Farmers’ perceptions about the risk of suicide and the available help schemes: a qualitative study in France

Introduction: The farming community is marked by a high suicide rate due to multiple factors (working environment, use of lethal means, low use of healthcare). In France, help schemes have been implemented. The aim of this study was to analyse the perceptions of farmers in Brittany, France about suicide and the help offered to farmers at risk of suicide.
Methods: For this qualitative study, semi-structured interviews were carried out and analysed according to a reflexive thematic analysis in the framework of an inductive approach.  
Results: Twenty-six farmers were interviewed. All had experienced the suicide of a relative or fellow farmer. Interviewed farmers had a good knowledge of suicide, its risk factors and the signs that precede the suicidal act. Paradoxically, while some interviewed farmers had suicidal thoughts, they did not feel at risk of suicide because they did not have a "suicidal temperament". In case of difficulties, farmers first sought support from their entourage, particularly their spouse. An improvement in the farm's financial situation was an important factor to boost their mental health. Participation in groups or training courses also was an important help. Sometimes, they thought about seeing a healthcare professional, particularly their GP, but not everyone saw the usefulness of this approach. Mental health professionals (psychologists and psychiatrists) often had a bad reputation, despite the help offered. They all spoke of the need to offer proactive help to farmers, aware of the low spontaneous help-seeking by colleagues in difficulty.
Discussion: The interviewed farmers perceived that suicide was something that concerned others and represented a form of weakness. These specific features in the description of psychological pain by farmers may partly explain the low prevalence of depressive symptoms. Experiencing the suicide of a colleague was a traumatic experience with psychological consequences and negative health consequences. It can serve as a basis for preventive actions. A targeted and systematic screening of mental health problems in these population by GPs might improve the identification of farmers at high risk of suicide.
Conclusion: These findings suggest that given the low spontaneous help-seeking by farmers experiencing difficulties, proactive support could be an option to be developed.    
Keywords:  Farmers, prevention, qualitative research, social support, suicide