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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="1.3" xml:lang="en" article-type="research-article"><?properties manuscript?><processing-meta base-tagset="archiving" mathml-version="3.0" table-model="xhtml" tagset-family="jats"><restricted-by>pmc</restricted-by></processing-meta><front><journal-meta><journal-id journal-id-type="nlm-journal-id">9421530</journal-id><journal-id journal-id-type="pubmed-jr-id">27360</journal-id><journal-id journal-id-type="nlm-ta">J Agromedicine</journal-id><journal-id journal-id-type="iso-abbrev">J Agromedicine</journal-id><journal-title-group><journal-title>Journal of agromedicine</journal-title></journal-title-group><issn pub-type="ppub">1059-924X</issn><issn pub-type="epub">1545-0813</issn></journal-meta><article-meta><article-id pub-id-type="pmid">34758703</article-id><article-id pub-id-type="pmc">8957597</article-id><article-id pub-id-type="doi">10.1080/1059924X.2021.2004962</article-id><article-id pub-id-type="manuscript">HHSPA1777665</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Agricultural Cooperatives in Mental Health: Farmers&#x02019; Perspectives on Potential Influence</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Liang</surname><given-names>Yanni</given-names></name></contrib><contrib contrib-type="author"><name><surname>Janssen</surname><given-names>Brandi</given-names></name></contrib><contrib contrib-type="author"><name><surname>Casteel</surname><given-names>Carri</given-names></name></contrib><contrib contrib-type="author"><name><surname>Nonnenmann</surname><given-names>Matthew</given-names></name></contrib><contrib contrib-type="author"><name><surname>Rohlman</surname><given-names>Diane S</given-names></name></contrib><aff id="A1">University of Iowa, College of Public Health, Department of Occupational and Environmental Health, Iowa City, Iowa, USA</aff></contrib-group><author-notes><corresp id="CR1">Corresponding Author: Yanni Liang, 145 N. Riverside Drive, Iowa City, IA 52241, <email>Yanni-Liang@uiowa.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>10</day><month>2</month><year>2022</year></pub-date><pub-date pub-type="ppub"><month>4</month><year>2022</year></pub-date><pub-date pub-type="epub"><day>26</day><month>11</month><year>2021</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>4</month><year>2023</year></pub-date><volume>27</volume><issue>2</issue><fpage>143</fpage><lpage>153</lpage><abstract id="ABS1"><sec id="S1"><title>Objective:</title><p id="P1">Agricultural cooperatives are formed to promote farmers&#x02019; economic, social, and legislative interests. Their role in influencing mental health is less known. We characterized farmers&#x02019; experiences with cooperatives and identified the potential impact of cooperatives in promoting mental health.</p></sec><sec id="S2"><title>Methods:</title><p id="P2">Semi-structured interviews were conducted in Wisconsin with 12 participants, including farmers, cooperative professionals, and agricultural extension educators. Participants were asked about stress among farmers; cooperative structures and services provided to farmers, and farmers&#x02019; interactions with the cooperatives; and the role cooperatives play in reducing stress among farmers.</p></sec><sec id="S3"><title>Results:</title><p id="P3">Three main themes were developed: <italic toggle="yes">stress farmers were experiencing</italic>, <italic toggle="yes">available resources from cooperatives</italic>, and the <italic toggle="yes">role of cooperatives in promoting farmers&#x02019; mental health</italic>. <italic toggle="yes">Stress farmers were experiencing</italic> was elucidated through the subthemes: increased stress, depression, and suicide and stressors involving finances, occupational pressure, relationships, isolation, and loneliness. <italic toggle="yes">Available resources from cooperatives</italic> were described in subthemes: cooperative characteristics, services, and engagement activities. <italic toggle="yes">The role of cooperatives in promoting farmers&#x02019; mental health</italic> was discussed through subthemes: serving as a mental health first responder for farmers, providing support networks, and divergent views on whether co-ops can protect farmers&#x02019; mental health.</p></sec><sec id="S4"><title>Conclusion:</title><p id="P4">Cooperatives provide members market stability, services, and opportunities for decision-making, social interaction, and civic engagement. These resources create a community where farmers feel a sense of belonging and retain a level of control. As rural communities continue to struggle with mental health resource shortages, identifying and evaluating community-based resources such as those offered by the cooperatives is imperative.</p></sec></abstract><kwd-group><kwd>farmers</kwd><kwd>cooperatives</kwd><kwd>mental health</kwd><kwd>services</kwd><kwd>engagement</kwd></kwd-group></article-meta></front><body><sec id="S5"><title>Introduction</title><p id="P5">Farmers encounter high rates of depression and suicide.<sup><xref rid="R1" ref-type="bibr">1</xref>&#x02013;<xref rid="R3" ref-type="bibr">3</xref></sup> The prevalence of depression among this population ranged from 7.4% to 35.0% depending on the type of farmers being sampled.<sup><xref rid="R4" ref-type="bibr">4</xref></sup> National death data shows that farming ranked fourth among occupations with the highest suicide deaths and suicide rate among male farmers was 36.1 per 100,000 population compared to 27.4 in all industries nationally.<sup><xref rid="R5" ref-type="bibr">5</xref></sup> Midwest farmers had a high risk of suicide<sup><xref rid="R6" ref-type="bibr">6</xref></sup> and depression.<sup><xref rid="R1" ref-type="bibr">1</xref></sup></p><p id="P6">Risk factors (<italic toggle="yes">e.g.