Modern-Day Plague: Understanding the Scope of Veterinary Suicide

When the Centers for Disease Control and Prevention (CDC) published data in early 2015 on the prevalence of risk factors for suicide among veterinarians, it revealed some shocking statistics^1,2:

• 6.8 percent of male and 10.9 percent of female veterinarians have serious psychological distress, compared with 3.5 percent and 4.4 percent of male and female adults, respectively, in the general population.
• 14 percent of male and 19 percent of female veterinarians have suicidal thoughts, three times that of the general U.S. population.
• 24.5 percent of male and 36.7 percent of female veterinarians have experienced depressive episodes since veterinary school graduation, about 1.5 times the prevalence among U.S. adults throughout their lifetime.
• 1.1 percent of male and 1.4 percent of female veterinarians have attempted suicide since veterinary school.

These data were based on results from an anonymous online questionnaire answered by more than 10,000 U.S. veterinarians, among whom 34 percent had been in practice for less than 10 years, 24.6 percent for 10 to 19 years and the remainder for more than 20 years. Nearly 70 percent of respondents were small animal practitioners.¹

In a statistical quirk, the survey revealed that among veterinarians, suicide attempts actually occur less often than in the general public. The CDC researchers believe that this is because their “ready access to drugs may more often result in lethal suicide attempts, leaving fewer survivors to respond to the survey.”¹

RELATED:

• Reasons for Suicide, Mental Health in Veterinary Profession
• Mental Health Statistics Vary in Veterinary Profession

These troubling statistics are “not reserved solely for general practitioners,” according to Danielle Carey, DVM, a mixed animal veterinarian practicing in Walla Walla, Washington. “In the last few years, the profession has lost notable behaviorists, surgeons, specialists and technicians to this mental illness,” she said.³

Nor is the scourge of veterinary suicide limited to the United States. A British study, for example, found that the suicide rate among veterinarians in the United Kingdom is at least twice that of other health care professionals and about four times higher than in the general population.⁴

A Multifactorial Problem

David Bartram, BVetMed, DECSRHM, FRCVS, international director of outcomes research for Zoetis and lead author of the British suicide study, narrows down the problem as follows: Veterinarians are (1) high-achieving personality types with all the attendant neuroses, (2) training and practice are natural stress inducers, (3) veterinarians have easy access to lethal drugs, and (4) the profession philosophically accepts euthanasia as a way to end suffering.

It’s a “vast and multifactorial” problem, agrees Shana Bohac, DVM, a staff veterinarian at Lakeway Veterinary Clinic in Edna, Texas.⁵ “Stress, student loan debt, personality, compassion fatigue, frequency of patient death and attitude toward euthanasia all play a role in this abounding problem,” she said.

Like most health care professionals, Dr. Bohac explained, veterinarians are driven perfectionists who don’t like to fail, and when they do — as most humans will — they tend to internalize problems. Also like their colleagues in human medicine, she said, veterinarians must work long hours, sacrifice personal and family time, and face life-and-death decisions every day.

The conditions of compassion fatigue and burnout, common among today’s medical professionals, are growing in the veterinary profession, as well.

“Traits that help us become great doctors and practitioners can also be to our detriment,” said Dr. Carey. She believes that a pillar of veterinary medicine “is to be a voice for the voiceless, but that doesn’t mean every [animal] can be saved — and for many of us, that is a very difficult pill to swallow.”³

She also addresses a form of emotional bullying by some pet owners.³ A trauma “that is unique to the profession is that decisions affecting diagnosis, treatment and quality of life of a patient are dependent on an owner’s financial capabilities,” she noted. “Often compounding this trauma is an owner upset that we cannot perform services at no cost. [Hearing that] we don’t love their pet enough only furthers many veterinary professionals’ isolation and depression,” she said.

Addressing the matter of “emotional labor” in the profession, Marie K. Holowaychuk, DVM, a small animal emergency and critical care specialist in Canada, said clients often ask veterinarians “how they are able to perform emotionally charged and frequently difficult euthanasias.”⁶ She found that “it is not the euthanasia itself that is difficult, but rather the intense discussions and deliberation that go along with it.”⁶ The profession requires emotional labor, “which is the process of managing feelings and expressions to fulfill the emotional requirements of our job,” she said. “This sometimes means showing feelings that do not match how we are feeling inside.” Emotional labor, she noted, “is typically much more demanding than the physical and intellectual labors of the work that we do as veterinary care providers.”

