Bowyer Harriet L, Pegler Ruth, Williams Christopher
Department of Psychology, Glasgow Caledonian University, Glasgow, United Kingdom.
Paediatric Clinical Psychology Service, National Health Service Scotland Greater Glasgow & Clyde, Glasgow, United Kingdom.
JMIR Form Res. 2023 Jun 19;7:e42573. doi: 10.2196/42573.
Farmers have higher rates of depression than nonfarmers and higher rates of suicide than the general population. Several barriers to help seeking have been identified in farmers, which may be overcome by offering web-based mental health support. Computerized cognitive behavioral therapy (cCBT) is an effective intervention used to prevent and treat mild to moderate depression but has not been evaluated in the farming community.
This study explored the feasibility of delivering a cCBT course tailored to farmers using a mixed methods approach.
Farmers (aged ≥18 years) with no, minimal, or moderately severe depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score <20) were recruited using web-based and offline advertisements and given access to a cCBT course consisting of 5 core modules and automated and personalized email support. Depression (PHQ-9), anxiety (General Anxiety Disorder-7), and social functioning (Work and Social Adjustment Scale) were measured at baseline and the 8-week follow-up. Wilcoxon signed rank tests assessed changes in scores for all outcome measures over time. Telephone interviews focusing on participant use and satisfaction with the course were analyzed using thematic analysis.
Overall, 56 participants were recruited; 27 (48%) through social media. Overall, 62% (35/56) of participants logged into the course. At baseline, almost half of the participants reported experiencing minimal depressive symptoms (25/56, 45%) and mild anxiety (25/56, 45%), and just over half (30/56, 54%) reported mild to moderate functional impairment. Posttreatment data were available for 27% (15/56) of participants (41/56, 73% attrition rate). On average, participants experienced fewer depressive symptoms (P=.38) and less functional impairment (P=.26) at the 8-week follow-up; these results were not statistically significant. Participants experienced significantly fewer symptoms of anxiety at the 8-week follow-up (P=.02). Most participants (13/14, 93%) found the course helpful and easy to access (10/13, 77%) and the email support helpful (12/14, 86%). Qualitative interviews identified heavy workloads and mental health stigma within the farming community as barriers to help seeking. Participants thought that web-based support would be helpful, being convenient and anonymous. There were concerns that older farmers and those with limited internet connections may have difficulty accessing the course. Improvements regarding the layout and content of the course were suggested. Dedicated support from someone with farming knowledge was recommended to improve retention.
cCBT may be a convenient way of supporting mental health within farming communities. However, challenges in recruiting and retaining farmers may indicate that cCBT supported only by email may not be an acceptable mode of mental health care delivery for many; however, it was valued by respondents. Involving farming organizations in planning, recruitment, and support may address these issues. Mental health awareness campaigns targeting farming communities may also help reduce stigma and improve recruitment and retention.
农民患抑郁症的比例高于非农民，自杀率也高于普通人群。已发现农民在寻求帮助方面存在多种障碍，而提供基于网络的心理健康支持可能会克服这些障碍。计算机化认知行为疗法（cCBT）是一种用于预防和治疗轻度至中度抑郁症的有效干预措施，但尚未在农业社区进行评估。
本研究采用混合方法探讨为农民提供量身定制的cCBT课程的可行性。
通过网络和线下广告招募年龄≥18岁、无、有轻微或中度严重抑郁症状（患者健康问卷-9[PHQ-9]评分<20）的农民，并让他们参加一个由5个核心模块以及自动化和个性化电子邮件支持组成的cCBT课程。在基线和8周随访时测量抑郁（PHQ-9）、焦虑（广泛性焦虑障碍-7）和社会功能（工作与社会适应量表）。采用Wilcoxon符号秩检验评估所有结局指标随时间的得分变化。使用主题分析法对聚焦于参与者对课程的使用和满意度的电话访谈进行分析。
总体而言，招募了56名参与者；其中27名（48%）通过社交媒体招募。总体而言，62%（35/56）的参与者登录了课程。在基线时，几乎一半的参与者报告有轻微抑郁症状（25/56，45%）和轻度焦虑（25/56，45%），略超过一半（30/56，54%）报告有轻度至中度功能障碍。27%（15/56）的参与者有治疗后数据（脱落率为41/56，73%）。在8周随访时，参与者平均抑郁症状减少（P = 0.38），功能障碍减轻（P = 0.26）；这些结果无统计学意义。在8周随访时，参与者的焦虑症状显著减少（P = 0.02）。大多数参与者（13/14，93%）认为课程有帮助且易于使用（10/13，77%），电子邮件支持也有帮助（12/14，86%）。定性访谈确定农业社区内的繁重工作量和心理健康污名是寻求帮助的障碍。参与者认为基于网络的支持会有帮助，因为方便且匿名。有人担心年长的农民和互联网连接有限的人可能难以访问该课程。建议对课程的布局和内容进行改进。建议由具有农业知识的人提供专门支持以提高留存率。
cCBT可能是支持农业社区心理健康的一种便捷方式。然而，招募和留住农民方面的挑战可能表明仅通过电子邮件支持的cCBT对许多人来说可能不是一种可接受的心理健康护理提供模式；然而，它受到了受访者的重视。让农业组织参与规划、招募和支持可能会解决这些问题。针对农业社区的心理健康宣传活动也可能有助于减少污名并改善招募和留存情况。