</italic>, market uncertainty,<sup><xref rid="R7" ref-type="bibr">7</xref></sup> occupational demands,<sup><xref rid="R8" ref-type="bibr">8</xref>&#x02013;<xref rid="R10" ref-type="bibr">10</xref></sup> isolation,<sup><xref rid="R11" ref-type="bibr">11</xref>,<xref rid="R12" ref-type="bibr">12</xref></sup> stigma,<sup><xref rid="R13" ref-type="bibr">13</xref></sup> and mental health resource shortages)<sup><xref rid="R14" ref-type="bibr">14</xref></sup> are well-documented. Farming is closely impacted by changing market prices and policies. For example, the recent (2018-21) US-China trade disputes reduced US commodity exports and resulted in financial distress and 80% of Midwest crop farmers reported 10-20% loss in net income.<sup><xref rid="R15" ref-type="bibr">15</xref></sup> Psychological distress stemming from financial insecurity has been an ongoing issue since the 1980s farm crisis.<sup><xref rid="R16" ref-type="bibr">16</xref></sup> In addition, it is well-established that farmers rarely take time-off, typically work alone, and are reluctant to discuss mental health. These factors can increase their mental health risks.</p><p id="P7">Protective factors are less understood, but available evidence suggests that financial stability, social support, and a sense of belonging are beneficial to farmers&#x02019; mental health.<sup><xref rid="R16" ref-type="bibr">16</xref>&#x02013;<xref rid="R18" ref-type="bibr">18</xref></sup> Mental illness is a multifaceted issue and prevention should use a public health approach. The Centers for Disease Control and Prevention recommends prevention of suicide by addressing multilevel factors (<italic toggle="yes">e.g.</italic>, enhancing financial security, social connectedness).</p><p id="P8">Resources (<italic toggle="yes">e.g.</italic>, market stability, engagement activities) provided by farmer-owned cooperatives (co-ops) may alleviate mental health risks.<sup><xref rid="R19" ref-type="bibr">19</xref></sup> Co-ops are established by farmer-members through a democratically controlled process to promote members&#x02019; economic and legislative interests.<sup><xref rid="R20" ref-type="bibr">20</xref>,<xref rid="R21" ref-type="bibr">21</xref></sup> The member-control process depends on co-op types and sizes. Co-ops typically are organized into marketing, supply, and service entities. Marketing co-ops sell members&#x02019; agricultural commodities; supply co-ops distribute farm inputs (<italic toggle="yes">e.g.</italic>, seeds, fertilizers), and service co-ops deliver services (<italic toggle="yes">e.g.</italic>, banking, education). Members are encouraged to participate in decision-making and advocacy (<italic toggle="yes">e.g.</italic>, engaging in policy discussions, advocating for issues affecting farmers). Co-ops represent most US dairy farmers and distribute more than 80% of the fluid milk produced nationwide.<sup><xref rid="R22" ref-type="bibr">22</xref></sup> In addition, co-ops offer programs to assist members with farm production and provide opportunities to participate in leadership initiatives and build relations.<sup><xref rid="R21" ref-type="bibr">21</xref></sup> However, the level of farmers&#x02019; participation in co-ops and whether co-op resources mitigate stress is unknown.</p><p id="P9">Mental health research among farmers has mainly focused on individual characteristics,<sup><xref rid="R23" ref-type="bibr">23</xref></sup> health conditions,<sup><xref rid="R12" ref-type="bibr">12</xref>,<xref rid="R24" ref-type="bibr">24</xref></sup> occupational exposures,<sup><xref rid="R8" ref-type="bibr">8</xref>,<xref rid="R25" ref-type="bibr">25</xref></sup> and social and environmental conditions.<sup><xref rid="R7" ref-type="bibr">7</xref>,<xref rid="R14" ref-type="bibr">14</xref></sup> Research describing co-op resources and how they impact farmers&#x02019; mental health has not been conducted. Although co-ops focus on farmers&#x02019; economic interest, their influence may extend beyond monetary objectives.</p><p id="P10">The purpose of our research was to contextualize Midwest dairy farmers&#x02019; co-op experiences and characterize how co-ops&#x02019; economic and social impacts affect farmers&#x02019; mental health. Our objectives were to (i) identify community-based resources by characterizing co-op services, engagement activities, and support networks, (ii) describe farmers&#x02019; participation in co-op resources, and (iii) document participants&#x02019; perceptions of co-op influence on farmer stress, depression, and suicide. Qualitative understanding of farmers&#x02019; experiences with and perceptions of co-ops can provide preliminary information for future quantitative research to test whether community-based resources impact mental health.</p></sec><sec id="S6"><title>Materials and Methods</title><p id="P11">A qualitative study was conducted with co-op members, co-op professionals (<italic toggle="yes">i.e.</italic>, staff, board members), retired farmers, and an agricultural extension educator who were familiar with co-op structures, programs offered, and farmers&#x02019; interactions with co-ops. Participants were recruited from three co-ops headquartered in Wisconsin using a snowball sampling technique. These co-ops have members from the region and one co-op has members nationally. The University of Iowa Institutional Review Board approved the study.</p><p id="P12">Semi-structured interviews were conducted with 12 participants in 2019. The first author (Liang) conducted, and audio recorded each interview (40-60 minutes). Liang transcribed all interviews verbatim, except three which were transcribed by a transcription company. Stress is defined as a psychological response to stressors.<sup><xref rid="R16" ref-type="bibr">16</xref>,<xref rid="R26" ref-type="bibr">26</xref></sup> All participants were asked about elevated stress among farmers (<italic toggle="yes">e.g</italic>., &#x0201c;Do you know of any farmers who may be experiencing [increased level of] stress? &#x0201d;), co-op services (<italic toggle="yes">e.g</italic>., &#x0201c;What services do you use from the co-op?