North Dakota ranked 12th in the United States in suicide rate per 100,000 citizens, and the Centers for Disease Control and Prevention published a widely cited study in July 2016 pointing to high rates of suicide among rural farmers.

"You have to consider the economic scenario facing farmers today. We're looking at a drop in income of about 65 percent comparative to what farmers in North Dakota were making in 2016," Mark Watne, president of the North Dakota Farmers Union, said. "It's quite hard to plan that much of a decline. That financial stress on farmers is certainly a contributing issue, but there's also a disadvantage to being the center of North America. Our shipping costs and the logistical costs associated with getting our supplies tend to make our pricing point a little higher and thus makes it more difficult for our farmers who may be paying some of the highest costs in the nation."

Addressing other concerns of North Dakota farming, Watne spoke of the weather conditions.

"We have quite a bit of uniqueness to our weather and as a result have a very short growing seasons," he said. "Our extremities in crop insurance have resulted in us participating at levels far greater than by those farmers in other areas of the country. We do have more extreme weather conditions that may impact crops and ultimately place time constraints on our farmers to harvest and sow-constraints that may be a contributing factor to the mental health concerns."

A University of Iowa study indicated that over the two previous decades, farmers and ranchers were found to average a rate of suicide 3.5 times that of the general population. This finding rings similarly to a finding touted by the CDC in 2016 that suicide rates were nearly five times the average.

The CDC retracted that report in June of this year, citing coding errors for certain occupational groups. In early November, the CDC released their study with new information that appeared to refute their previous claim that farmers and ranchers held an unusually high rate of suicide. The new study ranked farmers and ranchers eighth and ninth, respectively, among major occupational groups. This new report seemed to indicate that the national average of suicide in agriculture was aligned with the overall average.

A deeper dive into the numbers revealed, however, that the suicide rate for male "Farmers, Ranchers, and Other Agricultural Managers" was double that of the general population even after the "coding errors" were corrected.

The two conflicting CDC reports have fostered confusion in academia and within the mental health community as to the seriousness of the mental health concerns in agriculture-but all sides agree that rural America, regardless of profession, remains a hot-spot of mental health concern.

"Those of us who work with farmers on a daily basis know that mental and behavioral health is a major concern in farming communities," Carlotta McCleary, executive director of Mental Health America of North Dakota, said. "Over the past couple years, as family farmers' and ranchers' typical stresses have been compounded by the state of the farm economy, the issue has come to the forefront. All available research backs these concerns and reinforces the need to improve access to mental health services in rural areas."

Suicide rates represent the most dreaded outcome of mental health problems and fall short of painting a complete picture of behavioral health among farmers and farmworkers.

"There is still a stigma around mental health," McCleary said. "It's alarming and it's something that we should pay attention to."

Speaking to how Mental Health America of North Dakota has sought to tailor information and resources to those most at risk, McCleary said that her organization has a history of providing services to rural areas for farm stress.

"Statistics simply cannot be used to provide a comprehensive view of an issue as complex and deeply personal as one's mental well-being," McCleary said. "Instead, they're used to supplement the narratives and more concisely quantify and illustrate concern. There is hope out there; there are ways of getting resources. We need to talk more with one another, and by being more of a community we can help overcome the stress and reduce the suicide rates."

The National Suicide Prevention Lifeline is a national network of local crisis centers that provide free and confidential emotional support to people in suicidal crisis or emotional distress at 1-800-273-8255 or by texting to 211.