To the Editor:
There is a mental health crisis among farmers throughout the United States, reflected by consistently higher rates of suicide than the general population.1 Family physicians are uniquely positioned to help and can take the following steps: 1) identify the farmers in your practice; 2) understand farm culture and stressors; 3) screen for depression, anxiety, and drug and alcohol use; and 4) offer culturally sensitive treatment.
Farmers in 2025 look differently than one might expect and may not conform to typical stereotypes.2,3 They often seek care in more urban areas due to the lack of access in rural, under-served communities. For these reasons, it is important to take a detailed social and occupational history to identify farmers in a family practice setting.
Physicians should have a good understanding of farm culture and the stressors that weigh heavily on a farmer’s mind. Most farmers do not have paid time off or available help to cover their workload if they leave the farm to access mental health services. In farm culture, workers often neglect or ignore their own health needs to prioritize farming responsibilities. Due to the added stigma associated with mental health disorders, farmers typically ignore anxiety and depression until they experience physical symptoms or a crisis.
We recommend screening for depression and anxiety in all farming families, consistent with the recommendations of the US Preventive Services Task Force. Screening tools such as the Patient Health Questionnaire-9 (PHQ-9) and the GAD-7 are helpful, but they are no replacement for a conversation about personal stressors. Screening for drug and alcohol use is also recommended because these substances are often used as coping tools.
Farmers commonly avoid engaging in discussions around mental health and are hesitant to initiate treatment.4 If they do agree to take medication, they may be wary of adverse effects in the setting of operating heavy equipment, working with large animals, and doing physical labor. Clear communication about possible adverse effects, starting with a low dose, and comprehensive counseling about nonpharmacologic treatment options are good practice points.
Family doctors have a responsibility to be prepared to help farmers cultivate their mental health.