&#x0201d;), co-op benefits (<italic toggle="yes">e.g.</italic>, &#x0201c;What do you see as the benefits of being a co-op member?&#x0201d;), and co-op interactions (<italic toggle="yes">e.g</italic>., &#x0201c;How do you interact with the co-op?&#x0201d;). Members were also asked about their perception of co-ops in promoting farmers&#x02019; mental health. Co-op professionals were asked about organizational structures and member programs. The extension educator was asked about programs offered to assist farmers experiencing distress. Other questions asked of all participants included reasons to participate in co-ops, interactions among members, stressors, and help seeking behaviours (<italic toggle="yes">e.g.</italic>, &#x0201c;What do you think are some of the causes of the stress? Where do people turn for help?&#x0201d;).</p><p id="P13">Transcripts were analysed thematically from a position loosely identified as social constructionism. This theory emphasizes knowledge as socially constructed through human interactions and social practices.<sup><xref rid="R27" ref-type="bibr">27</xref></sup> Thematic analysis guided by the constructionist worldview attempts to understand sociocultural influence on human experiences. We surmised that famers&#x02019; experiences with co-ops and stress are socially constructed, and their meanings are derived from concepts, interactions, and expectations created by farmers.<sup><xref rid="R28" ref-type="bibr">28</xref></sup> Therefore, the analysis emphasized how participants constructed and understood co-ops through their descriptions of co-ops, the values they assigned, and their interactions with co-op staff, decision-makers, and other members. Transcripts were read carefully to identify data relevant to the research questions. Text segments among transcripts that explained co-op programs and benefits, farmers&#x02019; co-op involvements, stress, help-seeking behaviours, and protectiveness of co-op resources in mental health were coded. Candidate themes were created by grouping codes that shared similar meanings and reflected data patterns.<sup><xref rid="R29" ref-type="bibr">29</xref></sup> Final themes were constructed by consolidating candidate themes that jointly explained the data and research questions. During analysis, two authors met regularly to discuss the codes and themes being developed. The other authors with research backgrounds in qualitative studies, program evaluation, and agricultural safety and health reviewed the themes with the research questions and extracted data and provided feedback.</p></sec><sec id="S7"><title>Results</title><p id="P14">Most (83%) participants identified as farmers; two co-op managers were not farmers (<xref rid="T1" ref-type="table">Table 1</xref>). Most participants were male, grew up on farms, and were 30-60 years old. Farmers were dairy producers, operating farm enterprises with their family members. Among farmers, two had recently retired, four were farming while working as a co-op field staff, manager, or board member, and two did not have off-farm employment. The extension educator was also a farmer and co-op member.</p><p id="P15">Two of the co-ops participated in this study were marketing co-ops, prioritizing business activities in distributing products and generating profits for members. In addition to marketing and sales, these co-ops offered services such as technical support <italic toggle="yes">(e.g.</italic>, pasture management), consultation (<italic toggle="yes">e.g.</italic>, succession planning), and training. The other co-op was a service co-op, specializing in advocating for members&#x02019; legislative interests, providing training, and promoting cooperation among members.</p><p id="P16">Three main themes were developed: stress farmers were experiencing, available resources from co-ops, and the role of co-ops in promoting farmers&#x02019; mental health. Participants&#x02019; demographics are presented separately in <xref rid="T1" ref-type="table">Table 1</xref>. Two of the participated co-ops specialized in dairy marketing and sales while the third co-op focused on education and legislative advocacy.</p><sec id="S8"><title>Stress Farmers Were Experiencing</title><sec id="S9"><title>Stress, Depression, and Suicide</title><p id="P17">Participants agreed that stress, depression, and suicide were prevalent among farmers. All participants identified financial difficulty as a main stressor and recognized chronic stress could lead to depression and suicide.
<disp-quote id="Q1"><p id="P18">[W]e are working a lot to try to help these producers get through &#x02026; the stress, the depression, the suicide risk. And pretty much most of the farmers I talk to in the county right now, they&#x02019;re all under severe financial stress, which obviously leads to family stress, their own personal stress, with depression. (P12)</p><p id="P19">I guess the suicide rate is really increasing and stress lines are getting a lot of calls. (P9)</p></disp-quote></p></sec><sec id="S10"><title>Stressors</title><p id="P20">The extension educator explained that financial hardship, relationship conflicts, and health of family members contribute to suicide ideation:
<disp-quote id="Q2"><p id="P21">I had a situation where a person called here just asking me&#x02026; &#x0201c;what&#x02019;s the price a cow is going for?&#x0201d; &#x02026;. She was very depressed&#x02026; even had some suicidal thoughts just because of the family situation, with having to sell the cows. Her kids being mad at her, how she was going to divide stuff up. Her husband is in the nursing home, so she had the health stress. (P12)</p></disp-quote></p><p id="P22">Participants consistently described financial problems as a key trigger for heightened stress among farmers. A co-op manager and farmer stated that declining commodity prices have exacerbated indebtedness and uncertainties among farmers.
