Maggie McKay (Host): If you or someone you know is struggling with mental health, how do you know what to do? How to help someone else or yourself? Today, we'll learn some tools and resources to help with mental health in agricultural populations with Dr. Josie Rudolphi, Assistant Professor at University of Illinois at Urbana Champaign.

Welcome to Let's Talk with Carle Health, a podcast featuring Carle doctors, partners, and other experts, bringing you topics important to your health and wellness. Today's podcast is made possible through funding from the National Institute for Occupational Safety and Health via the National Children's Center for Rural and Agricultural Health and Safety Emerging Issues Program. Learn more about the Carle Health Center for Rural Health and Farm Safety by visiting carle.org/farmsafety, that's Carle, C-A-R-L-E.org/farmsafety, for resources, information, tips, and much more. Let us help you and your family healthy and safe. I'm your host Maggie McKay.

Every episode on our podcast addresses a new topic important to your health and safety, bringing in experts in respective fields of rural health and farm safety to discover risks and other advice and answer your most pressing questions. Thank you so much for joining us today, Dr. Rudolphi.

Dr. Josie Rudolphi: Thank you for having me.

Host: Dr. Rudolphi, today's episode is all about mental health. The topic of mental health can make a lot of people squirm. Talking about high blood pressure or asthma or any other medical condition seems a lot easier and has less stigma than that of mental health. But it seems like we've started to talk more freely about it post COVID-19. And high on the list is our farming population, be it adult or child. So, what can you tell us about the prevalence of anxiety and depression in the agricultural population?

Dr. Josie Rudolphi: Absolutely. So, we have a number of research projects that we've conducted at the University of Illinois and that our colleagues from around the country have also conducted. And consistently, we see higher prevalence estimates for anxiety and depression among farm populations than non-farm populations.

And so for example in a survey that I conducted a couple of years ago of young farmers, we found that 60-70% met the criteria for at least mild symptoms of depression or what we might consider to be a clinically significant condition. Whereas in the general population, we typically see closer to 20%. So, we consistently see, again, higher prevalence among agricultural populations, whether it be younger workers, older workers than we see among the general population. I also have a research project right now that's focused on farm youth. And unfortunately, we see a very high prevalence of depression in our farm youth. And what's important to note is that there's a very strong correlation between parents depressed mood and adolescent depressed mood in our sample.

Host: And what are some of the signs that a person might be struggling with mental wellness?

Dr. Josie Rudolphi: Yeah. This is a really good question and this is really important when we think about building community capacity to respond to our loved ones or our neighbors or our friends and offer some sort of assistance. So, what I tell people is to watch for changes in what that person's normal behavior or actions or emotions might be and changes that are persistent for two weeks or more. Two weeks or more is where we might start to say, "Okay, this isn't a mood change, I should say, over the course of a week, this is something that might be problematic." So, those might be changes in sleeping behaviors, someone sleeping too much or too little compared to how they used to sleep. Similar, we can look at changes in eating. So if someone starts eating a lot more than they usually do or eating a lot less. We can look for emotional changes. So, are people more irritable? Are they more reserved or reclusive? Are outbursts occurring a bit more often than usual? And so, we really encourage people to watch for behavioral, emotional, and even physical changes in their loved ones over a period of two weeks. And then, acknowledge these and have a conversation with that person and think about what some next steps might be.

Host: You touched on this a little bit, but let's talk more about the mental health impact a farmer may have on their kids.

Dr. Josie Rudolphi: Absolutely. So, there are approximately 2 million farm youth living and working on farms. And it's a really stressful work environment. And unfortunately, the line is often blurred between home and work on a farm. So, I always make the comparison that I grew up on a farm. The kitchen table was also the boardroom table. And so, at a very young age, I started to hear about the stresses of the farm, I learned about commodity prices at a very young age, I began to worry about the weather, far younger than I probably should have. So, we have to acknowledge that children are in this space, which is a little unique. Most of us don't children to work with us. But in the farm environment, it's very common to take a child to work. So with that, we have to acknowledge that they're probably absorbing some of the stress sores that are occurring in that environment. And as I mentioned, I have a project now funded by the National Children's Center for Rural Agricultural Health and Safety and we're surveying farm parents and farm adolescents. And what we're finding is that both a very high prevalence of depression and anxiety in both populations and a very strong correlation between parents depressed mood and adolescent depressed mood. So, it really suggests that when we think about farm stress and mental health resources and services, we certainly need to be thinking about the entire family union.

