or climatic conditions, and agricultural fields being located outside of urban areas. Depending upon the working environment and method of work, agricultural families frequently encounter health issues in terms of injuries, diseases, and premature mortality.7-9 Along with physical health issues, there are also high mental and behavioral disorders, and child neglect/abuse, growth deficiency and congenital anomalies due to pesticides in agriculture have been reported.7,10-16

In the limited amount of research that has been conducted, it has been found that 1 in five farmworkers have a history of major psychiatric disorder.17 Research from the Midwesttern United States suggests that 20%-40% of farmworkers have elevated symptoms of poor mental health. Stressors that cause these mental health issues include: separation from family; work demands; housing issues; income; language; and isolation, among others.15 The overall objective of the WHO Mental Health Action Plan is to promote mental well being, prevent mental disorders, provide care, enhance recovery, and reduce morbidity and mortality among persons with mental health problems.1 In pursuit of these goals, evidence-based research on risk and protective factors, and vulnerable populations ought to be done in every culture and community. The aims of the present study were: (i) to describe the prevalence of mental health problems in farmworkers in Southeastern Anatolia, (ii) to examine the risk factors and (iii) to determine their mental health needs.