<disp-quote id="Q3"><p id="P23">We&#x02019;re in the fifth year of low prices on the dairy side and on the crop side they&#x02019;re in their fourth year now for low prices. So anytime you see that many years before you have a good year, &#x02026; your asset values start dropping. That&#x02019;s when the banks start to put pressure on you, &#x02026; how are you going to pay that bill next year when you haven&#x02019;t been paid up for everything from last year, &#x02026; (P7)</p></disp-quote></p><p id="P24">Unprofitable commodity prices can escalate into bankruptcies when farm assets begin depreciating and banks restrict lending. Two retired farmers explained that farmers without working capital typically borrow from banks to plant crops, hoping for a profitable harvest to repay the loan. When market prices declined for several years, banks lose confidence in a farmer&#x02019;s ability to repay loans and reduce lending. The ability to secure operating loans can prevent a farmer from farming.</p><p id="P25">Other stressors participants identified were spousal disputes over financial decisions, crop failure, sick animals, severe weather, heavy workload, lack of leisure, equipment breakdown, isolation, and loneliness (P2, P4, P6, P7, P9, P10). Participants felt that ongoing farm consolidations worsen isolation as fewer farmers are left for interactions. Loneliness refers to the lack of satisfying social connections, including feelings of being alone, undervalued, or not being perceived truthfully.<sup><xref rid="R30" ref-type="bibr">30</xref></sup> Farmers believe that their work and land ethics are undervalued: &#x0201c;We figure out once what he [farmer-spouse] made on an hourly basis was negative $5 dollars&#x02026;.&#x0201d; (P2). They felt they were being misrepresented publicly: &#x0201c;We have been looked down upon for years because of the subsidies that farmers received.&#x0201d; (P7). Participants linked this misrepresentation to inequitable farm policies promoting consolidation and dismantling market competition for small producers.</p></sec></sec><sec id="S11"><title>Available Resources from Co-ops</title><sec id="S12"><title>Representation</title><p id="P26">Participants underscored that market access, decision-making opportunities, and co-op missions are key attributes attracting farmers to co-ops. A retired farmer explained that distributing through co-ops allows farmers to &#x0201c;bargain for a better price [and] &#x02026; have a better chance of retaining their market&#x0201d; (P6). Members&#x02019; financial interests are further protected through profit sharing. Members valued profit redistribution and considered it as &#x0201c;a pension almost for a farmer&#x02019;s retirement&#x0201d; (P8). Participating in co-op decision-making also draws farmers to co-ops, which is characterized as &#x0201c;hav[ing] a say in the co-op&#x0201d; (P4). A co-op&#x02019;s annual meeting was highlighted as an important activity for members to voice perspectives and build connections. In addition, co-ops organize engagement events at locations convenient to members throughout the year.</p><p id="P27">&#x0201c;Grassroots&#x0201d; and &#x0201c;true co-op values&#x0201d; are other features that appealed to farmers. They are defined as true farmer representation, equitable pay, and valuing farmers&#x02019; perspectives. Participants believe that small co-ops can better uphold these characteristics than large co-ops. They claim that large co-ops managed by non-farmer leadership are not representative of farmers&#x02019; experiences or interests.
<disp-quote id="Q4"><p id="P28">[T]here are a lot of us, &#x02026;, grassroots feel that some of the co-ops gotten too big, and they lost their grassroots&#x02026;. Their directors or their CEOs are not farmers. They are not down to the level the rest of us are, and they are getting a very high paycheck. (P5)</p></disp-quote></p><p id="P29">Several members revealed that they switched from a large co-op to their current co-ops because: &#x0201c;our voices weren&#x02019;t being heard and we weren&#x02019;t getting a fair price. So, &#x02026;, I joined [co-op name] to get back to the true co-op values.&#x0201d; (P1)</p><p id="P30">The concepts of trust, relatability, and representation were reiterated by multiple participants. In this study, all the included co-ops were structured so that only farmers can serve on the board of directors. Participants affirmed that this criterion ensures that they can elect leadership that is relatable, trustworthy, and representative of their experiences. The shared identity as a farmer between members and the board of directors creates that trust and relatability. One member disclosed, &#x0201c;we are talking with the actual board of directors which are other dairy farmers, our neighbours that are working just as hard as we are, and they are making the decisions you know&#x0201d; (P5).</p></sec><sec id="S13"><title>Services</title><p id="P31">In addition to having farmers in leadership positions, co-ops may protect farmers&#x02019; production and marketing interests. A co-op manager emphasized that marketing co-ops commit to sell members&#x02019; products profitably. A retired farmer contrasted the co-op market stability to the uncertainty encountered by non-co-op farmers: &#x0201c;If you&#x02019;re selling to a private buyer and he decides he doesn&#x02019;t need your milk any more he could drop you, whereas in a cooperative that probably won&#x02019;t happen.&#x0201d; (P6). A board member elaborated that co-ops with successful marketing strategies were paying farmers premium prices at &#x0201c;several times more &#x02026; maybe &#x02026; twice as much what regular milk is being sold for&#x0201d; (P8).</p><p id="P32">Another manager highlighted an additional core co-op service: farm visits. Field staff deliver various on-farm supports, ranging from checking milk quality, discussing farm plans, to preparing for inspections.
