Does Telephone Coaching Improve Farmers' Mental Health in the Long Term? Results of the 12-and 18-month Follow-Up of a Pragmatic Randomized Controlled Trial

Farmers and related professionals are at risk of depression due to laborious work requirements, financial challenges, seasonal working conditions, high residence in under-resourced areas, and low help-seeking behavior. This study aimed to evaluate the long-term effectiveness of personalized telephone coaching in reducing depressive symptom severity and other mental health problems in farmers. Participating farmers with elevated depressive symptoms (PHQ-9 >= 5) were randomly allocated to receive up to six months of personalized telephone coaching (N = 160) or enhanced treatment-as-usual (TAU +) with psychoeducational material via mail (N = 154). The coaching was conducted by psychologists and personalized in terms of sessions frequency, duration, and content. Depressive symptom severity and other mental health and work-related outcomes were assessed at baseline, and long-term after 12 and 18 months. Group differences were determined by covariance analysis adjusting for baseline severity. Group differences were observed in favor of the telephone coaching compared to TAU + in depressive symptom severity (d12months = -0.34, d18months = -0.31), perceived stress (d12months = -0.41, d18months = -0.37), emotional exhaustion (d12months = -0.29, d18months = -0.28), and cynicism (d12months = -0.32, d18months = -0.34) at both follow-ups. Group differences in anxiety (d = -0.28) and quality of life (d = 0.30) were only observed at the 12-month assessment. No group differences were observed in depression onset, insomnia severity, panic and agoraphobia symptoms, alcohol consumption, professional efficiency, or self-reported prognosis of working capacity. Personalized telephone coaching as a promising remote prevention offer can reduce depressive symptom severity, generalized anxiety, perceived stress, emotional exhaustion, and cynicism, while additional support may be necessary to address aspects related to professional performance.Clinical trial registration: DRKS00015655