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Why is our veterinary profession so at risk for suicide | VETgirl Veterinary CE Podcasts

In today’s VETgirl online veterinary continuing education podcast, we review the important topic of the prevalence of suicide in our field. Why do veterinarians and veterinary technicians have a higher rate of suicide as compared to other fields? In a recent publication in JAVMA by Nett et al, they review the field of mental health and wellness in the veterinary profession. This is an area receiving some much-needed attention recently, due to the occurrence of some widely publicized suicides amongst veterinary professionals during the last few years. (BTW, you can check out our free VETgirl webinar on suicide by Jeannine Moga here).

Previous studies completed in the USA, UK, and Australia have suggested that veterinarians are between 2 and 4X more likely than members of the general population to have thoughts of or commit suicide.  Studies also show that between 1 in 5 and 2 in 3 veterinarians suffer from major depression, which is an established risk factor for suicide. Due to the stigma of mental illness, there is a concern that many veterinarians do not seek treatment to improve their mental health.  Likewise, stressors in the veterinary workplace can lead to burnout, which has also been associated with suicide. Clearly this is an important topic that warrants further investigation and discussion.

So, Nett et al published a study in October 2015 entitled “Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinariansto assess the prevalence of risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. The intention of the authors was to further characterize the proportion of US veterinarians who might be at higher risk for suicide, to identify potential barriers to seeking mental health treatment among veterinarians, and to describe common practice-related stressors that might be targeted for suicide prevention.  The information for the study was collected via a web-based questionnaire that was made available between July and October 2014 via the Veterinary Information Network (VIN), VIN News Service, JAVMA News, and email messages to US veterinarians sent by their veterinary medical association, agriculture or livestock department, or health department of each state (excluding Maine), and Puerto Rico. The questionnaire was targeted to veterinarians and contained questions concerning demographics, practice setting, history of depression and mental health treatment, attitudes toward mental illness and mental health treatment, stressors related to veterinary practice, and satisfaction related to practicing veterinary medicine. Standardized questions from the Kessler-6 psychological distress scale that assess the presence of serious mental illness were also included. Veterinary graduates that had not been previously employed as a veterinarian were excluded.

Overall, there was a large response rate, with 11,627 eligible respondents (This is approximately 10% of the current working veterinary population in the USA). There were respondents from all 50 states, DC, and Puerto Rico. Approximately 1/3 were male, 89% currently employed as a veterinarian, and the largest groups represented as a percentage of all respondents were 30-39 year olds, with 10-19 years of practice experience, married, associate veterinarians, and working in small animal practice.

Approximately 9% of respondents reported currently experiencing serious psychological distress. Demographic characteristics that were associated with a higher prevalence of serious psychological distress included female sex, age 20-49 years old, marital status of separated, divorced, or not previously married, and no children.  Work-related characteristics that were associated with a higher prevalence of serious psychological distress included being a practice associate, practicing for less than 20 years, practicing shelter medicine, and not being a member of a veterinary medical association.

Approximately 1 in 3 respondents reported that they had previous depressive episodes, 17% had suicidal ideation, and 1% had attempted suicide since graduating from vet school. 19% reported that they were currently receiving treatment for a mental health condition or emotional problem. Less than half of those reporting current serious psychological distress were currently receiving mental health treatment. This finding is likely related to the fact that veterinarian respondents appeared to have less positive attitudes towards mental health treatment and mental illness, compared with other US adults.  Surprisingly, only 32% of veterinarians somewhat or strongly agreed that people are caring towards others with mental illness, compared to 60% of US adults.  And unfortunately, 17% of respondents who were unsure or who disagreed about accessibility of mental health treatment were more likely to have serious psychological stress, were less likely to currently be receiving mental health treatment, and were more likely to have experienced prior suicidal ideation.

The most commonly reported stressful factor associated with veterinary medicine was the demands of practice. A higher percentage of practice owners than associate or relief veterinarians reported practice management responsibilities and competition with other veterinary practices as stressful factors, whereas a higher percentage of associate and relief veterinarians than practice owners reported that professional mistakes, educational debt, unclear management and work role, and lack of participation in decision making were stressful factors.