<disp-quote id="Q5"><p id="P33">We keep pretty close eyes on the quality bacterial counts.&#x02026; We see trends if farms going up with counts, then we send people out there to help them fix.&#x02026; Like right now we are going to have &#x02026; federal inspections on farms, and our field people, &#x02026; have visited all those farms like a pre-inspection. (P4)</p></disp-quote></p><p id="P34">The on-farm service scope can vary across operations. A manager explained: &#x0201c;There could be technical needs like, they would like some help developing their pasture arrangement, and their grazing plan, or they&#x02019;re having health issues with their livestock&#x02026;. So, all along that range of topics.&#x0201d; (P11)</p></sec><sec id="S25"><title>Engagement</title><p id="P35">Co-ops also encourage members to participate in governance and social events. A manager stated that meetings and social activities were designed to gather feedback, assess needs, and &#x0201c;build a network between our farms, to connect one to another and to the co-op&#x0201d; (P11). He emphasized that education is an important engagement program: &#x0201c;We provide regular educational meetings to farmers, we travel around doing that, and then we take one on one consultation.&#x0201d;</p><p id="P36">Members appreciate opportunities to be informed of and share their views on co-op policies and outlooks. They repeated that having farmers as board members was necessary to promote transparency and ensure a sense of control. The shared experience as a farmer between members and board members creates an accessible and relatable environment for co-op engagement.
<disp-quote id="Q6"><p id="P37">They have &#x02026; open meetings for us farmers [to] get together. And it gives us a chance to talk, to discuss different kind of pay schedules, what&#x02019;s marketing, how does the future look for products, &#x02026;. I just like that we have an openness, and we are talking with the actual board of directors&#x02026;. (P5)</p></disp-quote></p><p id="P38">Members also discussed engagement activities related to advocating for legislative issues affecting farming communities:
<disp-quote id="Q7"><p id="P39">[W]e had our lobby day, &#x02026; lobbying our elected officials on water issues, healthcare, hemp, and anti-trust issues.&#x02026; We also encourage our members to do that on their own &#x02026;, but then also [attend] our local meetings. (P7)</p><p id="P40">We try to hold a variety of events. &#x02026; we sometimes have field days where we invite elected officials and leaders to come, &#x02026; so that they can pretend to be a farmer for a day or talk to farmers. (P8)</p></disp-quote></p></sec></sec><sec id="S14"><title>The Role of Co-ops in Promoting Farmers&#x02019; Mental Health</title><sec id="S15"><title>Responder</title><p id="P41">Distressed farmers have sought help from co-op staff and board members, who connected them to professional services accordingly. For example, a board member described that a call to the co-op &#x0201c;is probably the first call they would make because it is somebody you were familiar with. I refer them to the crisis hotline too because it is not just for mental health, but it is also for financial crisis and counseling too&#x02026;.&#x0201d; (P1) Field staff farm visits may also be a much-needed social interaction for farmers as the visits often lasted longer than scheduled:
<disp-quote id="Q8"><p id="P42">[A] lot of the times my visit should be an hour, &#x02026;, visiting through their protocols for their herd or their farm, &#x02026;, and they turn into a two-and-half-hour conversation because we got talking about other things and &#x02026;, I think it&#x02019;s good because it, &#x02026;, bouncing ideas off, maybe makes them feel like they are not so alone. (P3)</p></disp-quote></p><p id="P43">A field staff participant recalled her interactions with a newly widowed farmer who was accused of animal abuse. The field staff found that the complaint was the result of &#x0201c;a neighbour war&#x0201d;. As she indicated, the grieving farmer was under stress and needed empathy and support. Her example suggests that field staff are critical for farmers who may otherwise not seek help.
<disp-quote id="Q9"><p id="P44">I would say that&#x02019;s probably one [of] the most stressful people that I have been in contact [with] for a while. So, &#x02026;, he never really said &#x0201c;I am really stressed.&#x0201d; &#x02026; &#x0201c;This is really hard on me.&#x0201d; But you could see it.&#x02026; I tried to relate to him, to understand. &#x02026;, by the time I left, I felt like he was feeling better about what&#x02019;s going on in his world. (P3)</p></disp-quote></p></sec><sec id="S16"><title>Community</title><p id="P45">In addition to the field staff, participants identified assistance from board members and other members as part of their overall support networks: &#x0201c;There is a good network in the co-op, &#x02026; farmers helping other farmers, &#x02026;, you can call the board members, and they understand exactly what you are going through.&#x02026; That&#x02019;s really a big plus.&#x0201d; (P4). Board members play a key role in building the support networks by being available to members and sharing information on co-op affairs and market conditions.
