Improving the mental health of farmers: what types of remote support are acceptable, feasible, and improve outcomes? A feasibility RCT

Abstract

Abstract Background The farming community have high rates of poor mental health, and are relatively ‘hard to reach’ with mental health services. The aim of this study was therefore to undertake a feasibility RCT, based on two mental health interventions. These were (1) CBT based ‘Living Life to the Full for Farming Communities’ (LLTTF-F; www.llttf.com), and (2) a holistic social and emotional support service delivered by the Royal Scottish Agricultural Benevolent Institution (RSABI). The feasibility was supplemented by process evaluation. Methods This feasibility study aimed to recruit 40 individuals from the farming community who were experiencing a common health problem defined as a score of > = 8 on PHQ-9. A snowball approach was used to recruit interested individuals who had an association with farming. An initial telephone call screened for eligibility and obtained consent to randomisation to the two specified interventions, or to a thirdly group receiving a combination of both LLTTF-F and ‘Social and emotional support’. Participants were permitted to override the randomised option if they expressed a strong preference before the interventions began. Results Thirty-two participants provided baseline and three-month data. All three interventions showed positive improvements on PHQ-9 scores as follows: the ‘combined intervention’ mean baseline score was 18.1 compared to 12.0 at 3-month follow-up (mean change 6.1). ‘Social and emotional support’ mean baseline score was 11.3 compared to 6.7 at 3-month follow-up (mean change 4.6). ‘LLTTF-F CBT-based intervention only’ mean baseline score was 11.8 compared to 4.5 at 3-month follow-up (mean change 7.3). The retention rate was 81% at three months. In a sub-group of the LLTTF-F CBT-based intervention online materials were supplemented by telephone guided support. This approach received very positive feedback. Conclusions Recruitment from the farming community required intense effort, and good engagement can then be retained for at least three months. There is evidence that the interventions used were feasible, and tentative evidence that they had a demonstrable effect on mental wellbeing, with the LLTTFF providing the largest effect on PHQ-9 scores.