Rural SocioWgy 59(4), 1994, pp. 598-619Copyright © 1994 by the Rural Sociological Society

The Farm Crisis and Mental Health: A LongitudinalStudy of the 1980s1

Suzanne T. Ortega, David R. Johnson, Peter G. Beeson,* andBetty J. Craft**Department ofSociology, University ofNebraska-Lincoln,Lincoln, Nebraska 68588*Nebraska Department ofPublic Institutions, Lincoln, Nebraska 68509 and**College ofNursing, University ofNebraska Medical Center,Omaha, Nebraska 68198

ABSTRAGr This paper examines rural/urban differences and trends inmental health during the farm crisis of the 1980s in a large panel samplefrom a midwestern state. A community research perspective, which attri­butes differences to life styles, culture, and community context, is con­trasted with an economic stress perspective, which focuses on individualdifferences in economic circumstances as determinants of rural-urbandifferences in mental health. Survey samples from 1981, 1986, and 1989are used to examine differences among seven categories of communitytype. Multiple regression analysis of the trend and panel data providesupport for both the individual economic distress and community con­text models.

Introduction

During the 1980s, movies and news reports focused popular atten­tion on the psychological toll of the farm crisis. The media portrayedfarmers and rural residents as suffering from extreme emotionalstress that had the potential to erupt into violence or degenerateinto self-destruction. Not only was the rate of mental disorderamong farmers reported to be rising dramatically, widespread con­cern also was expressed that rural communities and social institu­tions were on the verge of collapse (Farney 1988; Riffer 1986; Wall1985). Precipitated in part by popular media attention, the 1980salso saw a revival of interest in rural mental health issues within thescientific community. Although a body of rural mental health re­search had existed for some time, the mid-1980s saw the develop­ment of an almost entirely new farm crisis literature. Empiricallyand conceptually, the new studies shared little with the earlier ruralcommunity mental health tradition. Thus, it is possible to identifytwo major traditions in rural mental health research, with the mid­1980s serving as a major point of demarcation.

I An earlier version of this paper was presented at the 1994 meeting of the MidwestSociological Society in St. Louis, MO. This research was supported by National Insti­tute of Mental Health grant ROIMH44317.

Farm Crisis - Ortega et al. 599

Rural-urban differences: the early approach

Compared with what is known about the problems of urban life,there is relatively little information on the quality of life and mentalhealth of rural Americans (Keller and Murray 1982). One reasonwhy scholars have historically given so little attention to rural mentalhealth issues has been the pervasive urban bias found in much ofthe social scientific literature. Given a simpler, more harmoniousand supportive way of life, scholars reasoned, rural residents wereunlikely to experience the myriad mental health problems found inurban communities. Thus, little rural mental health research wasconducted and what there was most often sought only to supportor debunk the popular image of urban pathology and rural bliss.Many of these studies were informed by the Chicago-school of com­munity research. Studies often gave a fairly detailed picture of themental health status of a particular rural community and thensought to interpret results within the context of the community/social disorganization model. In contrast to the later farm crisis lit­erature, the focus of much of earlier work was on the community­level factors and processes that influence psychological well-beingrather than on the role of individual experiences or events. As isalso true of the farm crisis literature, however, the studies seldomincluded an urban comparison group and findings across studieswere inconsistent.

In one of the earliest reviews of rural-urban differences in therate of mental disorder, Dohrenwend (1975) reported that of theeight studies (using data from ten study sites) he examined, onlyone study found a higher total rate of psychiatric disorder in a ruralsetting; one study reported no difference and eight reported a mar­ginally higher rate in urban communities. Findings with respect tospecific disorders were even more mixed. Nevertheless, Dohren­wend (1975) concluded that rates of schizophrenia, neurosis, andpersonality disorder usually were higher in urban areas but that ratesof functional psychoses and manic-depressive illness probably werehigher in rural areas. On the balance, the Dohrenwends (1971)concluded that overall rates of mental disorder are higher in urbanareas.

A number of scholars, however, have challenged the Dohrenwendconclusion (Srole 1978; Srole and Fischer 1978) and the debateremains largely unresolved. For instance, one study from the early1970s found that the percentage of respondents scoring as "prob­able cases" was 10.5 in rural areas, 14.9 in villages, and only 7.8 inurban areas (Schwab et al. 1974). In a 1981 review, Mueller con­cluded that existing evidence showed no clear pattern of rural-urbandifferences, at least when global screening instruments were usedto measure mental health. In a series of studies using epidemiolog-

600 Rural Sociology, Vol. 59, No.4, "Winter 1994

ical catchment area data, researchers found higher levels of depres­sion in urban areas, slightly higher alcohol dependence and abuserates in rural areas, and no community differences in most othertypes of disorder (Blazer et al. 1987; Crowell et al. 1986; George etal. 1986). The Colorado catchment study (Cialo et al. 1992), whichhad a more rural sample, found differences in depression betweenrural and urban counties that reflected high rates in central cities,low rates in suburban areas, relatively high rates in small towns, andlow rates in nonsuburban rural farm and nonfarm areas. Finally,Kessler et al. (1994) found few overall differences between urbanand rural communities in the rate or lifetime prevalence of mentaldisorder but did report a significantly lower likelihood of multiplemental disorders among rural residents during the 12 months pre­ceding the interview.

As Neff (1983) indicated, one reason why studies of some formsof disorder-depression, for example-yield contradictory results isthat researchers have given insufficient attention to the variabilitythat exists within and among rural communities. This criticism is atleast as true of the farm crisis studies as it is of the earlier work andis one of the major inadequacies in the literature that this paperaddresses.

The farm crisis

Until the farm crisis of the mid-1980s, research on rural mentalhealth remained a small and relatively peripheral part of psychiatricepidemiology. However, in response to the protracted downturn inthe agricultural economy, in reaction to widespread media attention,and in the wake of highly dramatic Congressional testimony (Hef­fernan and Heffernan 1985; Lasley 1986b), studies incorporatingrural areas increased. Rather than being based in the earlier tradi­tion of rural mental health research, the new work found its con­ceptual and methodological roots in the previous two decades ofresearch, which had demonstrated the consistent and rather strongrelationship between economic stress and mental health. If the men­tal health of rural residents was indeed declining in the 1980s, thelogic ran, it must be because of the enormous financial burdensindividual farmers and their families were experiencing. Accordingto this model, the relationship between a declining agriculturally­based economy and mental disorder is simply a special case of themore general relationship between economic and psychological dis­tress.

