Myra Badger, a Family & Community Wellness extension agent in Ward County, leads a QPR training session in 2025. Provided by NSDU Extension.
BISMARCK, N.D. (North Dakota News Cooperative) – Are you doing okay? I’m here if you need to vent. How can I help? I know you’re going through a rough patch.
Melissa Markegard, North Dakota Health and Human Services suicide prevention administrator, said an important piece of suicide prevention is having the conversations that may look hard or uncomfortable from the outside, but don’t necessarily have to be.
“This is a conversation to say hey, I see you, I see that there’s a lot going on in your life right now. We all know it, let me know if you need something,” Markegard said.
Shoot a text. Grab a coffee. Get dinner. Just getting together with someone going through a hard time might make a big difference, she said.
“I think suicide prevention is all of us, as community members and human beings, paying attention to what’s happening to one another,” Markegard said.
Currently, that’s not happening enough, particularly when it comes to working-age men who may be struggling across the state.
High risk
Nationwide, farmers have a rate of suicide 3.5 times higher and veterans have a 58% higher risk than the general population.
In North Dakota, the number hovers around 10-15 farmer suicides per year, according to Markegard. Data from the U.S. Department of Veterans Affairs shows an average of 20 veteran suicides annually in the state.
Around 80% of suicides in North Dakota are men, with some of the highest rates compared to overall population in rural counties. In 2023, veterans accounted for a little over 13% of the 146 suicides in the state.
Preliminary data shows a slight uptick in the next two years, with 148 suicide deaths in 2024 and 162 in 2025.
Over the past 20 years, North Dakota had a 57% increase in suicide rates, which was the highest increase in the nation.
Men struggling with hopelessness, depression, anxiety, addiction or other mental health challenges are less likely to call hotlines or seek help through therapy.
According to a new study from Crisis Text Line, a nonprofit working with the national 988 Suicide & Crisis Lifeline, analyzing 1.5 million text messages to the hotline found that only 20% identified as male.
Markegard notes that all calls and texts to the 988 line in North Dakota are routed to counselors based in the state who may have a better understanding of the local situation, and would only go out of state if they are occupied with other clients.
High stress
Bridgette Readel of agriculture consulting service Ag Mafia, who lives in Hunter, ND, said a rash of six suicides in the region late last summer into early fall shows the high stress many farmers are under at the moment.
High input costs, the uncertainties related to trade and global supply chains, and lower commodity prices add up along with things like family dynamics, a sense of isolation, and communities where farms are larger but towns are not.
Readel said that more openness and a willingness to talk can work, and that one-on-one conversations with trusted, discreet sources is most successful.
“I have a couple of farmer friends who have struggled, either themselves, with addiction or depression or anxiety, or in their families, and they’re willing to talk one-on-one with others,” Readel said.
Readel said it is important for residents in smaller towns and rural areas to take training like Question-Persuade-Refer or QPR, offered by groups like NDSU Extension, or a mental health first aid course to increase the ability for those seeking help to have discreet one-on-one discussions.
Adriana Drusini, program coordinator for Farm and Ranch Stress at NDSU, said the ideal candidates for QPR training are spouses of farmers.
“That’s the person they have close and they can trust,” Drusini said. “So, if the wives attend the trainings or somebody in the immediate family, they are going to be equipped with the skills to ask the questions, to figure out what’s going on and to help people before they put that suicidal idea in their minds.”
Local religious leaders, healthcare professionals, or other community leaders are also prime candidates for such training, practitioners say, as is increasing telehealth penetration or one-on-one house calls.
More focus on setting a self-care regimen – regular exercise, a healthy diet, lower alcohol consumption, adequate sleep – would be ideal, but juggling all that is difficult for men with high-pressure professions.
For farmers, whose jobs require long hours where they are making decisions all day, coupled with weather fluctuations and a packed but variable family schedule, finding that time daily can be difficult to impossible.
Successful interventions
Markegard said she’s seen success in some of the couples’ retreat programs for farmers in several locations across the state.
“It’s really fantastic for building connections because we’ve found farmers, or rural guys, don’t like to talk about all this, even with their wives,” Markegard said. “The couples’ retreats really get them communicating, and communicating appropriately, and it’s not just them but they’re with other couples who have the same types of experiences.”
Florence Becot, a rural sociologist at Penn State who focuses on rural mental health challenges, said another aspect of the pressure on farmers is the sense that communities aren’t what they once were.
“There’s this sense that there’s been a dismantling of rural communities and people are mourning that,” Becot said. “I think that has really come up in our interviews, and in a survey that we did over the winter of 1,700 farmers, that sense of a loss of what we had, a sense that we don’t have neighbors like we used to.”
That increases the importance of interventions around creating community, creating third spaces, and other opportunities for farmers or veterans to decompress outside of their grinding day-to-day work that doesn’t necessarily involve a local bar, those in the space say.
Other initiatives, such as the Black Box Project, spearheaded by the national group Stop Soldier Suicide, have involved families who are the victims of suicide attempts to prevent it from happening to others.
The project allows researchers working with the families to scour the digital history of a suicide victim from phones and computers to try to find out why the person got to a crisis point in the first place.
First started with veterans, the group is looking at extending this to other high-risk groups.
Keith Hotle, CEO of Stop Veteran Suicide, who also worked as a senior public health administrator at the Wyoming Department of Health for 10 years, said the program is helping build interventions before a person gets to a crisis point.
“When we go back and look at what that digital private life was like the three months before they died, we see these spikes in risk factors, it’s very much like an EKG, it spikes up and down,” Hotle said.
This includes increases in sleep disturbances, people living a very different digital life compared to what they’re presenting in real life, and a gradual withdrawal from their normal connectivity to friends and family in the weeks and months before their death, he said.
Teaching people how to have conversations with those who are struggling is one of the most helpful aspects, Hotle said.
“Ultimately, the best gatekeepers are those who live within the home,” Hotle said.
For the wider community, thinking about the unique aspects each area has is something to create connectivity and build support around, he said.
“That’s not just an escape valve, but it builds that infrastructure of connectivity,” Hotle said.
Locally, the North Dakota HHS is currently rolling out more suicide prevention support and training for rural healthcare providers, with a $400,000 grant from the Rural Health Transformation Program that it hopes can make more inroads.
While the award has not yet been granted, the organization selected will work with rural and tribal healthcare providers to coordinate training, technical assistance and standardize screening.
This will include more routine screenings by clinical healthcare providers, strengthening referral protocols and standardizing follow-up procedures following attempted suicides.
Additionally, NDSU Extension will have a free suicide prevention webinar on May 28 for those interested in learning more. Registration is available at ndsu.ag/QPR-May-2026 or by contacting Drusini at adriana.drusini@ndsu.edu or Sean Brotherson at sean.brotherson@ndsu.edu
Editor’s note: If you or someone you know is struggling with thoughts of self-harm or suicide, call the National Suicide Prevention Lifeline at 988 or contact the Crisis Text Line by texting TALK to 741741.
The North Dakota News Cooperative is a nonprofit news organization providing reliable and independent reporting on issues and events that impact the lives of North Dakotans. The organization increases the public’s access to quality journalism and advances news literacy across the state.
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