Download Farmworkers and Mental Health - National Center for Farmworker

FARMWORKER HEALTH FACTSHEETS
Farmworkers and Mental Health
As is now known, mental health is an important component of an individual’s overall
health. Poor mental health affects an individual’s productivity (such as at work or school), their
hobbies and motivations, their ability to handle stress, and their overall contentment and ability to
enjoy life. Because the farmworker population has a separate set of stressors, poor mental health
can be especially difficult to identify, treat, and overcome. The following is a collection of recent
facts and figures pertaining to the mental health of agricultural workers. The last section of the
factsheet includes recommendations and advice for healthcare and service providers who work
with this population.
General Information
 When talking about diagnosing, the main categories of mental health disorders include mood
disorders, schizophrenia, anxiety disorders, eating disorders, attention deficit hyperactivity
disorder, autism, and personality disorders.1
 Anxiety disorders are the most commonly occurring as they affect 18 percent of the
population.2 They include the following:
 Panic disorder;
 Obsessive-compulsive disorder;
 Post-traumatic stress disorder;
 Generalized anxiety disorder;
 Social phobia;
 Agoraphobia; and
 Specified phobias.3
 There are many factors that contribute to an individual’s mental health. According to the
University of Maryland Medical Center, genes, biochemistry, environment, history, and
psychological profile all contribute to anxiety disorders.4
 Each disorder is accompanied by its specific symptoms, but in general, warning signs and
symptoms include social withdrawal, unusual drop in functioning like in school or work,
difficulty with concentration, memory or logical thought, loss of initiative or desire, feeling
“disconnected,” changes in sleep and appetite, and rapid shifts in feelings such as mood
swings.5
 There are also traditional Mexican folk illnesses that are important to the understanding of
mental health among this population. For example, susto is a condition that can include
several symptoms including disturbed sleep, depression, gastro-intestinal issues, and
listlessness that are brought on by a sudden frightful event.6 Nervios is a set of symptoms that
can include worry, jumpiness, irritability, depression, agitation, and nervousness.7
 One report on a study of farmworkers along the U.S.-Mexico border found that 41
percent of participant reported nervios, 37 percent reported depression and 17 percent
reported latidos (or heart palpitations), which were attributed to anxiety.8
NCFH, May 2013
Occurrence among the Population
 Compared to non-Hispanic Whites, Mexican Americans receive a lot less mental health
treatment for their mental health issues.9 A 2008 national study found that 60 percent of
Whites with depression received treatment, whereas only 36 percent of Hispanics did.10
 One research study that was conducted included 146 Mexican Americans with depressive
symptoms and offered 8 behavioral, problem-solving treatment sessions. The study suggests
that this population is not receptive to traditional forms of therapy for mental health. The
following were the conclusions published:
 Previous studies found have found that Latinos with depressive disorders are less
likely to find anti-depressants acceptable, and are also least likely to engage in
psychotherapy;
 After an initial evaluation, 29 patients declined treatment usually because of time
conflicts and other conflicting commitments;
 Sixty-two (62) patients agreed to treatment, but could not be contacted to schedule an
appointment or did schedule but did not keep an appointment; and
 Depressive symptom severity did decrease among those 24 individuals who attended
at least 4 of the 8 sessions offered. 11
 A study conducted in North Carolina found a positive correlation between levels of daytime
sleepiness and levels of depressive symptoms among farmworkers.12 Of the 300 farmworkers
surveyed, 28 percent reported having elevated levels of depressive symptoms.13 The study
also found that excessive daytime sleepiness and depressive symptoms increased with
increasing age. 14 These statistics are especially problematic and dangerous since agricultural
work requires dangerous machinery and tools, toxic pesticides, and transferring heavy
loads.15
Mental Health Risk Factors
 There are several underlying factors that contribute to the poor mental health of farmworkers.
Some of them are factors that are internally associated with the nature of agricultural work
and the requirements of the lifestyle, such as frequent mobility, long work hours, limited or
nonexistent benefits. Others are caused more from internal variables that plague the
farmworker population, such as differences in culture, language, and lack of familiarity with
the U.S. health care system.
