Author ORCID Identifier
Date Available
8-2-2025
Year of Publication
2025
Document Type
Doctoral Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
Nursing
Department/School/Program
Nursing
Faculty
Martha Biddle
Faculty
Jean Edward
Abstract
High rates of depression and suicide continue to be a concern, despite four decades of growing research into the mental health of farmers. Most farmers have an awareness of a need for improved mental health, but a lack of knowledge persists. As agricultural production demands increase and the number of family farms decreases, the stress placed upon farmers to support the food chain is higher than ever. Understanding the association between farm demands and resources among farmers is key for the development and implementation of programs to decrease occupational stress and depressive symptoms to improve mental health outcomes across farming populations.
The purpose of this dissertation was to: 1) explore the current science of farmer research and identify studies with (a) educational interventions to reduce psychosocial stress as measured by reliable and valid instruments in farm and rural populations and (b) identify educational strategies utilized among effective interventions, 2) identify predictors of depressive symptoms among a sample of male farmers aged 50 and older, and 3) establish the reliability and validity of the 12-item John Henry Active Coping Scale (JHAC) among a sample of male farmers aged 50 and over.
This dissertation consists of three manuscripts: a systematic review of educational interventions to reduce stress among farm and rural populations; a secondary analysis of farm demands and resources associated with depressive symptoms in older male farmers; and psychometric analysis of the John Henry Active Coping Scale. First, a search of literature published between January 1980 and October 2020 was conducted across 4 electronic databases and internet sources to identify research that reported outcomes of stress reduction educational interventions among farm and rural populations. Literature was excluded that: (1) used cognitive behavioral therapy, (2) reported out-comes of post-traumatic distress disorders, and (3) examined clinical guidelines or policy change. Interventions that were based on cognitive behavioral therapy were excluded so the results from the review were accessible and applicable within community settings in rural populations. Of 256 full-text eligible manuscripts, the final selection of 22 studies were categorized into 2 educational intervention delivery methods: home/community setting or virtual. Fourteen out of 22 studies reported significant stress reduction. Virtual interventions had the most promising impact on psychosocial stress with significant reduction reported in 4 of 6 studies; however, mixed results were found among all delivery methods.
Next, a secondary analysis was conducted on a sample of 423 older male farmers from Kentucky and South Caroline who participated in a 4-year longitudinal cohort study. The secondary analysis aimed to identify farm demands and resources (e.g. perceived stress, self-reported health, financial adequacy, and satisfaction with life as a farmer) associated with depressive symptoms, as guided by the Modified Farm Demands-Resources Model. At baseline, all farmers were 50 years of age or older and most (87.3%) owned their farms. In this sample, most farmers produced cattle, hay, tobacco or a mixture of commodities. Statistical analysis revealed that mean (SD) total scores of a 4-item Perceived Stress Scale (PSS) and John Henry Active Coping Scale (JHAC) was 10.4 (3.5) and 41.1 (4.5), respectively. Mean score of the CES-D was 34.9 (6.6). Both perceived stress and depressive symptom mean scores were below the mid-point of the scale, suggesting low levels of stress and depression. Linear regression revealed that perceived stress, self-reported health, and financial adequacy to meet expenses explained 43% of the variance in depressive symptom scoring (R² = 0.42). The adjusted R² value of 0.42 indicates a slight adjustment for the number of predictors in the model. Three independent variables made a unique statistically significant contribution to the model (perceived stress, self-reported health, and financial adequacy to meet expenses). Neither John Henry Active Coping nor farming satisfaction were significant predictors of depressive symptoms.
Finally, psychometric testing was conducted on the John Henry Active Coping Scale including internal consistency reliability; construct validity using factor analysis; and convergent validity of the 12-item scale. The sample was comprised of 495 farmers from Kentucky and South Carolina. Cronbach's alpha for the JHAC (α = .79) indicated adequate internal consistency. Correlation coefficients of the corrected item–totals were greater than .30, indicating adequate homogeneity of the items and consistently acceptable reliability. Principle Axis Factoring with direct oblimin rotation identified a two-factor structure with eigenvalues exceeding 1 that explained 40.7% with the majority of variance loading onto factor 1. Inspection of Cattell’s scree plot identified horizontal direction change after components 1 and 2; however, it was difficult to determine whether the scree followed Component 1 or 2. Parallel analysis was used to scrutinize the recommended 2-factor structure, with conceptual interpretation supporting a unidimensional factor structure. Overall, additional testing is warranted to further evaluate the reliability and validity of the instrument in more diverse populations of farmers.
In summary, future research is needed to examine farm demands and resources of the Modified Farm Demands-Resources Model to better understand the construct of depressive symptoms among farm populations. Occupational nurses are instrumental in promoting improved health care that is accessible to the unique occupational context of farming. Additional research is needed to develop and implement stress reduction interventions and mental health programs and better understand the relationship between farm demands and resources and mental health outcomes.
Digital Object Identifier (DOI)
https://doi.org/10.13023/etd.2025.280
Funding Information
This study was supported by the Central Appalachian Regional Education and Research Center (CARERC) through Grant 6T42OH010278.
Recommended Citation
Derringer, Julie C., "A COMPREHENSIVE EXPLORATION OF STRESS AND DEPRESSIVE SYMPTOMS IN FARM POPULATIONS" (2025). Theses and Dissertations--Nursing. 75.
https://uknowledge.uky.edu/nursing_etds/75
