Mental health disorders among Thai farmers: occupational and non-occupational stressors

Figures & data

Table 1. Demographic characteristics of the participants.

Parameters		Spray (%)	No Spray (%)	p-value*
Gender	Male	66	36	<0.0001
	Female	34	64
Highest education level obtained	Less than primary school	2	7	NS
	Primary	49	44
	Secondary/vocational	47	43
	Bachelor’s or higher	3	6
Marital status	Single	26	24	NS
	Married/living together	68	69
	Married/not living together	1	1
	Widow	4	6
	Divorced/separated	0	1
Farming as the primary job	Yes	95	74	<0.0001
	No	5	26
Having a secondary job with a primary job as a farmer	Yes	21	8	0.0495
	No	74	65
	Did not have a primary job as a farmer (has a secondary job as a farmer)	5	26
	Missing	1	2
Household members	1-2	25	24	NS
	3-4	53	56
	5-6	15	16
	7-8	7	4
Head of household	Yes	64	32	NS
	No	36	66
	Missing	1	0
Household income per month (THB)	≤1000	0	1	NS
	1001-5000	19	15
	5001-10000	28	27
	10001-25000	36	47
	25001-50000	16	8
	>50000	1	2
	Do not know/do not want to respond	1	2
Satisfaction with household income/expenses	Satisfied with saving	9	10	NS
	Satisfied with no saving	59	55
	Not satisfied	30	35
	Do not know/do not want to respond	0	0
	Missing	2	0
Indebtedness	Yes	62	44	0.0102
	No	36	53
	Do not want to respond	2	3
Having health insurance	Yes	93	94	NS
	No	7	6
Smoking status	Yes	22	9	0.0074
	No	76	90
	Quit	2	2
Alcohol consumption status	Yes	55	27	<0.0001
	No	43	72
	Quit	1	1
Living within a 1-km radius from areas where there is pesticide application	Yes	38	52	0.0268
	No	62	48
Household pesticide application	Yes	90	88	NS
	No	10	12
		Spray mean ± sd	No Spray mean ± sd	p-value*
Age (years)		48 ± 16	46 ± 18	NS
Farming years (years)		22 ± 15	18 ± 16	0.0314
Farming hours (hours)		29 ± 14	28 ± 15	NS
Agricultural practice score fractions (higher = better practices)		86.73 ± 9.10	85.63 ± 12.94	NS
PPE use score fractions (higher = better practices)		55.16 ± 18.79	50.58 ± 17.83	0.0428
PPE use score fractions in the past (higher = better practices)		53.46 ± 20.13	26.06 ± 31.72	<0.0001
Farm-related perceived stress score fractions (higher = more stress)		15.00 ± 12.63	14.52 ± 11.99	NS
Financial-related perceived stress score fractions (higher = more stress)		35.84 ± 18.52	30.82 ± 15.86	0.0171
Social-related perceived stress score fractions (higher = more stress)		8.63 ± 12.94	10.59 ± 13.11	NS

p-values were calculated using Chi-squared test and t-test (No Spray vs. Spray groups), *p-value < 0.05; NS = not statistically  significant.

Table 2. Comparison of perceived farm stressors between the Spray and No Spray groups of farmers.

Farm Stressor Indicators	Spray members (%)		No Spray members (%)		p-value*
	Not/Little Stressful	Moderately/ Very Stressful	Not/Little Stressful	Moderately/ Very Stressful
Work-related
Farm injuries and accidents	85	15	84	16	NS
The weather (inadequate/drought/flood, etc.)	26	74	37	63	0.065
Having too much and intense overall agricultural workload	92	8	93	7	NS
Concern over the future of the farm/ranch	93	7	95	5	NS
Not having the manpower to operate the farm	95	5	96	4	NS
Government policies	82	18	86	14	NS
Injuries caused by dealing with machines, mechanical equipment, and sharp objects	91	9	90	10	NS
Illnesses caused by dealing with hazardous chemicals (pesticides, chemical fertilizers)	90	10	86	14	NS
Problems with balancing the many roles I perform as a family member and a farmer	95	5	94	6	NS
Problems with machinery (purchases, repairs, breakdowns)	90	10	90	10	NS
Problems with crops (illness, disease, noxious weeds, rodents)	62	38	76	24	0.013
Working with extended family members in the farm operation (parents, in-laws, children)	99	1	98	2	NS
Having too much work for one person	97	3	96	4	NS
Dealing with non-relative help (incompetent help, finding good help, supervising help)	98	2	99	1	NS
Finance-related
Market prices for your crops	28	72	35	65	NS
Not enough money for day-to-day expenses	47	53	58	42	0.067
High debt load	50	50	57	43	NS
Taxes	97	3	98	2	NS
Not enough cash/capital for unexpected problems (illness, health care, breakdowns, etc.)	78	22	86	14	0.084
Financing for retirement	79	21	87	13	0.078
Social-related
Distance from shopping centers/school/recreation centers, etc.	90	10	90	10	NS
Lack of close neighbors	97	3	94	6	NS
Limited social interaction opportunities	95	5	91	9	NS
Not enough time to spend together as a family in recreation	90	10	93	7	NS
Distance from hospitals, clinics, doctors	98	2	98	2	NS

