Farmer suicide and access to care in Iowa

Suicide is a leading cause of death around the world, in the United States, in Iowa, and among farmers. Occupational suicides, such as farmer suicide, have been increasing drastically since the year 2007. It has been found that those in the agriculture, forestry, and fishing sector had a 50 percent higher risk of suicide compared to other occupational groups. Suicide prevention strategies may not adequately reach rural residents (farmers) due to economic, geographic, and/or cultural barriers. According to the decennial census, 36 percent of Iowa’s population resided in rural areas. Iowa Death Certificate Records between 2011 and 2014 were utilized to examine the relationships between farmer suicides and access to care in Iowa. Farmer suicides were compared based on county rurality and mental health provider shortage designation. Whether a county had a farmer suicide, was rural, had a certified mental health center, or mental health provider shortage area was assessed to discover where farmer suicides were occurring. In Iowa, 86 counties were mental health provider shortage areas, there were 72 certified mental health centers that provided outpatient care, and 81 farmer suicides occurred during the study period. Statistical analyses and odds ratios did not find any significant association between farmer suicides and county rurality, certified mental health centers, or mental health provider shortage areas. However, counties with at least one certified mental health center were more likely to have one or more farmer suicide and counties designated as mental health provider shortage areas were at less risk of having a farmer suicide. Limitations of this study include capturing mental health centers open during the study period and all mental health centers in the state. Further studies are needed to better understand how farmers interact with mental health care facilities.