What Finally Makes Farmers Call: Help-Seeking Amid Compounding Stressors in Agricultural Mental Health

Background Agricultural workers face elevated mental health risks, and suicide rates consistently exceed those of the general population, yet little is known about their help-seeking behaviors during crises. Understanding when and why farmers decide when to seek crisis assistance can inform earlier intervention strategies and reduce barriers to care in this high-risk occupational group.Objective This study identifies stressors, help-seeking patterns, and barriers among callers to an agricultural mental health crisis helpline, with particular attention to how combinations of stressors prompt help-seeking and what factors predict help acceptance or refusal of services.Methods We conducted directed content analysis of call narratives from AgriStress Helpline, a U.S. agricultural mental health helpline spanning February 2022 through July 2025. Using a two-phase coding approach, all narratives were categorized by call type, and 321 crisis calls underwent detailed thematic coding for stressor types (financial, weather/climate, health, family/relationship, social isolation), help-seeking outcomes (accepted, explored, refused, disconnected), and barriers mentioned. Multivariable logistic regression examined predictors and outcomes, including referral acceptance and suicide ideation, with inter-rater reliability assessed using Cohen’s kappa on a 10% double-coded subset.Results Of the 911 total helpline contacts, 35.2% (n = 321) involved mental health crises. Among crisis callers, health concerns (60.5%), social isolation (58.6%), and family/relationship issues (56.4%) were more prevalent than financial stress (38.3%) or weather events (7.8%), challenging assumptions about primary agricultural stressors. Most crisis callers (81.1%) reported multiple concurrent stressors, with a mean of 2.5 stressors per call. Suicide ideation was mentioned in 14.0% of crisis calls, with the highest prevalence in health-related crises (20.1%). Nearly 80% of crisis callers accepted (46.4%) or explored (31.5%) help options. Social isolation was the only significant predictor of help refusal (ORHelpAcceptance = 0.08, 95% CI: 0.00–0.39), while health concerns significantly predicted suicide ideation (OR = 3.41, 95% CI: 1.47–9.36).Conclusions Agricultural crisis calls typically result from multiple cascading stressors rather than isolated problems, with health and interpersonal concerns more prominent than economic factors at crisis points. Social isolation functions as both a critical stressor and a barrier to engagement, requiring specialized intervention approaches for isolated agricultural populations. Results were derived from a unique help-seeking dataset that may reflect a subset of the population; more research into agricultural help-seeking is needed to inform additional interventions.