An emerging occupational threat?

UNITED KINGDOM — Veterinarians' suicide rate is proportionally four times that of the general population and twice that of other health professionals, studies show.

Job stress, lethal drug access and euthanasia acceptance are among the potential driving forces behind DVMs' heightened risk, according to "Veterinary Surgeons and Suicide: Influences, Opportunities and Research Directions," published in the UK's Veterinary Record.

Health-care professionals, including doctors, pharmacists and dentists, are all high suicide risks based on their proportional mortality ratio (PMR), with veterinarians topping the list as the most susceptible, say article authors David Bartram, BVetMed, DipM, MCIM, CDipAF, MRCVS, and David Baldwin, MB, BS, DM, FRCPsych, at the University of Southampton School of Medicine in Hampshire, UK.

Table 1: Interplay of factors

"The number of veterinarians who die by suicide is four times higher than would be expected based on suicide rates for the general population," Bartram says.

The reasons for this elevated susceptibility are unknown, but Bartram is performing a mental-health study of the UK veterinary profession to determine what they might be.

His study will assess work-related stress, other key stressors and potential intervention strategies in the profession, compare veterinarian data with that of the general population and explore the relationship between mental well-being and demographics, including age, gender and type of practice, among other factors.

"Such research would be important not only for the well-being of individual members of the profession, but also in view of the potentially deleterious impact of practitioners' mental ill health on the welfare of animals under their care and the additional insight that research in this professional group might provide into influences on suicide in other occupations," according to Baldwin and Bartram's Veterinary Record article.

Although study results are not expected until the fall, Bartram and Baldwin point a hypothetical finger at several possible influences — including attitudes, opportunities and personal characteristics seen in the profession — that they believe are driving the trend.

Access to pharmaceuticals

Deliberate drug ingestion is the most common method of veterinarian suicide, most likely because lethal medication is so openly available in the profession.

DVMs "have ready access to medicines, as they are typically stored in practice premises, and knowledge of medicines for self-poisoning, which together offer a possible contributory factor for their high suicide rate," say Baldwin and Bartram in the article.

Intentional medicinal overdose accounts for an average of 82 percent of veterinarian suicides, compared with only 33 percent in the general population, which typically does not have the everyday availability of drugs. "Access to lethal means has a strong influence on the suicide rate," the article says.

Table 2: By the numbers

Death in daily life

Euthanasia is a frequent duty of veterinarians, and the action must often be explained, encouraged and justified to clients. This constant interaction, performance and support of euthanasia in the animal population may affect profession attitudes on death in general. A small-scale European study determined that 93 percent of veterinary health-care workers interviewed approved of human euthanasia, the authors say.

"Veterinary surgeons may experience uncomfortable tension between their desire to preserve life and their inability to treat a case effectively, which may be ameliorated by adapting their attitudes to preserving life to perceive euthanasia as a positive outcome. This altered attitude to death may then facilitate self-justification and lower inhibitions toward suicide as a rational solution to their own problems."

Job dissatisfaction

Depression is a factor impacting suicide, and those choosing to join the veterinary profession may have predisposed personalities that ultimately lead to depression, say Bartram and Baldwin.

"It is possible that the choice of a veterinary career is subconsciously influenced by factors such as a preference for working with animals rather than people, with consequential influences on the risk of depressive illness through relative social isolation," the article says.

Regret also is apparent through the profession; Baldwin and Bartram cite a study revealing that, while 53 percent of practicing veterinarians would still enter the profession knowing what they know now, 20 percent would not and 27 percent were not sure. This disenchantment of almost half of those surveyed most likely has a negative impact on the profession's overall mental health, according to the article.

"There is a need for veterinarians to recognize mental-health problems in themselves and to seek help before the problems become chronic and potentially destabilizing," Baldwin and Bartram say.

Surviving with stress

More than 80 percent of UK veterinary surgeons surveyed consider the profession to be stressful — specifically citing long working hours, client expectations, unexpected clinical outcomes, after-hours on-call duties, peer, manager and client relationships, lack of resources, emotional exhaustion, inadequate professional support, personal finances, the possibility of client complaints or litigation and making professional mistakes as key stressors.

"Most new veterinary graduates move abruptly from the university environment to the relative professional and social isolation of general private practice. Many work with little supervision, do not always have access to assistance from other veterinary colleagues and make professional mistakes, which have a considerable emotional impact on themselves and may be a significant factor in the development of suicidal thoughts," says the article.

Perceived and actual stress is alarming, with Baldwin and Bartram noting an association between work stress and suicide rates, and a study reporting one-third of students at a U.S. veterinary school showing symptoms of depression.

Until Bartram's study is complete, the true reasons behind the DVM suicide risk and rate remain murky and inferential at best. "It might merely be that veterinarians have greater and less restricted access to medicines, or the 'culture of death' in the profession, which is familiarity with and acceptance of euthanasia, or some inherent difference in the psychological characteristics of individuals entering the profession. It might be all or none of these. No one knows," Bartram says.