One by one, the three men from the same close-knit community took their own lives.

Their deaths spanned a two-year stretch starting in mid-2015 and shook the village of Georgetown, Ohio, about 40 miles southeast of Cincinnati.

All of the men were in their 50s and 60s.

All were farmers.

Heather Utter, whose husband’s cousin was the third to die by suicide, worries that her father could be next. The longtime dairy farmer, who for years struggled to keep his operation afloat, sold the last of his cows in January amid his declining health and dwindling finances. The decision crushed him.

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“He’s done nothing but milk cows all his life,” said Utter, whose father declined to be interviewed.

“It was a big decision, a sad decision. But at what point do you say enough is enough?”

American farmers produce nearly all of the country’s food and contribute some $133 billion annually to the gross domestic product.

But U.S. farmers are saddled with near-record debt, declaring bankruptcy at rising rates and selling off their farms amid an uncertain future clouded by climate change and whipsawed by tariffs and bailouts.

For some, the burden is too much.

Farmers are among the most likely to die by suicide, compared with other occupations, according to a January study by the Centers for Disease Control and Prevention. The study also found that suicide rates overall had increased by 40% in less than two decades.

The problem has plagued agricultural communities across the nation, but perhaps nowhere more so than the Midwest, where extreme weather and falling prices have bludgeoned dairy and crop producers in recent years.

More than 450 farmers killed themselves across nine Midwestern states from 2014 to 2018, according to data collected by the USA TODAY Network and the Midwest Center for Investigative Reporting. The real total is likely to be higher because not every state provided suicide data for every year and some redacted portions of the data.

The deaths coincide with the near-doubling of calls to a crisis hotline operated by Farm Aid, a nonprofit agency whose mission is to help farmers keep their land. More than a thousand people dialed the number in 2018 alone, said spokeswoman Jennifer Fahy.

Even the $28 billion in federal aid provided by the Trump administration over two years wasn’t enough to erase the fallout from the trade war with China, many farmers said.

It’s not the first time that Washington’s efforts to help farmers have fallen short.

In 2008, Congress approved the Farm and Ranch Stress Assistance Network Act to provide behavioral health programs to agricultural workers via grants to states.

But it appropriated no money for the legislation until last year — more than one decade and hundreds of suicides later.

Some of the first four pilot programs awarded funding still have not seen any money.

“Farmers, ranchers and agriculture workers are experiencing severe stress and high rates of suicide,” said U.S. Sen. Tammy Baldwin, D-Wisconsin, who sponsored the bipartisan bill to fund the initiative. “Unfortunately, Washington has been slow to recognize the challenges that farmers are facing.”

Reporters spoke to more than two dozen farmers, mental health professionals and other experts across the Midwest who said the problem needs attention now.

Devastating economic events on their own do not cause suicides, experts said, but can be the last straw for a person already suffering from depression or under long-term stress.

“We like to identify something as the cause,” said Ted Matthews, a psychologist who works exclusively with farm families in Minnesota. “Right now, they talk about commodity prices being the cause, and it’s definitely a cause, but it is not the only one by any stretch.”

Case in point: After her family shuttered the dairy farm, Utter said, it relieved the immediate pressures — including those on her sister and brother-in-law, who helped milk her father’s cows daily despite their own full-time jobs.

But it created a different kind of stress for her father, said Utter, who serves as the Ohio Farm Bureau’s director for a four-county region including Georgetown.