p-values were calculated using Chi-squared test (No Spray vs. Spray groups), *p-value < 0.1; NS = not statistically significant.

Table 3. Correlation between binary categories of perceived farm stressors (not/little vs. moderately/very stressful) and binary levels mental health disorders (no/little vs moderate/severe symptoms) among the participants.

Farm Stressor Indicators	Chi-squared p-values*
Work-related	ST5-stress	DASS21-stress	DASS21-depression	DASS21-anxiety
Farm injuries and accidents	NS	NS	0.025	0.099
The weather (inadequate /drought/flood, etc.)	NS	NS	NS	NS
Having too much and intense overall agricultural workload	0.081	NS	NS	NS
Concern over the future of the farm	<0.001	NS	0.027	NS
Not having the manpower to operate the farm	0.001	NS	0.027	NS
Government policies	0.008	NS	NS	NS
Injuries caused by dealing with machines, mechanical equipment, and sharp objects	<0.001	0.041	0.018	0.005
Illnesses caused by dealing with hazardous chemicals (pesticides, chemical fertilizers)	0.079	NS	0.041	0.019
Problems with balancing the many roles I perform as a family member and a farmer	0.001	NS	0.002	0.018
Problems with machinery (purchases, repairs, breakdowns)	0.007	0.045	0.003	0.032
Problems with crops (illness, disease, noxious weeds, rodents)	NS	NS	NS	NS
Working with extended family members in the farm operation (parents, in-laws, children)	0.075	0.058	0.010	0.001
Having too much work for one person	<0.001	0.007	0.007	0.003
Dealing with non-relative help (incompetent help, finding good help, supervising help)	0.006	0.044	0.010	NS
Finance-related
Market prices for your crops	NS	NS	NS	NS
Not enough money for day-to-day expenses	0.064	NS	0.016	0.004
High debt load	0.041	NS	0.015	0.010
Taxes	NS	NS	NS	NS
Not enough cash/capital for unexpected problems (illness, health care, breakdowns, etc.)	0.054	NS	0.047	0.064
Financing for retirement	NS	NS	NS	NS
Social-related
Distance from shopping centers/school/recreation centers, etc.	NS	NS	NS	NS
Lack of close neighbors	0.009	NS	NS	NS
Limited social interaction opportunities	0.002	NS	NS	NS
Not enough time to spend together as a family in recreation	<0.001	0.002	<0.001	<0.001
Distance from hospitals, clinics, doctors	0.002	0.073	0.001	0.065

The 9Q-depression was not included in the Chi-squared test as all responses reported in the 9Q questionnaire were no/little of symptoms, with zero response reported moderately/severe symptoms. *p-value < 0.1; NS = not statistically significant.

Table 4. Comparison of mental health disorder scores between No Spray and Spray groups.