 One study published in 2008 reported on which determinants inherit to farmwork and the
farmworker lifestyle resulted in poor mental health by using signs of anxiety and depression
as measures. The following conclusions were observed:
 Five domains of stress were noted: legality and logistics, social isolation, work
conditions, family and substance abuse by others,
 Social isolation was the strongest contributor to anxiety, and
 Stressful working conditions had the strongest effect on depression.16
 A qualitative study published in 2008 examined the factors that contribute to depression
among 38 adult Mexican immigrant men.17 This is a good proxy for the population as a 2009
national update on agricultural workers by the Department of Labor found that 68% of
farmworkers were born in Mexico.18 When interviewed for the causes of depression, the
following responses, all related to the immigrant experience, were noted:
 Separation from loved ones and/or family,
 Discrimination and harassment in the community
 Long hours and multiple jobs,
 Not having a job or receiving bad pay,
 Social isolation, and
NCFH, May 2013


 A change in drug or alcohol use.19
As far as remedies for depression, the men reported the following:
 Drinking and taking drugs to reduce symptoms,
 Seeking professional help, without the use of medications,
 Increased and encouraged community socializing, and
 Reuniting with family.20
A National Agricultural Worker’s Study report presented that in 2009, 68 percent of
farmworkers were born in Mexico and that 15 percent are either indigenous Mexicans or
Central Americans.21 Another study found that in some regions of California, as much as 46
percent of farmworkers were indigenous Mexicans.22 This is important as there are
implications to those cultural/linguistic differences between indigenous and non-indigenous
(or mestizo) Mexican farmworkers. For example, depressive syndromes are more prevalent
among indigenous Mexican farmworkers than those who are non-indigenous and Spanish
literacy contributed to a decreased likelihood in having a depressive syndrome.23
Although poor mental health is regarded as a stigma, it seems to be especially apparent within
the Latino culture. Latina women, for example, are more likely than White or Black women
to endorse feeling embarrassed about discussing personal issues, fearing what others may
think, or believing family members may think they are crazy.24
Substance Abuse
 Migration from Mexico to the United States has been linked to substance use and abuse. One
research study interviewed 5826 individuals in Mexico.25 Respondents who migrated to the
United States or who had family who migrated to the United States were more likely to:
 Use alcohol, marijuana, cocaine, and other illicit drugs at least once in their lifetime;
 Develop a substance use disorder; and
 Have a current (within the last 12 months) substance use disorder.26
 One study conducted in North Carolina that interviewed 125 male migrant farmworkers
reported that 30 percent had a positive screen for alcohol dependence.27
 A study conducted among agricultural workers concluded that the frequency of substance
abuse, in this case crack-cocaine, alcohol and marijuana, was not necessarily tied to ethnicity
but rather related to the type of crop work that the worker conducted as some crop’s work and
harvest is much more stressful and demanding than others.28
Advice and Recommendations for Healthcare or Service Providers
 A study which gathered the input of 15 researchers who each have a background in the
research of treatment and services for the Hispanic population published that
Latinos/Hispanics are discouraged from seeking mental health treatment due to the cultural
insensitivity, stereotyping, and unacknowledged racism they have experienced with health
care providers in the past.29
 Studies have found that there are traditional values in the Latino culture that contribute to the
under-use of mental health services. Some of these values include respect, familism and
allocentrism which are built around the premise of courtesy, reliance on family members as
opposed to those who are non-family, and an emphasis on family goals as opposed to those of
an individual.30 Fatalism is another important component in Latino culture, and it is the idea
that problems such as those related to health are beyond an individual’s control. 31
 It is important for health or other service providers to be knowledgeable on how elements that
are intrinsic to the population such as folk illness,32 traditional cultural values,33 and the
immigrant experience34 contribute to agricultural workers’ poor mental health and work
NCFH, May 2013

against treatment-seeking behavior.
One report concluded that identifying the different factors that contribute to farmworker
stress can aid in the designing of programs and practices that help manage or even prevent
those mental health issues that plague this population.35 One idea is to organize a social
network within the farmworker community that will support an interactive and positive outlet
such as a sporting event.36
1
National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human
Services. The Numbers that Count: Mental Disorders in America. 2013.
http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-inamerica/index.shtml#Intro
2
Ibid.
3
Ibid.
4
University of Maryland Medical Center. Anxiety Disorders: Causes.2011. Available online:
http://www.umm.edu/patiented/articles/what_causes_anxiety_disorders_000028_2.htm
5
American Psychiatric Association. Mental Health Topics: Warning Signs of Mental Illness. 2012.
Accessed online: http://www.psychiatry.org/mental-health/more-topics/warning-signs-of-mental-illness.
6
Rubel, A., O’Nell, C., Collando-Ardon, R. Susto, A Folk Illness. University of California Press, 1984.
7
Roberta, B., Weller, S., de Alba Garcia, J., et al., A Cross-Cultural Approach to the Study of the Folk
Illness Nervios. Culture, Medicine & Psychiatry, Vol. 27, No. 3, 2003.
8
Weigel, M., Armijos, R., Hall, Y., et al. The Household Food Insecurity and Health Outcomes of U.S.Mexico Border Migrant and Seasonal Farmworkers. Journal of Immigrant and Minority Health, Vol. 9,
2007.
9
Petterson, S., Williams, I., Hauenstein, E. et al., Race and Ethnicity and Rural Mental Health Treatment.
The Journal for the Poor and Underserved, Vol. 20, No. 3, 2009.
10
Alegria, M., Chatterji, P., Wells, K., et al. Disparity in Depression Treatment among Racial and Ethnic
Minority Populations in the United States. Psychiatric Services, Vol. 59, No. 11, 2008.