The focus of the farm crisis literature, then, has been on theexperiences of farmers and their families and research has generallybeen consistent with an individual stress model or process, such asthat outlined by Pearlin et al. (1981). One of the earliest and most

Farm Crisis - Ortega et al. 601

often cited farm crisis studies is the Heffernans' 1985 examinationof 42 Missouri farm families. In-depth interviews were conductedwith families that had been forced out of farming by the agriculturalcrisis. All of the women and all but one of the men indicated thatthey experienced depression at some point in the process of exitingfarming. More than half of the men and three-quarters of the wom­en continued to experience depression one year after losing theirfarm. Almost two-thirds of the men and women became withdrawnfrom family members and friends. Increased substance abuse (most­ly alcohol) was reported, and half the men and one-third of thewomen reported that they had become more physically aggressivetoward family members. Graham (1986) replicated the Heffernans'study on 28 New York families who had been forced from their farmsand found similar results. Studies of rural households in Iowa (Bul­tena et al. 1986; Conger and Elder 1994; Hoyt 1988; Lasley 1986a,1986b), Nebraska (Johnson and Booth 1990), North Dakota (Kett­ner et al. 1988), North Carolina (Schulman and Armstrong 1989),and Pennsylvania (Murray 1985) also have uncovered significant re­lationships between economic hardship and psychological distress.

In a somewhat different research vein, surveys of staff and clientsof rural community mental health agencies found an apparent in­crease in outpatient referrals and client visits during the mid-1980s(Ellis 1986; Hsieh et al. 1988; Joslin and Rosmann 1986; Mermel­stein and Sundet 1987). In these studies and others (Marotz-Baden1988; Nebraska Farm Crisis Hotline 1986; Olson and Schellenberg1986; Schellenberg et al. 1985), the increased incidence of ruralpsychological distress was explained primarily in terms of increasedeconomic pressures stemming from the farm crisis.

Difficulties with existing rural mental health research

Although the literature on the farm crisis has significantly expandedunderstanding of rural mental health needs, both the farm crisisliterature and studies conducted within the older rural communitytradition have a number of methodological flaws. First, and perhapsmost significant, studies lack a consistent definition of rural. Inmany studies, rural is simply defined as nonmetropolitan; in others,the experiences of farmers are taken as representative of the entirerural population. However, one of the most salient characteristics ofrural America is the heterogeneity of its population (Cordes 1989;Glenn and Hill 1977; Hardy and Ross 1990) and the diversity of itseconomic base. Failure to take this diversity into account means thatresearch regarding the farm or agricultural crisis may have beeninappropriately applied to rural America at large. Since the mid­1980s, economic recovery has taken place at different rates and todifferent degrees in the various rural economic sectors. Thus, re-

602 Rural Sociology, Vol. 59, No.4, "Winter 1994

search that documents the current mental health status of ruralresidents vis-a-vis their urban counterparts and that disentangles theshort- from long-term consequences of the farm crisis must takerural diversity into account.

In a related vein, rural mental health research seldom has beentruly comparative; studies infrequently include an urban comparisongroup or data from more than one point in time. Since mentalhealth measures seldom are consistent from study to study and sincemost of the rural studies have used small, nonrepresentative sam­ples, it is impossible to determine whether rural residents are anymore or less distressed than urban residents and whether their men­tal health status worsened over time.

In contrast, this study uses a representative statewide sample ofNebraskans in a panel design that includes residents of differenttypes of rural and urban communities who were interviewed in 1981,1986, and 1989. The well-known Warheit scale (Warheit et al. 1986)is used to assess three different types of mental impairment: de­pression, anxiety, and psychosocial dysfunction. The research re­ported here is generally guided by the stress model implicit in thefarm crisis literature. However, the results also have an explicit bear­ing on the earlier community mental health tradition. Specificallythe following basic questions are addressed: During the farm crisisperiod (1981-1989) was there a change in the prevalence of psy­chological symptoms among farm and rural populations? If so, wasthis change specific to, or more pronounced among, the farm pop­ulation? Are the observed changes in the prevalence of psycholog­ical symptoms among rural populations related to changes in per­sonal economic circumstances? If so, are personal economic factorsalone able to account for the effects of community type on levels ofpsychological impairment?

Methods

Study samples

The data used in this study were collected in three telephone surveysconducted in 1981, 1986, and 1989. The 1981 survey consisted of1,890 respondents representative of adults living in households inthe State of Nebraska. Sampling was done by random digit dialing.A random procedure was used to select the adult to be interviewedin the sampled selected households. Of the 1,878 respondents tothe 1986 survey, 60 percent were selected from the 1981 survey, andthe rest were new respondents also drawn by random digit dialingtechniques. The 1989 survey also involved a panel component. Allrespondents to the 1986 survey were included. The 1989 survey alsoincluded a sample of new respondents selected using similar sam­pling procedures but disproportionately stratified to overrepresent

Farm Crisis - Ortega et al. 603

specific areas. Fifty percent of the supplemental sample came fromrural counties, 40 percent from nonmetropolitan (nonmetro), and10 percent from metropolitan (metro). There were a total of 2,525respondents in the 1989 survey. Of these, 1,441 were from the 1986panel. Of the 1986 respondents, 985 were also in the 1981 survey(johnson et al. 1992). Analysis of the panel nonrespondents foundno evidence to suggest that they had higher rates of depression,alcohol use, or economic distress than respondents.

Three different, but overlapping samples drawn from these sur­veys are used. To retain as large and representative sample as pos­sible in each of the three years, the surveys are treated as separatecross-sections. To gain information on individual changes, sampleswere used consisting of individuals interviewed in 1981 and 1986and those interviewed in 1986 and 1989. Sample size was 985 forthe 1981-1986 panel and 1,441 for the 1986-1989 panel.

Measures oj mental health status

Mental health status was measured by three of the five scales devel­oped by Warheit (Schwab et al. 1979) and used in a number ofcommunity surveys throughout the United States (Warheit 1979;Warheit et al. 1975, 1976, 1986). These items are similar to generalimpairment scales such as the 22-item index (Langner 1962) andthe health opinion survey (Gurin et al. 1960; MacMillan 1957) buthave the additional advantage of subscales focused on symptom clus­ters. The depression measure is a summated scale of 17 items tap­ping sadness, feelings of rejection, despair, and inactivity. Anxiety isa 12-item scale measuring an abnormal sense of apprehension orfear felt by the respondent. The psychosocial dysfunction scale in­cludes 11 items gauging how much extreme worry and nervousnessaffect the respondent's social-role activity. These scales were devel­oped from a larger set of items and created through scale and factoranalysis in a large sample from a Florida county (Schwab et al. 1979).Reliability and validity tests conducted by Schwab et al. (1979) foundthe scales were able to differentiate between clinical and nonclinicalpopulations, were consistent with judgments of psychiatrists, andhad alpha reliability coefficients over 0.80. 2

Impairment scales, such as those used here, although not de­signed to differentiate specific psychiatric diagnosis, are generallygood measures of reaction to stress (Ross and Mirowsky 1989; Wiess­man et al. 1986). Johnson and Ortega (1991) found that the pat-

2 In this study, the depression scale (alpha = 0.80) ranges from 1 to 30 with a meanscore of 13.0. Anxiety (alpha = 0.80) has a mean of 4.9; respondents range from 0to 25. Finally, psychosocial dysfunction (alpha = 0.86) ranges from 0 to 20 with amean of 1.7. Potential responses to these items were based on 3 to 5 ordinal cate­gories of symptom frequency.