Mental Health Disorder Parameters [Total Scores]	% of farmers reported moderate/severe levels of mental health symptoms	Scores mean ± sd [range]			p-value*
		Total (N = 270)	No Spray (n = 124)	Spray (n = 146)
ST5-stress [15]	12	2.1 ± 2.3 [0-14]	2.2 ± 2.5 [0-14]	1.9 ± 2.0 [0-9]	NS
DASS21-stress [21]	4	1.6 ± 2.4 [0-19]	1.7 ± 2.6 [0-19]	1.6 ± 2.1 [0-8]	NS
9Q-depression [27]	0	2.1 ± 2.5 [0-13]	2.3 ± 2.7 [0-13]	1.9 ± 2.4 [0-10]	NS
DASS21-depression [21]	3	1.0 ± 1.8 [0-15]	1.2 ± 2.2 [0-15]	0.9 ± 1.5 [0-7]	NS
DASS21-anxiety [21]	9	1.0 ± 1.6 [0-11]	1.1 ± 1.7 [0-11]	1.0 ± 1.5 [0-6]	NS
COVID Stress Scores (CSS) [92]	54	26.1 ± 9.6 [2-58]	26.7 ± 9.5 [5-58]	25.6 ± 9.7 [2-58]	NS
CSS-phobia [44]	44	17.6 ± 6.9 [0-37]	17.9 ± 6.6 [0-34]	17.2 ± 7.1 [0-37]	NS
CSS-stress [24]	29	1.3 ± 2.3 [0-9]	1.4 ± 2.3 [0-9]	1.3 ± 2.3 [0-15]	NS
CSS-checking [24]	40	7.2 ± 3.1 [0-22]	7.4 ± 3.3 [0-22]	7.1 ± 2.9 [0-16]	NS

p-values were calculated using t-test (No Spray vs Spray groups), *p-value < 0.1; NS = not statistically significant.

Table 5. Univariate logistic regression analysis of four mental health disorder scales where survey scores categorized as moderate/severe vs. no/little.

Parameters	ST5-stress		DASS21-stress		DASS21-depression		DASS21-anxiety
	OR (95%CI)**	p-value*	OR (95%CI) **	p-value*	OR (95%CI) **	p-value*	OR (95%CI) **	p-value*
Gender (male vs. female)	3.966 (1.788,9.732)	0.001		NS	3.450 (1.003,15.814)	0.070		NS
Education (primary school and less vs. secondary/vocation school and above)	0.345 (0.146,0.748)	0.010		NS		NS		NS
Having a secondary job with a primary job as a farmer (yes vs. no)	4.914 (2.060,11.615)	<0.001		NS	6.571 (1.662,27.718)	0.007	6.532 (2.331,18.679)	<0.001
Farming Hours		NS		NS	1.036 (1.001,1.070)	0.032	1.030 (0.998,1.056)	0.057
Living within a 1-km radius of an area where there is pesticide application (yes vs. no)		NS		NS	4.036 (1.173,18.507)	0.040		NS
Agricultural practice score fractions	0.033 (0.002,0.803)	0.032		NS	0.008 (0.000,0.790)	0.030	0.008 (0.000,0.339)	0.009
PPE use score fractions	0.498 (0.224,1.070)	0.077		NS	0.291 (0.063,1.032)	0.073	0.145 (0.033,0.455)	0.003
Historical years of engaging in pesticide spraying	5.095 (2.130,11.853)	<0.001		NS	5.842 (1.635,19.562)	0.004	5.973 (2.161,15.898)	<0.001
Farm-related stressor score fractions	1.075 (1.047,1.107)	<0.001	1.082 (1.028,1.145)	0.003	1.071 (1.035,1.111)	<0.001	1.075 (1.044,1.111)	<0.001
Financial-related stressor score fractions	1.030 (1.009,1.053)	0.006	1.064 (1.010,1.125)	0.022	1.045 (1.012,1.081)	0.007	1.045 (1.018,1.074)	0.001
Social-related stressor score fractions	1.061 (1.036, 1.089)	<0.001	1.084 (1.023,1.158)	0.007	1.059 (1.024,1.097)	<0.001	1.063 (1.034,1.094)	<0.001

A variety of demographic, farming practice and farm stress indicators were examined as predictors.

p-values were calculated using logistic regression, *p-value < 0.1; NS = not statistically significant, **estimated odds ratio.

Table 6. Selected multiple logistic regression models of four mental health disorder scales where survey scores categorized as moderate/severe vs. no/little among the participants.