11
Schmaling, K.. and Hernandez, D. Problem-solving for Depression among Mexican Americans in
Primary Care. Journal of Health Care for the Poor and Underserved, No. 19, 2008.
12
Sandberg, J., Grzywacz, J., Talton, J., et al. A Cross-Sectional Exploration of Excessive Daytime
Sleepiness, Depression, and Musculoskeletal Pain among Migrant Farmworkers. Journal of Agromedicine,
No. 17, 2012.
13
Ibid.
14
Ibid.
15
Ibid.
16
Hiott, A.E., Grzywacz, J.G., Davis, S.W., Quandt., S.A. et al. Migrant Farmworker Stress: Mental
Health Implications. National Rural Health Association, Winter 2008.
17
Lackey, Gerald. “Feeling Blue” in Spanish: A Qualitative Inquiry of Depression among Mexican
NCFH, May 2013
Immigrants, Social Science & Medicine, Vol. 67, 2008.
18
Carroll, D., Georges, A. and Saltz, R. Changing Characteristics of U.S. Farm Workers: 21 Years of
Findings from the National Agricultural Workers Survey (presentation, Immigration Reform and
Agriculture Conference: Implications for Farmers, Farm Workers and Communities, Washington D.C.,
May 12, 2011).
19
Lackey, Gerald. “Feeling Blue” in Spanish: A Qualitative Inquiry of Depression among Mexican
Immigrants, Social Science & Medicine, Vol. 67, 2008.
20
Ibid.
21
Carroll, D., Georges, A. and Saltz, R. Changing Characteristics of U.S. Farm Workers: 21 Years of
Findings from the National Agricultural Workers Survey (presentation, Immigration Reform and
Agriculture Conference: Implications for Farmers, Farm Workers and Communities, Washington D.C.,
May 12, 2011).
22
Mines, R., Nichols, S., and Runsten, D. California’s Indigenous Farmworkers. 2010. Available online:
www.indigenousfarmworkers.org
23
Donlan, W. and Lee, J. Indigenous and Mestizo Mexican Farmworkers: A Comparative Mental Health
Analysis. Journal of Rural Community Psychology. Vol.E13, No. 1. 2010.
24
Arcury, T. and Quandt, S. (eds), Chapter 7: Mental Health among Farmworkers in the Eastern United
States, Latino Farmworkers in the Eastern United States, 2009.
25
Borges, G., Medina-Mora, M., Breslau, J. et al. The Effect of Migration to the United States on Substance
Use Disorders among Returned Mexican Migrants and Families of Migrants. The American Journal of
Public Health, Vol. 97, No. 10, 2007.
26
Ibid.
27
Grzywacz, J., Quandt, S., Isom, S., et al. Alcohol Use among Immigrant Latino Farmworkers in North
Carolina. American Journal of Industrial Medicine, Vol 50, 2007.
28
Bletzer, K., and Weatherby, N. Variation in Drug and Alcohol use among Agricultural Laborers:
Watermelon men in the Rural South. Human Organization, Vol. 68, No. 2, 2009.
29
Vega, W., Karno, M., Alegria, M., et al. Research Issues for Improving Treatment of U.S. Hispanics with
Persistent Mental Disorders, Psychiatric Services, Vol. 58, No. 3, 2007.
30
Schmaling, K. and Hernandez, D. Problem-solving for Depression among Mexican Americans in
Primary Care. Journal of Health Care for the Poor and Underserved, No. 19, 2008.
31
Ibid.
32
Arcury, T. and Quandt, S. (eds), Chapter 7: Mental Health among Farmworkers in the Eastern United
States, Latino Farmworkers in the Eastern United States, 2009.
33
Schmaling, K. and Hernandez, D. Problem-solving for Depression among Mexican Americans in
Primary Care. Journal of Health Care for the Poor and Underserved, No. 19, 2008.
34
Lackey, Gerald. “Feeling Blue” in Spanish: A Qualitative Inquiry of Depression among Mexican
Immigrants, Social Science & Medicine, Vol. 67, 2008.
35
Hiott, A.E., Grzywacz, J.G., Davis, S.W., et al. Migrant Farmworker Stress: Mental Health Implications.
National Rural Health Association, Winter 2008.
36
Arcury, T. and Quandt, S. (eds), Chapter 7: Mental Health among Farmworkers in the Eastern United
States, Latino Farmworkers in the Eastern United States, 2009.
________________________________________
Agricultural Worker Factsheets are published by the National Center for Farmworker Health, Inc. 1770
FM 967, Buda, TX 7861 0, (512) 312-2700. This publication was made possible through grant number
U30CS0 9737 from the Health Resources and Services Administration, Bureau of Primary Health Care,
and its contents are solely the responsibility of the authors and do not necessarily represent the official
views of HRSA.
NCFH, May 2013