<disp-quote id="Q10"><p id="P46">I talked to the board members quite often.&#x02026; We talk about almost anything. It can be from the weather to church. It could be about milk, how is the market going &#x02026;, how are the other farmers in our co-op? &#x02026;, some of them are really stress out.&#x02026; We talk about if we get extra feed, pass the word&#x02026;. So, it is a pretty good network. (P5)</p></disp-quote></p><p id="P47">Participants emphasized that peer support is an important part of the networks. They recounted stories of members who separately developed and shared solutions for stray voltage and lungworm infection (common issues in livestock farming). The voltage solution was &#x0201c;thousands of dollars savings for members&#x0201d; (P1). Peer support could also be demonstrated through feeling a sense of belonging. One manager reported that members attending the co-ops&#x02019; financial management events were more interested in social interactions than consultations. He described that members were looking for &#x0201c;camaraderie, not being on an island, [and] supporting one another&#x0201d; (P11).</p></sec><sec id="S17"><title>Facilitator</title><p id="P48">In addition to support networks, co-op board members and managers indicated that co-ops are interested in facilitating mental health discussions. A co-op board member stated that their organization has started to raise mental health awareness by offering stress management information and encouraging members to discuss mental health. For example, &#x0201c;I do know that [co-op name] is talking more and more sharing the methods of rural mental health and try to encourage other farmers to speak, give them tools to address individual mental health issues.&#x0201d; (P8) A co-op manager also expressed interest in disseminating mental health information to farmers: &#x0201c;I think we definitely be interested. If we can help some of the farmers, we for sure be interested in doing that.&#x0201d; (P4). A manager of another co-op pointed out the need for appropriate interventions and co-ops&#x02019; involvement in mental health could potentially benefit all farmers regardless of membership: &#x0201c;We try to figure out that model that could work, that we could help our members out and even non-members too.&#x0201d; (P7). In parallel, farmer-participants stated that members typically are willing to discuss mental health issues with board members:
<disp-quote id="Q11"><p id="P49">They absolutely do. The board gets calls, the members of the board get calls all the time. (P5)</p><p id="P50">So many people [are] calling him [board member], he is in contact with different co-op members daily. &#x02026; farmers are used to having issues and just dealing with it, but it got to so bad where they actually going to pick up the phone, th1en it&#x02019;s really bad. (P2)</p></disp-quote></p><p id="P51">A board member confirmed that distressed farmers feel comfortable revealing their emotions: &#x0201c;A lot of the phone calls they are brutally honest how stress they are.&#x0201d; (P1)</p></sec><sec id="S18"><title>Debate</title><p id="P52">Despite participants descriptions of co-ops as important support networks, different perspectives were reported on whether co-ops protect farmers&#x02019; mental health when asked directly. Some members perceived a protective impact because co-op resources provide a stress buffer. Co-ops contribute to financial stability through internal pricing and quota systems and redistributing profit to members. Collectively, co-ops can spread market risks among members and thus lighten the burden on individuals. Furthermore, the co-op support networks provide a sense of community and remind farmers that they are not alone in tough times. Knowing that one is not alone could potentially lower stress: &#x0201c;It can be absorbing a little easier because we all [are] absorbing it&#x02026;. We are &#x02026; all one.&#x0201d; (P5)</p><p id="P53">Furthermore, a co-op manager and retired farmer (who founded one of the participated co-ops with six other farmers) explained that co-ops offer an economic and grassroot solution to mitigate stress: &#x0201c;Farm crisis was somewhat a foundation for my involvement in the cooperative in the 1980s because that was also a very stressful time.&#x0201d; (P10)</p><p id="P54">Members who disagreed on co-ops&#x02019; protective impact reasoned that co-ops could not remove financial problems. Specifically, co-ops were unable to offer operating loans to farmers facing bankruptcy:
<disp-quote id="Q12"><p id="P55">[W]e try to help each other out&#x02026;. With the economies, it would be nice if we could write that check out &#x02026; to keep everybody in business, but with not having that availability [it] is very frustrating. (P7)</p></disp-quote></p><p id="P56">Co-ops&#x02019; inability to shape banking policies underscores an ongoing financial barrier for small producers. Participants suggested that banks preferred lending to bigger farms with more assets, even if they have a higher per cow debt than small producers (<italic toggle="yes">e.g.</italic>, $12,000 versus $3,500). These practices accelerate farm consolidations and challenge small family farms.