604 Rural Sociology, Vol. 59, No.4, Winter 1994

terns of relationships in an economic distress model developed byPearlin et al. (1981) yielded nearly identical results for the Warheitdepression scale and two other depression measures.

Community type and economic effects

Economic conditions are measured at two levels: aggregate and in­dividual. In keeping with the farm-erisis tradition, community typeis used as an aggregate-level indicator of differential exposure toeconomic distress. Because they are most directly dependent on theagricultural economy, farmers and ranchers are likely to have ex­perienced the greatest economic distress during the 1980s rural eco­nomic crisis. Rural nonfarm residents also are likely to have expe­rienced economic distress because of close ties to the farm economy.This tie is likely to decrease as community size becomes larger. Cityand metro residents are more removed from the effects of ruraleconomic crisis as economic conditions in these areas are more de­pendent on national trends. Respondents were classified into oneof seven residence categories: (1) farmers and ranchers (1,064 ofthe 6,293 in the cross-sectional samples), (2) rural nonfarm (522),(3) village (communities less than 1,000, 661), (4) small town (com­munities between 1,000 and 2,500, 604), (5) town (communitiesbetween 2,500 and 10,000 population, 768), (6) city (cities from10,000 to 50,000, 906), and (7) metro areas (cities over 50,000,1,768). In addition to the hypothesized differences in economic cli­mate, community type also indexes the variety of social and culturalfactors that were the focus of much early rural mental health re­search. The second economic measure is an individual-level indica­tor of the respondent's subjective evaluation of his or her own eco­nomic circumstances. The item asks: What about your financialprospects: Do you feel that you are better off this year (34.6%) thanyou were two years ago at this time, about the same (45.1 %), orworse off (20.2%)?

In the analysis of the 1986-1989 panel, one additional economicindicator is used. This is a summated scale of economic problemsthat respondents reported occurring to them in the three years be­tween 1986 and 1989. The greater the score, the more economicproblems reported. Seven items were used, including filing for bank­ruptcy, taking an extra job to make ends meet, and getting behindon bills or house payments; scores ranged from 0 to 6 with a meanof 1.9. The farm crisis tradition implies that community type influ­ences psychological distress primarily by influencing individual ex­posure to economic stressors. Controlling for individual financialprospects, according to this perspective, should largely eliminate theeffects of community type. Of course, communities also differ withrespect to a number of demographic variables that are known to

Farm Crisis - Ortega et al. 605

impact mental health. Thus, controls for respondents' age (range= 18-99, mean = 48.4), educational attainment (in years) (range= 0-27, mean = 13.0), and gender (females, 58%; males 42%) areincluded in most analyses.

Findings

Analysis of cross-sectional data.

First, the effect of year and community type on psychological stressin the cross-sectional sample is examined. The large sample size(6,293) relative to those found in the panel samples allows for morestatistical power in estimates of the effects of community type in thethree time periods.

A series of regression models examines the relationship of yearand community type to economic prospects and the three symptomsubscales (Table 1). Economic prospects, coded so that higherscores indicate worse prospects, is the dependent variable in models1 and 2. Because the reference group (omitted group) for the setof dummy variables representing community type is metro resi­dence, the coefficients for the residence categories represent differ­ences from metro areas. Findings from model 1 show that prospectswere significantly poorer in farm, village, and small-town areas. Thisindicates that compared with metro areas, economic pessimism ismore pronounced in the smaller communities. The only rural areawhere this is not the case is among rural nonfarm residents. Therural nonfarm category includes residents ofboth suburbs and ruralareas more distant from large cities, which may account for the dif­ference. Although prospects generally are worse in 1986, the overalldifference between 1981 and 1986 is not significant (b = -0.019).By 1989, however, economic prospects in the state were significantlybetter (b = -0.191). It would be expected that the trend in pros­pects would be quite different for farmers, as they were most im­pacted by the agricultural economic conditions which changed dra­matically between 1981 and 1986. A term added in model 2examines the interaction between year and farm residence and com­pares 1986 with the other two years combined. This term is statisti­cally significant (p< 0.01) and suggests that the decline in prospectsin 1986 is greater in the farm communities than in the other com­munities combined (no significant interactions by year for the otherresidence categories were found). This is consistent with the dete­riorating farm economy between 1981 and 1986 and the subsequentimprovement by 1989.

The relationship of residence and year to three measures of men­tal symptoms is presented in the remaining columns of Table 1. Theresults of the regression in model 3 show that depression was sig­nificantly higher overall in 1986 than in the other two years. The

~ 0\

Tab

le1.

Reg

ress

ion

mo

del

sfo

rcr

oss-

sect

iona

lan

alys

is(u

nst

and

ard

ized

regr

essi

onco

effi

cien

ts)

(N=

6,29

3)~ ~ .....

.E

cono

mic

pros

pect

sD

epre

ssio

n~

Ind

epen

den

tvar

iabl

es(1

)(2

)(3

)(4

)(5

)~'

Edu

cati

on-0

.01

3*

*-0

.01

3*

*-0

.30

9*

*-0

.30

9*

*-0

.28

8*

*~

Gen

der

(fem

ale

=2)

0.03

8*0.

039*

1.12

8**

1.13

2**

1.07

3**

Age

0.00

9**

0.00

9**

-0.0

31

**

-0.0

31

**

-0.0

44

·~ ~

Yea

ro

fsu

rvey

'

""19

81-0

.01

90.

028

-0.9

03

**

-0.7

29

**

-0.7

72

**

~\O

1989

-0.1

91

**

-0.1

41

**

-0.4

13

*-0

.23

3-0

.02

0~

Res

iden

ce"

Far

m0.

112*

*0.

055·

-0.3

42

-0.5

50

*-0

.63

3*

~4l.

.

Rur

aln

on

farm

0.05

6-0

.00

4-0

.55

0-0

.77

2*

-0.7

65

*~

Vill

age

0.08

1*0.

077*

0.18

30.

169

0.05

3S

mal

lto

wn

0.12

1**

0.11

7**

-0.5

31

-0.5

47

-0.7

23

*~

Tow

n0.