What was scary? While 73% of respondents agreed that they made the right career choice to enter veterinary medicine, 13% said that they were planning to leave veterinary medicine.  That’s more than 1 out of every 10 of us, guys! The most commonly cited reasons for leaving included the demands of practice, practice management responsibilities, and client complaints. I personally think it’s also due to poor work-life-balance, burnout, and our workaholic Myers-Briggs personalities.

So, what are the authors’ conclusions about these sad and disturbing findings?  Well…it is clear that the mental health of veterinarians is below that of other US adults.  When compared on the basis of sex, veterinarians have higher rates of serious psychological distress, depression, and suicidal ideation, and are less likely to believe that mental health treatment helps people lead normal lives or that people are caring towards others with mental illness.  Clearly, these beliefs are hindering veterinarians who need the most help, from seeking support.  The authors also draw attention to the fact that a larger percentage of the veterinarian respondents were female, compared to the average adult work-force, and because females have a higher incidence of mental illness and psychological distress, this likely increased those findings within this study.  However, the findings remain relevant as women make up more than 70% of vet school graduates since 2000.

And although a higher rate of suicidal ideation was reported, there were fewer non-fatal suicide attempts compared to the general adult US population. This result is likely two-fold: one, because veterinarians have easy access to lethal means to commit suicide (via barbiturate overdose or otherwise), non-fatal attempts are unlikely.  And two, it is possible that the feeling of needing to cope with the suicidal thoughts, fulfill family responsibilities, or tend to children are factors that reduce suicidal tendencies.  This was unclear from the study; therefore, further research is needed to understand the reasons why some veterinarians who consider suicide do not attempt it.

Given how different the attitudes among veterinarians are towards mental health and treatment for mental illness compared to US adults, it is clear that a stigma regarding mental health is prevalent.  It is possible that veterinarians also see mental illness as a weakness. Clearly, efforts are needed at the beginning of the veterinary medical curriculum to reduce the perceived stigma towards those with mental illness. We as veterinary professionals must get over this stigma, folks, and support our fellow colleagues!

This study also highlights the importance of social support as a protective factor for psychological health related to occupational stressors. Given that poorer psychological health was related to not being married or in a committed relationship, being separated or divorced, not having children, and not being a member of a veterinary medical association, it suggests that those veterinarians with a potential weaker social support system are at risk.  Likewise, the study findings suggest that less experienced veterinarians in practice for < 5 years had more psychological distress than those practicing for > 10 years.  These findings imply that the transition from veterinary school where higher degrees of social support exist, to a veterinary practice setting that can be more professional and socially isolating and technically demanding, is challenging for less experienced or younger veterinarians. However, the study findings might also simply be representing a cohort effect whereby those entering veterinary school more recently are more vulnerable to psychological stressors compared to previous cohorts, or that older veterinarians are less willing to discuss or admit to psychological distress. Certainly, different selection criteria, greater competition, increased educational costs, and other changes in the field of veterinary medicine might all be contributing to the increased psychological distress affecting younger veterinarians.

Some limitations to this study should be mentioned including the web-based design that might have been skewed towards younger veterinarians, the self-reporting of mental illness as opposed to a clinical diagnosis by a mental health care professional, and the likelihood that those interested in the subject of mental health would be more likely to complete the survey.

Additional studies are clearly needed to identify practical and effective tools that can be used to ease the transition from veterinary school to a practice setting, to determine whether less experienced veterinarians have reduced distress as they gain experience, and to determine whether less experienced veterinarians who have serious psychological distress leave the profession more often than do veterinarians who do not have serious psychological distress.  Take home message – please take care of yourself and seek help when it is needed!  Listen to the partner podcast on “Making strides towards veterinary wellness in the workplace” for more information on how you can do just that!

References:

  1. Nett RJ, Witte TK, Holzbauer SM, et al. Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinariansJ Am Vet Med Assoc 2015;247(8):945-955.

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