Taking Action

The American Veterinary Medical Association (AVMA) states that “taking action to prevent and treat mental illness in veterinary professionals may become more imperative in coming years.” The group points to two other factors affecting veterinarians:

• Women, who statistically experience depression and suicidal thoughts more often than men do,⁷ now represent about 80 percent of enrolled U.S. veterinary students,⁸ 55 percent of current practitioners⁸ and 42 percent of veterinary school administrators.⁹
• The nation’s newly minted veterinarians are facing massive educational loan obligations and related anxiety. The average veterinary medical school graduate carries about $167,000 in student debt, a debt-to-income ratio double that of medical doctors.¹⁰

Seek Help

Experts offer some tips for combating this serious problem. First and foremost, veterinarians who believe they are having serious emotional difficulties should never feel any shame in seeking professional help. All doctors must embrace the credo “Heal thyself.” The AVMA lists numerous mental wellness resources for veterinary professionals on its website.

The Professional Quality of Life assessment, available at proqol.org/ProQol_Test.html and on the AVMA website, can help veterinarians determine how they are affected in three areas of compassion — satisfaction, stress and fatigue — and identify where to focus self-care, according to the AMVA.

Regain Your Passion

“Remember what led you into the profession in the first place and how good it felt when you got your degree and then your first job. Identify what it was that made you look forward to going to work each day. Try to regain your passion, dreams and plans for the future,” said Patricia Wohlferth-Bethke, DVM, director of the AVMA’s Veterinary Career Center.

Help One Another

Veterinarians must reconnect with their profession and stand ready to assist each other. Keep an eye on your colleagues and reach out to those you think need a boost. A thoughtful appreciation of the unique professional challenges (the old “you’re not alone” line) can often provide some peace of mind.

Mind Your Physical Health

“Physical health and mental wellness are inextricably related,” according to the AVMA. “Veterinarians face special challenges in this arena because of the physical challenges of the work. If anything, this may make it even more important that they pay attention to physical health. In the workplace, veterinarians need to be mindful of ergonomics and take proper precautions to guard against occupational hazards.”

Mr. Kelly is a long-time health care writer and editor. He has written for the Physician’s Money Digest^TM, Dentist’s Money Digest^TM and Veterinarian’s Money Digest^® websites. He lives at the Jersey Shore and welcomes comments at gregkelly@monmouthbeachlife.com.

References:

• Nett RJ, Witte TK, Holzbauer SM, et al. Notes from the field: prevalence of risk factors for suicide among veterinarians — United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(5):131-132.
• Larkin M. Study: 1 in 6 veterinarians have considered suicide. American Veterinary Medical Association website. www.avma.org/News/JAVMANews/Pages/150401d.aspx. Published March 18, 2015. Accessed August 30, 2017.
• Carey D. Veterinarians also susceptible to workplace, financial stressors. Union-Bulletin website. www.union-bulletin.com/local_columnists/vet_views/veterinarians-also-susceptible-to-workplace-financial-stressors/article_41aae97a-633b-11e7-91d6-1346d87b825f.html. Published July 7. 2017. Accessed August 30, 2017.
• Bartram DJ, Baldwin DS. Veterinary surgeons and suicide: a structured review of possible influences on increased risk. Vet Rec. 2010;166(13):388-397. doi: 10.1136/vr.b4794.
• Bohac S. Veterinary suicide. Victoria Advocate website. www.victoriaadvocate.com/news/2017/jun/25/veterinary-suicide/. Published June 25, 2017. Accessed August 30, 2017.
• Holowaychuk, M. Does euthanasia impact the mental health of veterinary care providers? Critical Care Vet website. www.criticalcarevet.ca/euthanasia-impact-mental-health-veterinary-care-providers/. Published July 19, 2017. Accessed August 30, 2017.
• Mental Health America. Depression in women. MHA website. www.mentalhealthamerica.net/conditions/depression-women. Accessed August 30, 2017.
• Kumble J., & Smith, D. F. Leaders of the pack: women and the future of veterinary medicine. West Lafayette, IN: Purdue University Press; 2017.
• Larkin M. Women leaders continue to build their ranks. American Veterinary Medical Association website. https://www.avma.org/News/JAVMANews/Pages/170615c.aspx. Published June 15, 2017women. Accessed August 30, 2017.
• American Veterinary Medical Association. Financing your veterinary medical education. AVMA website. www.avma.org/About/SAVMA/StudentFinancialResources/Pages/default.aspx. Accessed August 30, 2017.