036

0.03

6-0

.42

2-0

.42

2-0

.47

6.....

..C

ity-0

.00

0-0

.00

1-0

.24

9-0

.25

0-0

.24

8\0

FAR

MX

1986

0.20

1**

0.72

7·0.

423

~

Eco

nom

icpr

ospe

cts

1.50

3**

Con

stan

t1.

567

1.53

317

.45

17.3

315

.02

R-s

quar

ed0.

086*

*0.

089*

*0.

030*

*0.

031*

*0.

057*

*

Tab

le1.

Co

nti

nu

ed

Anx

iety

Psy

chos

ocia

ldy

sfun

ctio

n

Ind

epen

den

tva

riab

les

(6)

(7)

(8)

(9)

(10)

(11)

Edu

cati

on-0

.344

**-0

.34

4*

*-0

.33

2-0

.06

9*

*-0

.069

**-0

.06

1*

*G

end

er(f

emal

e=

2)0.

817*

*0.

819*

*0.

785

0.49

5**

0.49

7**

0.47

4**

Age

0.04

5**

0.04

5**

0.03

7-0

.02

8*

*-0

.028

**-0

.03

3*

*

Yea

rof

surv

ey-

1981

-0.3

11

-0.2

32

-0.2

57

-0.5

93

**

-0.4

92**

-0.5

09

**

1989

-0.2

21

-0.1

40

-0.0

17

-0.3

76

**

-0.2

72

*-0

.18

9

Res

iden

ce"

~F

arm

-1.3

77**

-1.4

71**

-1.5

19

-0.5

81

**

-0.7

02**

-0.7

34

**

~R

ural

no

nfa

rm-0

.57

1*

-0.6

72

*-0

.66

8-0

.14

0-0

.26

9-0

.26

6V

illag

e-0

.27

5-0

.28

1-0

.34

8-0

.43

5*

*-0

.443

**-0

.48

8*

*

~Sm

all

tow

n0.

018

0.01

1-0

.09

0-0

.05

5-0

.06

5-0

.13

3T

own

-0.7

25**

-0.7

24

**

-0.7

56

-0.3

69

*-0

.36

8*

-0.3

90

**

City

-0.0

65

-0.0

65

-0.0

64

-0.0

83

-0.0

83

-0.0

83

IFA

RM

X19

860.

329

0.15

40.

420<

0.30

3~

Eco

nom

icpr

ospe

cts

0.86

70.

582*

*C

onst

ant

6.48

66.

430

5.09

93.

746

3.67

52.

782

~R

-squ

ared

0.06

8**

0.06

8**

0.07

8**

0.02

8**

0.02

9**

0.04

1*~ .....

•O

mit

ted

gro

up

is19

86.

I:l r--

bO

mit

ted

gro

ug

ism

etr0

fc0l

itan

.<S

iB"n

ifica

ntat

.05

leve

lon

e-ta

iled

test

).*

Sig

nifi

cant

at0,

05le

vel;

**S

igni

fica

ntat

0.01

leve

l.~ "I

608 Rural Sociology, Vol. 59, No.4, "'Winter 1994

coefficients for the six residence categories show that, with the ex­ception of villages, depression scores are lower in nonmetro areasthan in the metro reference category. However, none of these dif­ferences is statistically significant. In model 4 the interaction offarmresidence and year (1986) was added to the equation. The coeffi­cient for this term confirms the expectation that depression in farmareas was significantly higher in 1986 than in the other two years.Although the interaction term is only significant at the 0.05 levelwith a one-tailed test, this is an appropriate test as the effect is con­sistent with the direction expected. Regression model 5 has econom­ic prospects added to the equation. The interaction effect is reducedby about 40 percent and is no longer significant, suggesting that atleast part of the community effect on farmers' depression in 1986resulted from their poorer economic prospects. In fact, after con­trolling for economic prospects and the 1986/farm interaction, withthe exception of village residents, rural place of residence is asso­ciated with lower levels of depression, a finding consistent with theview of the early mental health literature that rural social structure,culture, or both are protective of the mental health of rural resi­dents.

Turning to the analysis of anxiety symptoms, no significant rela­tionship with year is found. Generally, anxiety is lower in more ruralareas-significantly lower than metro areas for farmers and ruralnonfarm residents. The interaction effect of farm residence by yearis not significant. Finally, economic prospect is not significantly re­lated to anxiety in this equation.

The pattern for psychosocial dysfunction more closely resemblesthat found for symptoms of depression. These dysfunctions are low­er in the more rural areas and all residence groups have lower scoresthan those found in the metro areas of the state. Dysfunction scoresalso are significantly higher in 1986 than in the other two years. Theinteraction of farm with year also is significant and follows the samepattern observed for depression. Finally, the interaction effect is re­duced to nonsignificance after controlling for economic prospects,indicating that the higher levels among farmers in 1986 reflectedthe economic problems.

In summary, the effects of residence, while modest, are consistentwith a model that expects lower levels of psychological disorder inthe rural areas and anticipates that farm areas will show the greatestresponse to changes in the economy over the 8-year span of thethree surveys. While residence and year work together to yield asignificant effect on these disorders, the small amount of varianceaccounted for in these models (2.8-7.8%) suggests the overall ef­fects of community and the farm crisis are modest. For example,farmers in 1986 compared to the pre- and post-crisis years averaged

Farm Crisis- Ortega et at. 609

only around three-fourths of a point more on the depression scale,which has a range from 1-30.

It is clear from these data that trends in individual perceptions ofeconomic prospects closely parallel trends in the state and nationaleconomy during the decade. Findings thus support two of the as­sumptions often found in the farm crisis literature about the impactof economic trends on individual lives: farmers did experience sig­nificant increases in individual economic stress during the first halfof the decade and by the mid-1980s farm economic distress anddepression exceeded that of metro areas. It is also clear that in theaggregate, individual economic distress explains some, but not all,of the community-level differences in depression and psychosocialdysfunction.

Analysis of change data

A second way to examine the relationship between community type,economic distress, and mental health is to focus on the individualswho were interviewed at two different times. In contrast to the cross­sectional analysis, a panel analysis reveals individual-level change inmental health status and in perceived financial prospects; it elimi­nates differences between samples as an explanation for the results.

The analysis will focus on two separate panels-respondents in­terviewed in both the 1981 and 1986 waves and those interviewedin both 1986 and 1989. The dependent variables are change in eachof the Warheit scales, estimated by including first-wave scores as anindependent variable in the regression. There are two major inde­pendent variables-a measure of change in financial prospects andcommunity type. Respondent's age in years, education, and genderare included as control variables. In the 1986-1989 panel an addi­tional measure of individual economic conditions-economic prob­lems since 1986-is included.

