The ripple effect: a digital intervention to reduce suicide stigma among farming men

Alison J Kennedy,Susan A Brumby,Vincent Lawrence Versace,Tristan Brumby-Rendell

doi:10.1186/s12889-020-08954-5

Abstract

BackgroundCompared with the general population, Australian farmers—particularly men—have been identified as at greater risk of suicide. A complex range of factors are thought to contribute to this risk, including the experience of Stigma. stigma also impacts those who have attempted suicide, their carers, and those bereaved by suicide—manifesting as shame, guilt, social isolation, concealment of death, reduced help seeking and ongoing risk of suicide. This paper evaluates the effectiveness of an intervention, tailored for the farming context, designed to reduce stigma among farming men with a lived experience of suicide.MethodsThe digital intervention used an adult learning model providing opportunity to share insights, reflect, learn and apply new knowledge among people with shared farming interests, suicide experience and cultural context. A range of content—tailored to the gender, farming type and suicide experience of participants—included video stories, postcard messages, education and personal goal setting. Pre- and post- assessment of suicide stigma and literacy was complemented by qualitative data collection during the intervention and participant feedback surveys.ResultsThe intervention was successful in reaching members of the target group from across Australia’s rural communities—with diverse geographic locations and farming industries represented. One hundred and sixty-nine participants from the target group (farming males aged 30–64 years) were recruited. While the Stigma of Suicide Scale failed to identify a reduction in self- or perceived-stigma, qualitative data and participant feedback identified behavioural indicators of stigma reduction. Four subthemes—‘growth’, ‘new realisations’, ‘hope’ and ‘encouragement’—highlighted attitudinal and behaviour change indicative of reduced stigma associated with mental health and suicide.Participants’ baseline suicide literacy (Literacy of Suicide Scale) was high when compared with previous community samples and total literacy scores did not demonstrate significant improvement over time, although literacy about the link between suicide and alcoholism did significantly improve.ConclusionsThese results highlight opportunities in groups with high suicide literacy for targeted stigma reduction and suicide prevention efforts for both the target group and other populations within Australia and internationally. Results also highlight the need to reassess how stigma change is understood and evaluated across a wider range of population groups.Trial registrationThis research project was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12616000289415) on 7th March, 2016.

Highlights

Compared with the general population, Australian farmers— men—have been identified as at greater risk of suicide
Overall recruitment to the digital intervention exceeded the goal set in the Research Protocol (n = 473) [41]
The intervention was successful in reaching members of the target group from across Australia’s rural communities—with negligible participation in capital cities— representing diversity of both geographic location and farming industry

Summary

Introduction

Compared with the general population, Australian farmers— men—have been identified as at greater risk of suicide. The risk of suicide significantly increases in rural and remote Australia— for males [1]—with the rate of suicide between 2011 and 2015 suggesting a growing urban-rural divide with sharper increases in death rates outside of major cities [2] This is despite similar prevalence of diagnosed mental health conditions across metropolitan and rural areas [3]. In rural Australia, geographic isolation, traditional gender and cultural expectations, and close-knit communities can constrain open discussion about mental health and suicide, and reinforce the effects of stigma [9]. Within this context, the avoidance of emotional vulnerability—combined with feelings of weakness, shame, guilt, selfishness, and the sense of rejection associated with the experience of suicide—can be damaging [11, 12]. General population samples in areas of high suicide have been identified as experiencing increased stigma associated with psychological problems [15]

Methods

Results

Discussion

Conclusion