PROJECT SUMMARY / ABSTRACT
There is a growing mental health crisis among rural and agricultural communities in the U.S., including high
rates of depression, suicide, and substance use (Reidhead et al., 2020), with substantial economic and life
expectancy consequences (Stein et al., 2017). Social isolation (i.e., objective markers of little contact with
others) and loneliness (i.e., perceived isolation) are widely recognized as important determinants of health
(Cornwell & Waite, 2009) and suicide ideation (Klonsky & May, 2015) particularly in rural populations (Henning-
Smith et al., 2018b). Existential isolation (EI) is a third type of interpersonal isolation defined as the subjective
feeling that others do not understand one’s own subjective experiences (Helm et al., 2019). Research suggests
EI differs in substantive ways from loneliness and social isolation, including incremental validity over loneliness
in predicting depression and suicide ideation (Helm et al., 2020). Recent research has identified parallels
between the EI and rural mental health landscapes (i.e., greater prevalence among men, less intention to
utilize mental health services, associations with a fragmented cultural identity and community alienation),
suggesting EI may be a potent predictor of rural mental health outcomes. Yet no research has examined the
role of different types of isolation more generally, and the experiences of EI specifically, in agricultural and rural
populations, leaving a notable gap in our understanding of rural mental health. The proposed research seeks
to fill this gap and provide foundational insights toward identifying avenues for future targeted interventions. By
partnering with the University of Missouri Extension, the proposed research will utilize a multi-method approach
to identify the relationships between types of interpersonal isolation, mental health, and substance use in rural
and agricultural communities. Participants will be recruited from an existing database of farmers, ranchers, and
farm families identified by existing MU Extension outreach programs. An initial cross-sectional study will
assess interpersonal isolation, mental health, substance use, perceived community stigma towards mental
health, and attitudes towards mental health services to identify the prevalence and baseline relationships
between interpersonal isolation, social stigmas, and mental health. A subset of this initial sample will be
recruited for longitudinal assessments to examine temporal and mediational pathways between interpersonal
isolation, mental health, and substance use. An additional and independent subset of the initial cross-sectional
sample will be recruited to complete qualitative measures of personal experiences with isolation, mental health,
and community stigma to develop a deeper understanding of the lived experiences of rural and agricultural
community members. Consistent with NIH’s mission to increase understanding of health barriers and NIMHD’s
mission to support research that improves minority health and reduce health disparities, the proposed study
will increase understanding of how interpersonal isolation contributes to the mental health crisis in rural and
agricultural communities, with the goal of providing insights toward avenues for future targeted interventions.