Adverse Mental Health Outcomes	Variables	Estimated odds ratio (95%CI)	p-values	AIC
ST5-stress	Spray vs. No Spray	1.030 (0.496,2.166)	0.937	204.25
	Spray vs. No spray adjusted for gender (male vs. female) and having a secondary job with a primary job as a farmer (yes/no)	1.608 (0.638,4.255)	0.322	154.12
	Spray vs. No spray adjusted for gender (male vs. female), having a secondary job with a primary job as a farmer (yes/no), and COVID-related stress scores	1.626 (0.618,4.506)	0.333	144.54
	Farm-related perceived stress score fractions	1.075 (1.047,1.107)	<0.001*	174.41
	Farm-related perceived stress score fractions adjusted for gender (male vs. female) and Agricultural practice score fraction (≤ mean score fraction vs. > mean score fraction)	1.069 (1.037,1.106)	<0.001*	158.04
	Farm-related perceived stress score fractions adjusted for gender (male vs. female), Agricultural practice score fraction (≤ mean score fraction vs. > mean score fraction), and COVID-related stress scores	1.069 (1.033,1.110)	<0.001*	160.04
DASS21-stress	Spray vs. No Spray	0.278 (0.014,2.201)	0.270	44.15
	Spray vs. No Spray adjusted for gender (male vs. female) and Historical years of engaging in pesticide spraying (≤ 20 vs. >20 years)	0.164 (0.005,2.097)	0.224	45.95
	Spray vs. No Spray adjusted for gender (male vs. female), Historical years of engaging in pesticide spraying (≤ 20 vs. >20 years), and COVID-related stress scores	0.171 (0.004,2.336)	0.248	45.69
	Farm-related perceived stress score fractions	1.082 (1.028,1.145)	<0.001*	37.24
	Farm-related perceived stress score fractions adjusted for gender (male vs. female) and Historical years of engaging in pesticide spraying (≤ 20 vs. >20 years)	1.075 (1.021,1.141)	0.007*	40.72
	Farm-related perceived stress score fractions adjusted for gender (male vs. female), Historical years of engaging in pesticide spraying (≤ 20 vs. >20 years) and COVID-related stress scores	1.078 (1.006,1.161)	0.045*	42.71
DASS21-depression	Spray vs. No Spray	1.199 (0.373,4.142)	0.762	102.09
	Spray vs. No Spray adjusted for gender (male vs. female), and having a secondary job with a primary job as a farmer (yes/no)	2.475 (0.515,17.971)	0.293	74.46
	Spray vs. No Spray adjusted for gender (male vs. female), having a secondary job with a primary job as a farmer (yes/no), and COVID-related stress scores	2.444 (0.458,19.514)	0.329	67.10
	Farm-related perceived stress score fractions	1.071 (1.035,1.111)	<0.001*	87.79
	Farm-related perceived stress score fractions adjusted for gender (male vs. female) and Historical years of engaging in pesticide spraying (≤ 20 vs. >20 years)	1.057 (1.014,1.103)	0.007*	69.07
	Farm-related perceived stress score fractions adjusted for gender (male vs. female), Historical years of engaging in pesticide spraying (≤ 20 vs. >20 years), and COVID-related stress scores	1.028 (0.977,1.081)	0.264	66.94
DASS21-anxiety	Spray vs. No Spray	1.634 (0.647,4.475)	0.312	145.33
	Spray vs. No Spray adjusted for gender (male vs. female), Agricultural practice scores (≤ mean score fraction vs. > mean score fraction), and PPE use score fraction (≤ mean score fraction vs. > mean score fraction)	2.877 (1.000,8.937)	0.056*	121.08
	Spray vs. No Spray adjusted for gender (male vs. female), Agricultural practice scores (≤ mean score fraction vs. > mean score fraction), PPE use score fraction (≤ mean score fraction vs. > mean score fraction), and COVID-related stress scores	2.783 (0.947,8.821)	0.051*	119.03
	Farm-related perceived stress score fractions	1.075 (1.044,1.111)	<0.001*	123.73
	Farm-related perceived stress score fractions adjusted for gender (male vs. female), Agricultural practice scores (≤ mean score fraction vs. > mean score fraction), and PPE use score fraction (≤ mean score fraction vs. > mean score fraction)	1.068 (1.030,1.112)	<0.001*	112.16
	Farm-related perceived stress score fractions adjusted for gender (male vs. female), Agricultural practice scores (≤ mean score fraction vs. > mean score fraction), PPE use score fraction (≤ mean score fraction vs. > mean score fraction), and COVID-related stress scores	1.062 (1.020,1.112)	0.005*	113.92

p-values were calculated using logistic regression, *p-value < 0.05.