Farming Community Mental Health Questionnaire
For men and women ages 12 years and up that are in the farming or related industry. This survey is completely voluntary and anonymous. The purpose of this brief survey is to collect basic information in order to best serve the mental health needs of the farming community. Please answer all questions as honestly and completely as possible.
What is your gender?
Prefer not to say
What is your age?
under 18 years
65 years +
I would rather not say
What best describes your relationship to the farming industry?
Farming business owner
Business employee/employer that supports the farming industry
Family member or friend of someone in the farming industry
Zip Code where you live:
Do you have insurance to cover mental/behavioral health services?
Yes, I have comprehensive health coverage
Yes, I have coverage but I have high out-of-pocket expenses or high deductible
No, my insurance does not cover mental health services
I do not have health insurance
I don't know
Have you or someone you know struggled with depression, suicidal thoughts, extreme/prolonged stress, or anxiety?
I don't know
If "Yes" to the question above, did you/they receive the help they needed?
I don't know
If "No" to the question above, why did you/they not receive the help they needed?
Unsure where to find help
Difficulty reaching out
Embarrassed to admit that I am struggling
Tried to find help, but was unsuccessful
Felt that I should just "get over it"
Unsure if I am really "sick"
No one to talk to that understands
My mental struggles have (please check all that apply):
Prevented me from running my farm or farm-related business well
Kept me from wanting to go to work / lack of motivation
Prevented me from going to public places (e.g., restaurants, Walmart, church); kept me wanting to stay at home
Affected my relationship with my significant other/spouse, children or grandchildren in a negative way
Kept me from making the income I needed to
Caused me to miss work
Impaired my ability to focus on a task
I haven't experienced mental struggles
Have any of the following caused you stress in the last 5 years (please check all that apply)?
Little job control
Nonwork or irregular work
Relationship conflicts in occupation or personal life
This is not applicable to me
What options below would you be willing to try to help keep your mind healthy (please check all that apply)?
A regular group meeting with others like me that are struggling; people that I know
A regular group meeting with others like me that are struggling; people that I don't know
An in-person counselor, someone that I can talk to that can help me
A counselor on my phone or computer; someone that I can talk to that can help me
Family counseling; seeing a counselor as a group with other members of my family
Something you can do every day such as exercise or meditation
If you were to go to counseling, what would be important to you (please check all that apply)?
Ease of making the appointment
My privacy; I don't want anyone to know
Getting in to see someone right away
Not having to drive far
What is important to you about a counselor?
Their understanding of rural life
Their ability to listen
Their ability to connect with you
Whether you know them personally or not
Their years of experience in counseling
Their philosophy on faith
Their philosophy on whether to use medication
Please tell us anything else you would like us to know about about the mental struggles affecting you or someone you know, or anything else about how Arukah can help the mental health of the farming community.
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