<disp-quote id="Q13"><p id="P57">[I]t is a little frustrating because the bigger operations they are it seems they have more debt per cow, and the small guys &#x02026; trying to make a living, promoting that community awareness the most, is the first guy that got run out of business most of the time. (P6)</p></disp-quote></p></sec></sec></sec><sec id="S19"><title>Discussion</title><p id="P58">Our participants confirmed that financial difficulties have elevated stress, depression, and suicide risks among farmers. Financial difficulties underline an existing income disparity in agriculture. USDA data from 1993-2018 documented a persistent decline of farmers&#x02019; share from food dollars consumers spent.<sup><xref rid="R31" ref-type="bibr">31</xref></sup> Farmers receive 15 cents per food dollar today compared to 41 cents in 1950s,<sup><xref rid="R32" ref-type="bibr">32</xref></sup> Consolidations in agribusinesses and commodity markets expose farmers to increased costs of production and declined profitability.<sup><xref rid="R33" ref-type="bibr">33</xref>,<xref rid="R34" ref-type="bibr">34</xref></sup> Obtaining market stability and decision-making opportunities through co-ops allows farmers to mitigate financial challenges. Other stressors reported (<italic toggle="yes">e.g.</italic>, relationship tension, social isolation) were consistent with the literature.<sup><xref rid="R11" ref-type="bibr">11</xref>,<xref rid="R35" ref-type="bibr">35</xref>&#x02013;<xref rid="R38" ref-type="bibr">38</xref></sup> Furthermore, farm consolidations and rural depopulation have dwindled support networks for farm families.<sup><xref rid="R39" ref-type="bibr">39</xref></sup> Participants who overcame the 1980s farm crisis confirmed social isolation and loneliness as they reminisced about crowded school activities and church gatherings where farmers used to socialize. These interactions have now been significantly reduced.</p><p id="P59">Our findings suggest that co-op resources may alleviate mental health risks by promoting financial wellbeing and legislative interests. Marketing co-ops empower members to maintain competitiveness<sup><xref rid="R22" ref-type="bibr">22</xref>,<xref rid="R40" ref-type="bibr">40</xref></sup> by collectively processing and distributing products and negotiating markets.<sup><xref rid="R41" ref-type="bibr">41</xref>,<xref rid="R42" ref-type="bibr">42</xref></sup> Our participants agreed that marketing co-ops improved members&#x02019; financial wellbeing by offering stable markets, equitable prices, and profit sharing. Service co-ops play a similar critical role by advocating for farmers&#x02019; legislative and social interests.<sup><xref rid="R43" ref-type="bibr">43</xref></sup> They organize members to petition elected representatives for legislative support through engagement activities such as lobby day where farmers directly voice concerns with representatives.<sup><xref rid="R44" ref-type="bibr">44</xref></sup> Through governing co-op development (<italic toggle="yes">e.g.</italic>, selecting board members) and engaging in co-op sponsored meetings and lobbying activities, farmers could resist consolidation, retain representation, and advocate for their legislative interests at local, state, and federal levels. Small co-ops assist members to achieve these objectives through upholding farmer leadership, shared governance, and pay equity practices. Conversely, members identified large co-ops as a consolidation outcome that deviated from the democratically controlled and profit-sharing principles.</p><p id="P60">Additionally, co-ops generate a sense of control and cultivate connectedness. Members gain a sense of control through participating in business discussions and voting on issues affecting co-op development. Having a sense of control encourages positive coping behaviours for adversity, which lowers stress and depression risks.<sup><xref rid="R45" ref-type="bibr">45</xref>,<xref rid="R46" ref-type="bibr">46</xref></sup> Co-op programs soften social isolation and loneliness as members use them to obtain information and connect with peers. Having farmers on the leadership and staff strengthens connectedness because their shared identity as a farmer fosters a relatable and supportive environment for interactions. The relatability and trust projected through the farmer identity also promotes help-seeking. Distressed farmers have sought help from co-op board members and field staff who assisted them with farm planning and advised them to utilize mental health services. Farmers tend to seek help from their peers,<sup><xref rid="R23" ref-type="bibr">23</xref>,<xref rid="R47" ref-type="bibr">47</xref></sup> and perceived social support is linked to increased willingness to seek help.<sup><xref rid="R48" ref-type="bibr">48</xref></sup> As peers, co-op board members and field staff can assist reducing stigma by encouraging distressed farmers to seek help and by connecting them with resources.</p><p id="P61">Stress, depression, and suicide among farmers have been reported since the 1980s.<sup><xref rid="R49" ref-type="bibr">49</xref>,<xref rid="R50" ref-type="bibr">50</xref></sup> Identifying the roles of farmer-led organizations such as co-ops could uncover opportunities to work with communities in developing and implementing culturally appropriate intervention programs. Further research is necessary to examine relationships between co-op program use and mental health outcomes. For example, investigating whether the use and satisfaction of co-op programs mediate depressive symptoms could identify intervention opportunities for co-ops. Co-ops could promote greater member participation in programs that showed positive impacts. This study revealed that providing mental health training to co-op board members and field staff may enhance their capacity to assist distressed farmers. Co-ops could incorporate mental health topics into field programs and increase the offering of program that are in demand. The overall findings of co-ops&#x02019; positive influences suggest that federal policy should support co-ops by protecting the Capper&#x02013;Volstead Act that allows farmers to collectively distribute and market farm commodities.<sup><xref rid="R51" ref-type="bibr">51</xref></sup> Lastly, future research may examine the roles of co-ops in assisting farmers during crises such as a pandemic.</p><sec id="S20"><title>Limitations</title><p id="P62">Our sample size was modest; however, it was comparable to previous qualitative studies.<sup><xref rid="R52" ref-type="bibr">52</xref>,<xref rid="R53" ref-type="bibr">53</xref></sup> Qualitative research provides rich descriptions of participants&#x02019; lived experiences, and 10-12 interviews is effective in identifying meaningful discoveries before reaching thematic saturation.