Community type is based on residence in the first wave and iscoded as a set of dummy variables to represent the seven categories.Some of the respondents moved to a different type of communitybetween waves of the panel and this move may have been in re­sponse to individual or community economic problems. Seventy per­cent of those farming in 1981 were still farming in 1986. Between1986 and 1989 (a shorter time period) 81 percent were still farmingthree years later. The most residential instability was found for therural nonfarm category; 48 percent (1981-1986) and 58 percent(1986-1989) of these residents remained in this category. For allother residence categories, the percent still residing in the sametype of community over the period between the waves was in therange from 83 to 94 percent. There was considerable movement inthe samples between the farm and the rural nonfarm category. This

610 Rural Sociology, Vol. 59, No.4, Winter 1994

mostly reflected persons who had retired from or otherwise leftfarming but who continued to live in the same rural residence.

For the 1981-1986 panel, models are presented before and afterincluding economic prospects in the equation (Table 2). The resultsyield a number of significant effects of residence on change in de­pression. Depression scores increased in all residence categoriescompared to the metro area, significantly so in five of the six. Thelargest increases were in the farm and city categories. When eco­nomic prospects in 1981 and 1986 were included in the equation,the effects for the residence categories generally are reduced, butseveral remain statistically significant. Thus, even though individual­level change in economic prospects (as measured by the 1986 score)is significantly related to depression, it only partially accounts formental health differences between communities.

Community effects in this panel are confined to the depressionscale; no significant residence effects are found in the analyses ofanxiety and psychosocial dysfunction. However, economic prospectsin 1981 and 1986 are significantly related to change in anxiety, andprospects measured in 1986 are significantly related to psychosocialdysfunction.

While most of the place of residence effects in the 1986-1989panel are found for depression, some effects do emerge for anxietyand psychosocial dysfunction symptom scales (Table 3). Mirroringthe improvement in the agricultural economy between 1986 and1989, farm households, relative to the reference metro group,showed a significant reduction in depression over this time period.Small towns also showed substantial and significant reductions indepression during this period, but rural nonfarm communities andvillages did not. These changes in depression occurred largely in­dependent of individual-level changes in either economic prospectsor problems. As shown in model 3, when prospects and problemsare included in the regression models, residence effects on depres­sion are unchanged. For the anxiety subscale, however, economicvariables did show a mediating effect. The significant effect amongrural nonfarm residents on anxiety is reduced to nonsignificanceafter the economic variables are included in the equation (models5 and 6).

The results for psychosocial dysfunction generally parallel thosefor depression in the 1986-1989 panel. For this variable, five of theresidence categories have significantly lower dysfunction scores thanfound in the metro area, but these effects do not change muchwhen economic stress variables are added to the equation. This pat­tern of results suggests that residence has a significant effect onchange in mental health status for some sets of symptoms and incertain years. Moreover, this effect is net of change in financial pros-

Tab

le2.

Reg

ress

ion

anal

ysis

of

sym

ptom

scal

esfo

rth

e19

81-1

986

pan

el

Psyc

hoso

cial

dysf

unct

ion

Ind

epen

den

tvar

iabl

es

Scal

esc

ore

in19

81A

geG

end

er(f

emal

e=

2)E

duca

tion

Dep

ress

ion

Anx

iety

(1)

(2)

(3)

(4)

0.54

2**

0.52

3**

0.61

8**

0.61

0**

0.01

30.

000

0.06

5**

0.05

5**

0.70

3*0.

594

0.36

10.

269

0.00

60.

014

-0.0

04

0.00

5

(5)

0.40

4**

-0.0

19

**

0.62

1**

0.00

5

(6)

0.39

8**

-0.0

24

**

0.55

3**

0.01

1

,Ref

eren

ceg

rou

pis

met

ropo

lita

n.*

Sig

nifi

cant

at0.

05le

vel;

**S

igni

fica

ntat

0.01

leve

l.

Res

iden

ce'

Far

mR

ural

no

nfa

rmV

illag

eSm

all

tow

nT

own

City

Eco

nom

icpr

ospe

cts

1981

Eco

nom

icpr

ospe

cts

1986

Con

stan

tR

-squ

ared

1.53

3**

1.40

7**

1.37

7**

1.25

00.

259

1.54

2*

3.61

30.

303

1.02

5*1.

133*

1.09

10.

867

0.10

61.

414*

*

0.20

71.

438*

*1.

461

0.32

1

-0.2

17

0.09

1-0

.48

5-0

.26

2-0

.24

80.

654

-1.4

20

0.38

6

-0.5

80

-0.1

18

-0.6

94

-0.5

47

-0.3

43

0.56

4

0.27

3**

1.01

1**

-3.3

16

0.40

4

0.43

10.

047

-0.1

29

0.01

3-0

.20

30.

166

0.93

80.

141

0.18

1-0

.07

7-0

.26

3-0

.16

6-0

.27

60.

112

0.03

40.

717*

*-0

.16

20.

162

~ ~ ~ I ~ ~ ~ ~ :- ~ '-

~ t\)

Tab

le3.

Reg

ress

ion

anal

ysis

of

sym

ptom

scal

esfo

rth

e19

86-1

989

pan

el~ i:l

Dep

ress

ion

Anx

iety

Psy

chos

ocia

ldy

sfun

ctio

n..... ~

Ind

epen

den

tvar

iabl

es(1

)(2

)(3

)(4

)(5

)(6

)(7

)(8

)(9

)~.

Scal

esc

ore

in19

860.

565*

*0.

606*

*0.

593*

*0.

611*

*0.

638*

*0.

634*

*0.

354*

*0.

384*

*0.

382*

*~

Gen

der

(fem

ale

=2)

0.08

80.

156

0.11

0-0

.15

0-0

.11

9-0

.13

20.

082

0.11

50.

096

Age

0.00

70.

006

-0.0

10

0.04

6**

0.03

3**

0.02

9**

-0.0

02

-0.0

09

-0.0

15

~E

duca

tion

-0.0

58

-0.0

73

-0.0

69

-0.0

68

-0.0

78

-0.0

77

-0.0

47

-0.0

61

*-0

.05

9I""

"

Res

iden

ce'

\.It

Far

m-0

.86

9*

-0.8

49

*-0

.91

6*

-0.3

00

-0.2

90

-0.3

09

-0.5

79

*-0

.59

9*

*-0

.59

9*

*~\O

Rur

aln

on

farm

-0.0

24

0.15

30.

133

-0.8

22

*-0

.67

4-0

.67

8-0

.77

2*

*-0

.66

5*

-0.6

61

*~

Vill

age

0.01

70.

