Perceived Stress, Depression, and the Protective Role of Family Structure among Farmers in Rural Maharashtra, India: An Explanatory Sequential Mixed-methods Study

Abstract Background: Agricultural work represents a vocation with elevated risks shaped by factors such as financial volatility, environmental unpredictability, and professional pressures that negatively affect psychological health. Methods and Materials: An explanatory mixed-methods study was carried out. The quantitative phase involved a cross-sectional survey of 214 randomly selected farmers using the Perceived Stress Scale (PSS-10), Patient Health Questionnaire (PHQ-9), and Presumptive Stressful Life Events Scale (PSLES). The qualitative phase incorporated 15 in-depth interviews (IDIs) with farmers and key stakeholders to contextualize findings. Statistical Analysis: Data were analyzed using Jamovi (version 2.2.5). Descriptive and inferential statistics (Chi-square, Fisher’s exact test, t -test, and Spearman’s rank correlation) were applied. Multivariable binary logistic regression models were built ( N = 214) to identify independent psychological determinants, with P < 0.05 considered significant. Thematic analysis was used for qualitative data. Results: Moderate stress was reported by 50.9% (95% CI: 44.2–57.6%, n = 109), high stress by 18.3% (95% CI: 13.6–24.1%, n = 39), and low stress by 30.8% of the participants. Mild depressive symptoms were seen in 4% (95% CI: 2.1–7.4%, n = 9) of participants. In multivariable regression, a joint family structure emerged as a significant independent protective factor against moderate-to-high perceived stress (aOR = 0.306;95% CI: 0.122–0.769; P = 0.012). Key stressors included crop loss (60.7%), financial problems (43.5%), and large loans (29.4%). A positive correlation was found between stressful life events and depressive symptoms (ρ = 0.263, P < 0.001). Conclusions: While the incidence of clinical depression was low, the high perceived stress and regular exposure to detrimental life events indicate concealed psychological distress among farmers.