There's a lot of resource development and service delivery for our primary owner operators, perhaps the adult in the farming situation, but we are hopeful that this research would really help underscore the need for mental health resources and services that are specific to farm children and then, of course, something that's a little bit more appropriate for the farm family.

Host: And are there any more signs, more specific to just kids to look out for? I know you mentioned the sleeping and eating, but especially in kids, what should we look out for?

Dr. Josie Rudolphi: Yeah. In children especially, a lot of the same characteristics that we look for in adults. So, perhaps changes again in sleeping, perhaps regression in maturity. So, we think about perhaps a child that is suddenly having like night terrors or bed wetting or those sorts of behaviors that we think they may have matured out of. And so, we start to see regressions in those, but other types of situations. Perhaps somebody who experiences more social isolation, perhaps social anxiety, somebody who becomes very connected or somewhat clingy to an adult, that might be indicative of an anxiety type of disorder.

And then, of course, we want to watch for, again, changes. Changes in how they interact with their peers, more or a lot less; changes in what we would consider risk-taking behaviors. So, are there indications of early substance abuse, risk-taking in terms of driving or starting to explore perhaps violence or other types of activities? And then, we, of course, watch for changes in academic performance. So if you typically have a student that's very talented and typically achieving high academic marks and they suddenly start to bring home report cards that are not reflective of their typical behavior, those are sorts of things to watch for.

Host: And why do you think the numbers are up so high for both parents and kids in the agricultural communities?

Dr. Josie Rudolphi: Yeah. So, that's a good question to ask why we think they're up. The reality is we don't know for sure if we're seeing a spike. We don't have years of data or other studies to really make this comparison to. We're excited that this might inspire future research in which we can continue to surveil the situation and sort of watch for trends in family mental health on the farm. We do know it's been an incredibly stressful agricultural time or period. We know that we expect to see a reduction on farm income instances or experiences like COVID-19 certainly impacted everybody, but especially the farm families. And then, there's, of course, environmental conditions. Most of the country was plagued with severe drought last year. We're currently in what we consider a market downturn. And so, there's a lot going on. And we know that all of these types of stressors are associated with depression among adults. And so, we have to sort of make that connection for youth as well.

Host: Dr. Rudolphi, great information. One, last question. What do you do if you're concerned about someone else? How do you get them to seek help when they're in immediate distress?

Dr. Josie Rudolphi: Good question. So, it depends certainly on how comfortable you are acknowledging the situation with somebody. I always tell people to express concern, legitimate concern, and hopefully get a conversation started. So, saying, you know, "I'm really worried about you." If you are concerned somebody is going to harm themselves or someone else. I would encourage you to ask them if you could drive them to an emergency medical service, so like a local hospital or a clinic. If they refuse, you could ask if it'd be okay if you called somebody to come to the farm or wherever they might be. If it's a close friend, you might say, "I don't feel comfortable leaving you right now. So, we have to figure something out."

If it's not that serious, you might offer somebody the 988 hotline or we have various local farm hotlines that might be useful. We encourage somebody to seek out assistance from their primary care provider because they could help connect them to a lot of resources in their community. So, you might ask, "Can I help you make an appointment with your primary care?" And again, sort of triaging the situation, if it's not that serious either, really just talking to somebody. And there's so many people who just want to be heard. And we know that just communicating what you're going through and how you're feeling can be incredibly therapeutic. There's a reason people charge for those types of services. So, talking to somebody like a friend and then encouraging them to connect with somebody else. You know, encouraging them to go home and tell their partner how they're feeling, because then it brings more people into the situation, and it offers a lot more perspective.

Host: Well, this has been so educational. Great information. Thank you so much. We appreciate all this information and advice. And like you said, it seems hopeful that maybe this research will lead to more research and be helpful.

Dr. Josie Rudolphi: Absolutely.

Host: It's been a pleasure having you on our podcast. Thank you for being here. Again, that's Dr. Josie Rudolphi. And remember, you can count on Carle. Learn more about the Carle Center for Rural Health and Farm Safety by visiting carle.org/farmsafety, that's Carle, C-A-R-L-E.org/farmsafety, for resources information. tips and much more. Let us help keep you and your family healthy and safe. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening. Join us next time on Let's Talk with Carle Health.