It's not just the long hours in the hot sun, the grueling back-bending labor that can stress a migrant farmworker.
Health care professionals say social isolation and the threat of immigration enforcement and deportation are causing mental health issues for farmworkers, and those problems -- from anxiety to depression to Post-Traumatic Stress Disorder -- can take a toll on their bodies and ability to work.
"Immigration is a mental health issue because it puts so much stress on parents and families," said Roger Rosenthal, a lawyer and director of the Migrant Legal Action Program based in Washington, D.C. "Stress yields physical ailments."
Rosenthal said many migrant health clinics throughout the country are reporting they are seeing fewer farmworkers because they fear a doctor's visit could reveal their illegal status, and result in their expulsion from the country.
He was among the speakers during the 20th annual Midwest Stream Farmworker Health Forum from Nov. 18-20 in Austin, Texas. Several presenters at the forum said they worry that farmworkers are struggling with the stress of working long hours in communities where they have few options for socializing with people away from the farm.
The workers who lack legal documents to be in the country fear going to the grocery store, health center, Laundromat, even church because of stepped-up immigration enforcement, said Mary Jo Dudley, director of the Cornell Farmworker Program.
She said many of the cultural events that helped sustain workers have been canceled in upstate New York because farmworkers are so fearful of law enforcement. With few outlets to socialize off the farm, workers are increasingly turning to alcohol, drugs and prostitution for some solace, Dudley said.
When the workers are hired at a farm, many arrive with crushing debts, she said. A tightened southern border means many farmworkers have to pay smugglers more to get into the country. The average Mexican migrant pays about $3,000 to cross the border. For a worker from Guatemala, it's about $5,000, Dudley said.
Once they land a job, the workers lack transportation and feel a dependence on others for trips off farm. That lack of control makes many workers uneasy, she said.
Some of the workers have stayed for years, with many marrying and having children and homes.
The mixed immigration status, where the parents may lack documents but the children are Americans, also strains the family. The parents do not attend school events because they worry about law enforcement, and that lack of participation makes them feel they are failing as a parent, Dudley said.
She told people at the Austin forum that immigration enforcement officers are using new tactics to intimidate families, raiding homes at 5 a.m. and detaining workers without letting their families know where they have been taken. She estimated 25 percent of workers have suffered from PTSD because of the unsettling raids, difficult border crossings and survivor's guilt from their successful journey, while another family member or friend died in the desert.
The families left behind in Mexico also are suffering from the separations. The workers used to stay only a few months in the United States before returning home after harvest. But now, with border crossings more dangerous and expensive, many Mexicans are not going home, said Maria de Jesus Diaz-Perez, a researcher with a health center in Colorado.
She has interviewed families in Mexico and is finding high levels of anxiety from the wives and mothers of the workers who left for the U.S.
"Their greatest fear: They worry their husbands will never come back," Diaz-Perez said.