227

0.14

5-0

.40

3-0

.26

0-0

.28

4-0

.86

8*

*-0

.75

1*

-0.7

73

**

Smal

lto

wn

-1.4

57

**

-1.0

73

*-1

.28

1*

-0.5

78

-0.3

73

-0.4

33

-0.8

26

**

-0.6

42

*-0

.71

3*

~-l::o

.

Tow

n0.

330

0.45

30.

381

0.26

00.

340

0.31

7-0

.33

5-0

.26

7-0

.29

2

~C

ity-0

.56

7-0

.52

7-0

.49

0-0

.23

0-0

.16

7-0

.15

5-0

.67

7*

*-0

.63

7*

*-0

.61

8*

*

Eco

nom

icpr

ospe

cts

1986

-0.0

04

-0.1

16

-0.0

23

-0.1

41

-0.0

87

-0.1

82

&'E

cono

mic

pros

pect

s19

891.

139*

*0.

945*

*0.

363*

0.18

20.

535*

*0.

381*

I-..<

Eco

nom

icpr

oble

ms

0.43

0**

0.38

2**

0.31

6**

~C

onst

ant

4.08

75.

599

4.57

10.

517

1.56

01.

211

1.10

32.

156

1.69

1-l::

o.R

-squ

ared

0.41

40.

389

0.40

30.

447

0.43

40.

436

0.25

60.

220

0.23

2

aR

efer

ence

gro

up

ism

etro

poli

tan.

*S

igni

fica

ntat

0.05

leve

l;**

Sig

nifi

cant

at0.

01le

vel.

Farm Crisis- Ortega et al. 613

pects; controlling for prospects only marginally changes the degreeof the relationship."

In sum, individual-level changes in depression generally are con­sistent with the economic trends occurring in the state over theperiod of time covered by the study. Farmers showed the greatestincrease in depression between 1981 and 1986, a period that in­cludes the height of the agricultural crisis; by 1989, both the eco­nomic prospects and the depression of farm residents had returnedto roughly pre-crisis levels. Thus, individual-level change in depres­sion corresponds to economic trends at the aggregate level. How­ever, the relationship between the two is not simply a function ofeconomic changes occurring at the individual level. Because a con­trol for change in individual perception of financial prospects didlittle to reduce the effect of residence on change in mental healthstatus, it appears that community economic climate has mentalhealth consequences beyond those stemming from their impact onrespondents' personal financial prospects.

3 Several tests were performed to evaluate whether these findings were robust withrespect to the changes in residence over the panel, differences in samples, interactioneffects between type of community and the effects of individual economic variableson the symptoms scales, and the presence of a small number of outliers or influentialcases. Analysis models were repeated in which both place of residence in the firstwave and place of residence in the second wave were included. While highly collinear,place of residence in the second wave did not contribute a statistically significanteffect (0.05 level) beyond the effect of residence in the first wave to prediction ofthe three symptoms scales.

The relatively weak effect of the individual economic variables in explaining thereduction in depression and psychosocial dysfunction may reflect a different rela­tionship between economic prospects and stresses in different types of communities.This was tested by including interaction terms between the economic indicators andcommunity time. None of these was statistically significant, nor did the pattern ofthe coefficients suggest such a pattern. A small number of cases with substantialchanges in symptom scores over the panel period may possibly account for some ofthe effects observed. For example, the large increase in depression noted in the citiesbetween 1981-1986 and for small town between 1986-1989 may reflect the influenceof one or two persons making very large changes in depression. Cook's D (Fox 1991)was used to identify influential cases and the analysis was repeated with these casesremoved. While these had small effects on some of the estimates, the overall patternof findings we reported here did not vary; results apparently are not due to a smallnumber of influential cases. Finally, it is possible that substantial differences betweenthe respondents in the 1981-1986 and the 1986-1989 panels are responsible for thedifferent direction and pattern of community effects observed. The 1986-1989 re­gression analyses were repeated including only those respondents who were also inthe 1981-1986 panel. This reduced the sample size to 793 but did not alter the basicpattern of effects. For example, farm and town residents were still found to showsignificant relative reductions in depression and the economic variables did little toreduce this effect. These tests demonstrated that the findings in the panels wererobust with respect to interaction effects, influential cases, and sample biases.

614 Rural Sociology, Vol. 59, No.4, Winter 1994

Discussion and conclusions

The results indicate a specific relationship between the economicchanges associated 'with the farm crisis of the 1980s and the preva­lence of psychological symptoms among rural populations. In fact,the rate of depression among farmers appears to be directly tied tochanges in the farm economy.' These findings suggest social factorsand life events are part of the etiology of mental disorder (Cock­erham 1981) and economic stress may be a cause of mental disorder(Aldwin and Revenson 1986; Brenner 1973; Dooley and Catalano1980; Horwitz 1984).

Although individual economic prospects account for some of thevariation between communities in levels of psychological symptoms,they do not account for all of the difference. Results from this studyindicate that the economic context of community of residence, com­munity social structures, or urban/rural cultural differences alsomay have effects on mental health beyond their relationships to theperceived economic situation of the household; but exactly how orwhy they do so remains unclear. Some part of the difference inpsychological symptoms between rural and urban communities may,in fact, be something akin to the Heffernan and Heffernan (1986)concept of community depression. Further research is needed toexplore this finding more completely and to determine whether thiseffect is the result of social contagion (Turner 1957), social disor­ganization such as the decline of community social institutions (Farisand Dunham 1939), the weakening of social support networks (My­ers et al. 1975), or community attachment or integration (O'Brienet al. 1994). Studies with more complete measures of the householdand community economy, formal and informal support structures,specific mental disorders, and cultural responses to stress and help­seeking in the research design are needed before the mental healthconsequences of living in a declining or growing economic climatecan be assessed accurately.

The findings suggest that service providers must respond to anyeconomic crisis with both individual and community level mental­health prevention and intervention programs such as those devel­oped in response to the farm crisis (Cecil 1988; Benjamin 1988;Thompson and McCubbin 1987;Joslin and Rosmann 1986; Coulamet al. 1990). Programs designed to help rural residents through eco­nomic crisis-career counseling, job retraining, financial counsel­ing, and legal aid, for instance-should screen for depression and

• Nearly 30 percent of those fanning in 1981 had left fanning by 1986; between1986 and 1989 an additional 19 percentwere no longer fanning. In many ways, then,this study is based on a sample of survivors and, therefore, the finding that the farmcrisis produced symptoms of depression and changes in psychosocial functioningamong them is all the more noteworthy.