<sup><xref rid="R54" ref-type="bibr">54</xref></sup> Female farmers were underrepresented in this study, which limited our descriptions of female farmers&#x02019; co-op experiences and perceptions of mental health needs. All participants were from Wisconsin, which constricted the findings to a specific place and hindered our understanding of how co-op experiences may differ across regions. Finally, this study mainly focused on dairy farmers which limited the contextualization of all farmers&#x02019; co-op experiences. These findings may inform future research that assesses farmers&#x02019; experiences with diverse commodity co-ops.</p></sec></sec><sec id="S21"><title>Conclusions</title><p id="P63">Based on in-depth interviews of farmers and co-op staff and leaders, this study contextualized the influence of co-ops among farmers. Co-ops are proven agents in promoting economic benefits for farmers. Throughout the course of delivering services to farmers and encouraging them in decision-making and civic engagement, co-ops help nurture a community where farmers feel a sense of belonging and retain a level of control. Amidst mental health resource shortages, identifying and evaluating community-based resources such as those offered by the co-ops is imperative.</p></sec></body><back><ack id="S22"><title>Acknowledgments:</title><p id="P64">We would like to thank our study participants for their participation.</p><sec id="S23"><title>Funding:</title><p id="P65">Yanni Liang was funded by the Heartland Center for Occupational Safety and Health through the United States Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health [Training Grant Number T42OH008491]. 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An experiment with data saturation and variability</article-title>. <source>Field Methods</source>. <year>2006</year>;<volume>18</volume>(<issue>1</issue>), <fpage>59</fpage>&#x02013;<lpage>82</lpage>.</mixed-citation></ref></ref-list></back><floats-group><table-wrap position="float" id="T1"><label>Table 1.</label><caption><p id="P69">Participant Characteristics</p></caption><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/><col align="left" valign="middle" span="1"/></colgroup><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">ID</th><th align="left" valign="top" rowspan="1" colspan="1">Gender Identity</th><th align="left" valign="top" rowspan="1" colspan="1">Profession</th><th align="left" valign="top" rowspan="1" colspan="1">Age Range (years)</th><th align="left" valign="top" rowspan="1" colspan="1">Grew Up on Farm</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">P1</td><td align="left" valign="top" rowspan="1" colspan="1">Male</td><td align="left" valign="top" rowspan="1" colspan="1">Farmer &#x00026; board member</td><td align="center" valign="top" rowspan="1" colspan="1">55-65</td><td align="center" valign="top" rowspan="1" colspan="1">Yes</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P2</td><td align="left" valign="top" rowspan="1" colspan="1">Female</td><td align="left" valign="top" rowspan="1" colspan="1">Farmer</td><td align="center" valign="top" rowspan="1" colspan="1">45-55</td><td align="center" valign="top" rowspan="1" colspan="1">No</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P3</td><td align="left" valign="top" rowspan="1" colspan="1">Female</td><td align="left" valign="top" rowspan="1" colspan="1">Farmer &#x00026; co-op field staff</td><td align="center" valign="top" rowspan="1" colspan="1">30-50</td><td align="center" valign="top" rowspan="1" colspan="1">Yes</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P4</td><td align="left" valign="top" rowspan="1" colspan="1">Male</td><td align="left" valign="top" rowspan="1" colspan="1">Co-op manager</td><td align="center" valign="top" rowspan="1" colspan="1">50-60</td><td align="center" valign="top" rowspan="1" colspan="1">No</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P5</td><td align="left" valign="top" rowspan="1" colspan="1">Male</td><td align="left" valign="top" rowspan="1" colspan="1">Farmer</td><td align="center" valign="top" rowspan="1" colspan="1">55-65</td><td align="center" valign="top" rowspan="1" colspan="1">Yes</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P6</td><td align="left" valign="top" rowspan="1" colspan="1">Male</td><td align="left" valign="top" rowspan="1" colspan="1">Retired farmer</td><td align="center" valign="top" rowspan="1" colspan="1">65-75</td><td align="center" valign="top" rowspan="1" colspan="1">Yes</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P7</td><td align="left" valign="top" rowspan="1" colspan="1">Male</td><td align="left" valign="top" rowspan="1" colspan="1">Farmer &#x00026; co-op manager</td><td align="center" valign="top" rowspan="1" colspan="1">50-60</td><td align="center" valign="top" rowspan="1" colspan="1">Yes</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P8</td><td align="left" valign="top" rowspan="1" colspan="1">Male</td><td align="left" valign="top" rowspan="1" colspan="1">Farmer &#x00026; board member</td><td align="center" valign="top" rowspan="1" colspan="1">55-65</td><td align="center" valign="top" rowspan="1" colspan="1">Yes</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P9</td><td align="left" valign="top" rowspan="1" colspan="1">Male</td><td align="left" valign="top" rowspan="1" colspan="1">Retired farmer</td><td align="center" valign="top" rowspan="1" colspan="1">65-75</td><td align="center" valign="top" rowspan="1" colspan="1">Yes</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P10</td><td align="left" valign="top" rowspan="1" colspan="1">Male</td><td align="left" valign="top" rowspan="1" colspan="1">Co-op manager &#x00026; retired farmer</td><td align="center" valign="top" rowspan="1" colspan="1">60-70</td><td align="center" valign="top" rowspan="1" colspan="1">Yes</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P11</td><td align="left" valign="top" rowspan="1" colspan="1">Male</td><td align="left" valign="top" rowspan="1" colspan="1">Co-op manager</td><td align="center" valign="top" rowspan="1" colspan="1">45-55</td><td align="center" valign="top" rowspan="1" colspan="1">No</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">P12</td><td align="left" valign="top" rowspan="1" colspan="1">Female</td><td align="left" valign="top" rowspan="1" colspan="1">Farmer &#x00026; extension educator</td><td align="center" valign="top" rowspan="1" colspan="1">30-50</td><td align="center" valign="top" rowspan="1" colspan="1">Yes</td></tr></tbody></table></table-wrap></floats-group></article>