Farm Crisis- Ortega et al. 615

psychosocial impairment and have mechanisms in place to respondto clients with mental health needs. Untreated, depression is likelyto seriously limit the ability of individuals to benefit from programsdesigned to provide new economic opportunities. However, it is alsoimportant that mental health practitioners and policy makers rec­ognize that psychological symptoms are both situational and dynam­ic. On balance, mental health returned to pre-farm-erisis levels fol­lowing an upturn in the farm economy. Thus, mental healthintervention in the absence of efforts to improve rural economicopportunities and personal economic circumstances may do little toimprove the well-being of the farmers and rural residents.

Finally, results from comparisons of mental health symptomsacross a range of different sized communities raise questions aboutthe classification of communities on a rural-urban continuum. Thepattern of effects indicates that differences between the seven com­munity-type categories do not follow a strict continuum from moreto less rural. While the differences between community types-es­pecially different rural community types-were generally small,some of these differences correspond neither to incremental differ­ences in community size nor to some general pattern of a decliningrural economy. Future research must use more than two or threecategories to measure urban-rural differences and must incorporatemeasures capable of detecting fundamental differences in the socialorganization and culture of different types of communities. Findingsfrom this study demonstrate, for instance, that economic distresswithin certain industries (in this case agriculture) can have pro­nounced negative effects on the residents (in this case farmers) ofcommunities dependent on that industry. Future research is neededto ascertain whether similar patterns might be found as a result ofeconomic decline in mining, lumber, fishing, or other rural indus­tries or in any urban or suburban community that is dependent ona single, declining economic base; research also must begin to iden­tify those aspects of rural and urban culture and lifestyle that me­diate the relationship between declining local economies, personaleconomic hardships, and psychological distress.

References

Aldwin, C. M., and T. A. Revenson1986 "VUlnerability to economic stress." American Journal of Community Psy­

chology 14:161-75.Benjamin, M. L.

1988 "The rural crisis recovery act of 1987." Rural Community Mental Health15:3.

Blazer, Dan, Bradford A. Crowell, and Linda K. George1987 "Alcohol abuse and dependence in the rural South." Archives of General

Psychiatry 4:736-40.

616 Rural Sociology, Vol. 59, No.4, Winter 1994

Brenner,j. H.1973 Mental Illness and the Economy. Cambridge: Harvard University Press.

Bultena, Gordon, Paul Lasley, andjack Geller1986 "The farm crisis: patterns and impacts offinancial distress among Iowa farm

families." Rural Sociology 51:436--48.Cecil, H. F.

1988 "Stress: country style." journal of Rural Community Psychology 9:51-60.Cialo,james A., David L. Shern, Dan L. Tweed, Lee A. Kirkpatrick, and Natalie Sachs­Ericsson

1992 "The Colorado social health survey of mental health service needs: sam­pling, instrumentation, and major findings." Evaluation and Program Plan­ning 15:133-47.

Cockerham, W. C.1981 Sociology of Mental Disorder. Englewood Cliffs,!'U: Prentice-Hall.

Conger, Rand D., and Glen H. Elder1994 Families in Troubled Times: Adapting to Change in Rural America. New

York: Aldine De Gruyter.Cordes, Sam M.

1989 "The changing rural environment and the relationship between health ser­vices and rural development." Health Services Research 23:757-84.

Coulam, R. F., D. S. Hargrove, and T. H. Lentner1990 "NIMH funded rural mental health demonstration projects: technical assis­

tance report." Rural Community Mental Health 17:1-16.Crowell, B. A., L. K. George, D. Blazer, and R. Landennan

1986 "Psychosocial risk factors and urban/rural differences in the prevalence ofmajor depression." Britishjournal of Psychiatry 149:307-14.

Dohrenwend, Bruce P.1975 "Sociocultural and social-psychological factors in the genesis of mental dis­

orders." journal of Health and Social Behavior 16:365-92.Dohrenwend, Bruce P., and Barbara Snell Dohrenwend

1971 The prevalence of psychiatric disorder in urban vs. rural settings. Proceed­ings of the 5th World Congress of Psychiatry. Mexico City, Mexico.

Dooley, D. C., and R. Catalano1980 "Economic change as a cause of behavioral disorder." Psychological Bulle­

tin 87:450-68.Ellis, Richard A.

1986 Survey of factors associated with admissions to mental health centers inrural and urban Colorado counties. Denver, CO: Colorado Division ofMen­tal Health.

Faris, R. E., and H. W. Dunham1939 Mental Disorders in Urban Areas. Chicago: University of Chicago Press.

Farney, Dennis1988 "In Iowa, mental anguish still racks families, taxes social workers, even as

farm crisis abates." Wall Streetjournal CCXI(97) (May 18):70.Fox,john

1991 Regression Diagnostics. Newbury Park, CA: Sage.George, Linda K., Dana C. Hughes, and Dan G. Blazer

1986 "Urban/rural differences in the prevalence of anxiety disorders." Americanjournal of Social Psychiatry 6:249-58.

Glenn, Norval D., and Lester Hill1977 "Rural-urban differences in attitudes and behavior in the United States."

Annals of the American Academy of Political and Social Science 429:36-50.Graham, K. H.

1986 A description of the transition experiences of 28 New York farm familiesforced from their farms: 1982-1985. Master's thesis, Cornell University, Ith­aca, NY

Farm Crisis- Ortega et al. 617

Gurin, Gerald,Joseph Veroff, and Shiela Feld1960 Americans View Their Mental Health. New York: Basic Books.

Hardy, T. F., and P.J. Ross1990 An Update. The Diverse Social and Economic Structure of Non-Metropol­

itan America. Staff Report No. AGES9036. Washington, DC: Economic Re­search Service, Department of Agriculture.

Heffernan, William, and Judith Heffernan1985 The effects of the agricultural crisis on health and lives of farm families.

Testimony presented before the Committee on Agriculture, U.S. House ofRepresentatives (May 6), Washington, DC.

1986 "The farm crisis and the rural community." Pp. 99-153 in Subcommitteeon Agriculture and Transportation, New Dimensions in Rural Policy: Build­ing upon our Heritage. Joint Economic Committee. Washington, DC: Con­gress of the United States.

Horwitz, A. V.1984 "The economy and social pathology." Annual Review of Sociology 10:95­

119.Hoyt, Danny R.

1988 "Economic stress and mental health in rural Iowa." Unpublished manu­script, Department of Sociology and Anthropology. Ames, IA: Iowa StateUniversity.

Hsieh, Hudson H., Mujeeb H. Khan, Shih-Chuan Cheng, andJohnJ. Curran1988 "Increased drinking and the farm crisis: a preliminary report." Hospital

and Community Psychiatry 39:315-16.Johnson, David R., and Alan Booth

1990 "Rural economic decline and marital quality: a panel study of farm mar­riages." Family Relations 39:159-65.

Johnson, David R., and Suzanne T. Onega1991 Measuring depression: an empirical comparison of diagnostic and magni­

tude scaling methods. Paper presented at the Midwest Sociological Societymeeting. Des Moines, IA.

Johnson, David R., Suzanne T. Onega, Peter G. Beeson, and Betty Craft1992 Economic Decline and Psychosocial Impairment: Methodology Report. De­

partment of Sociology. Lincoln, NE: University of Nebraska-Lincoln.Joslin, F. S., and M. R. Rosmann

1986 Mental health assistance for farm crisis victims. Paper presented at the Na­tional Association for Rural Mental Health conference. East Lansing, MI.

Keller, Peter A., andJ. Dennis Murray1982 Handbook of Rural Community Mental Health. New York: Human Sciences

Press.Kessler, Ronald C., Katherine A. McGonagle, Shanyang Zhao, Christopher B. Nelson,Michael Hughes, Suzann Eshleman, Hans-Ulrich Wittchen, and Kenneth S. Kendler

1994 "Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders inthe United States." Archives of General Psychiatry 51:8-19.

Kettner, K. A., J. Geller, R. L. Ludtke, andJ. Kelly1988 "Economic hardship and stress among farm operators in North Dakota: the

buffering effect of social support." Great Plains Sociologist 1:69-88.Langner, Thomas S.

1962 "A twenty-two item screening score of psychiatric symptoms indicating im­pairment." Journal of Health and Social Behavior 3:269-76.

Lasley, Paul1986a "Iowa Farm and Rural Life Poll-Summary, Spring 1986." Department of

Sociology and Anthropology, Cooperative Extension Service. Ames, IA: IowaState University.

618 Rural Sociology, Vol. 59, No.4, Winter 1994

1986b The human toll of the farm crisis. Testimony prepared for a hearing onthe Select Committee on Children, Youth, and Families of the U.S. Houseof Representatives. Galesburg, IL.

MacMillan, Allister M.1957 "The health opinion survey: technique for estimating prevalence of psycho­

neurotic and related types of disorders in communities." Psychological Re­ports 3:325-39.

Marotz-Baden, Ramona1988 "Stressors: a rural-urban comparison." Pp. 74--82 in R. Marotz-Baden, C.

Hennon, and R. Brubaker (eds.), Families in Rural America: Stress, Adap­tation, and Revitalization. St. Paul, MN: National Council on Family Rela­tions.

Mermelstein,Joanne, and Paul A. Sundet1987 "Rural community mental health centers' responses to the farm crisis."

Human Services in the Rural Environment 10:21-26.Mueller, D.

1981 "The current status of urban-rural differences in psychological disorder: anemerging trend for depression." Journal of Nervous and Mental Disease169:18-27.

Murray,J. D.1985 "The small farm: economic and emotional stress." Rural Community Men­

tal Health Newsletter 12(1):12-13.Myers,J. K.,].]. Lindenthall, and M. P. Pepper

1975 "Life events, social integration, and psychiatric symptomatology." Journalof Health and Social Behavior 16:421-27.

Nebraska Farm Crisis Hotline1986 Rural Stress Project Final Report. Lincoln, NE: Interchurch Ministries of

Nebraska.Neff,James Alan

1983 "Urbanicity and depression reconsidered: the evidence regarding depres­sive symtompatology,' Journal of Nervous and Mental Disease 171:546-52.

O'Brien, David]., Edward W. Hasinger, and Larry Dershem1994 "Community attachment and depression among residents in two rural mid­

western communities." Rural Sociology 59:255-65.Olson, Kenneth R., and Richard P. Schellenberg

1986 "Farm stressors.' AmericanJournal of Community Psychology 14:555-69.Pearlin, Leonard I., Elizabeth G. Menaghan, Morton A. Lieberman, and Joseph T.

Mullan1981 "The stress process." Journal of Health and Social Behavior 22:337-56.

RifIer, Joyce1986 "Rural areas hit hard by growing mental health need." Hospitals 60(August

5):62.Ross, Catherine E., and John Mirowsky

1989 "Explaining social patterns of depression: control and problem solving-orsupport and talking." Journal of Health and Social Behavior 30:206-19.

Schellenberg, R., K. Olson, and D. Fuller1985 Burnout and stress in farmers. Paper presented at the National Association

for Rural Mental Health summer conference, Ithaca, NY.Schulman, Michael D., and Paula S. Armstrong

1989 "The farm crisis: an analysis of social psychological distress among NorthCarolina farm operators." American Journal of Community Psychology 17:423-41.

Schwab,JohnJ., Roger A. Bell, GeorgeJ. Warheit, and Ruby B. Schwab1979 Social Order and Mental Health: The Florida Health Study. New York: Brun­

ner/Mazel, Publishers.

Farm Crisis- Ortegaet al. 619

Schwab,JohnJ., George]. Warheit, and Charles E. Holzer III.1974 "Mental health: rural-urban comparisons." Mental Health and Society 1:

265-74.Srole, Leo

1978 "The city versus town and country: new evidence on an ancient bias." Pp.433-59 in L. Srole and A Kassan Fischer (eds.), Mental Health in the Me­tropolis (rev. ed.). New York: New York University Press.

Srole, Leo, and Anita Kassan Fischer (eds.)1978 Mental Health in the Metropolis (rev. ed.). New York: New York University

Press.Thompson, E. A, and H. I. McCubbin

1987 "Farm families in crisis: an overviewof resources." Family Relations 36:461-67.Turner, R H., and L. M. Killian

1957 Collective Behavior. Englewood Cliffs, !'IT: Prentice-Hall.Wall, Wendy L.

1985 "Farm crisis is taking subtle toll on children in distressed families." WallStreetJournal CCVI(92) (November 7):1,22.

Warheit, George J.1979 "Life events, coping, stress, and depressive symptomology,' AmericanJour­

nal of Psychiatry 136:502-7.Warheit, George]., Roger A Bell,JohnJ. Schwab, and Joanne M. Buhl

1986 "An epidemiologic assessment of mental health problems in the Southeast­ern United States." Pp. 191-208 in M. Weissman,]. Meyers, and C. Ross(eds.), Community Surveys of Psychiatric Disorder. New Brunswick, NJ: Rut­gers University Press.

Warheit, George J., Charles E. Holzer III, and Sandra A hey1975 "Race and mental illness: an epidemiologic update." Journal of Health and

Social Behavior 16:243-56.Warheit, George J., Charles E. Holzer, Roger A Bell, and Sandra A hey

1976 "Sex, marital status and mental health: a reappraisal." Social Forces 55:459-70.Weissman, Myrna M.,Jerome K. Myers, and Catherine E. Ross (eds.)

1986 Community Surveys of Psychiatric Disorders. New Brunswick, NJ: RutgersUniversity Press.