Failure to Acknowledge High Suicide Risk among Veterinarians
Publication: Journal of Veterinary Medical Education
Volume 39, Number 1
ABSTRACT
A high suicide risk has been reported among veterinarians in comparison to the general population. Postulated causes have included depression, substance abuse, work-related stress, reluctance to admit psychiatric problems, and access to lethal drugs and/or familiarity with euthanasia. Members of the Student Chapter of the American Veterinary Medical Association (AVMA), all veterinarians licensed in Alabama, and all US veterinary-association executive directors were surveyed regarding their attitudes concerning mental health issues, including veterinarian suicide. Only 10% of veterinary student respondents (N=58) believed that suicide risk is higher among veterinarians than in the general population. Of the 22 state associations' executive directors who participated in the survey, 37% believed that suicide is a significant concern for veterinarians and only 44% indicated that a veterinary wellness program was available in their respective states. Of the 1,455 licensed veterinarians in Alabama, 701 responded to the survey; 11% of respondents believed that suicide among veterinarians was a problem. In addition, 66% of respondents indicated that they had been “clinically depressed,” but 32% of those with depression had not sought treatment. More females (27%) than males (20%) admitted that they had “seriously considered suicide” (p<.01). Female veterinarians were more likely than male veterinarians (15% versus 7%) to indicate that they were “not sure they'd made the right career choice” (p<.001), and 4% of all respondents indicated “definitely not being happy with their career.” It is of concern that veterinarians not only have a higher risk of suicide but that they also have fewer support structures. The wide discrepancies between the published risk of suicide for veterinarians and their own views of their risk suggests an inadequate awareness of their own mental health vulnerability which could put them at higher risk.
Introduction
A recent article from the United Kingdom reported on the high prevalence of suicide among veterinarians,1 which is much higher than the rate of suicide in the general population and is also higher than the rate of suicide among other health professionals, who themselves are at a high risk of suicide. For example, male veterinarians between the ages of 45 and 64 had a relative risk (RR) of suicide that was 5.62 times higher than that of the general population and higher than that of pharmacists (RR=4.15), dentists (RR=5.19), and medical practitioners (RR=2.22). Female veterinarians had the highest relative risk (RR=7.62) compared to their non-veterinarian counterparts and a significantly higher risk than female physicians (RR=4.54). These numbers are remarkable and warrant concern.
The article1 mentioned that depression and substance abuse are significant risk factors for suicide. The strong link between alcohol and drug abuse and suicide has been discussed in a recent government publication.2 Physicians are known to have a significant risk of substance abuse, with reports of a 10% lifetime prevalence, but little is known about substance abuse among veterinarians. Other possible factors cited that contribute to higher rates of suicide among veterinarians include work-related stress, reluctance to admit psychiatric or substance-abuse problems, ready access to lethal drugs, and familiarity with and regular practice of euthanasia. An additional factor may be the relative isolation of veterinarians, who unlike other health professionals such as physicians and nurses, who regularly interact in the broader communal setting of a hospital, often work in a small office with their own employees. Interacting in a community where not everyone is employed by the affected individual fosters a greater likelihood of earlier intervention. For example, in a national survey of physician health programs, most referrals were from hospital leadership and rarely from the physician office staff.3
Method
The Medical Association of the State of Alabama ethics committee and institutional review board approved this study (IRB#: 2007–12–137 W).
Three separate anonymous surveys were conducted in 2008 to gather information regarding veterinary health and wellness and veterinary professionals' attitudes regarding well-being issues. The first was a survey conducted among students participating in the annual meeting of the Student Chapter of the American Veterinary Medical Association (SCAVMA). The survey was linked online to the conference Web site with a conspicuous button requesting volunteer participation in a wellness survey. The second survey was conducted among the 50 executive directors of veterinary medical associations in the US via the American Society of Veterinary Medical Association Executives' listserv. Finally, a survey was conducted among all licensed veterinarians in Alabama using a paper questionnaire (with an option for online completion) that was included in the materials sent to all licensed veterinarians for the annual renewal of their licenses by the regulatory licensing board. The respondents were promised anonymity and received an envelope in which to place the paper questionnaire to be returned with licensing renewal materials or separately by mail to the Alabama Veterinary Professionals Wellness Program (AVPWP).
Survey questionnaires were developed by the Alabama Veterinary Professionals Wellness Committee (see Table 1).
| SCAVMA survey | |
|---|---|
• Veterinary medicine is very stressful. | Yes, No, Not sure, Comment |
• I have been diagnosed with a mental illness (e.g., depression, anxiety, bipolar disorder, etc.). | Yes, No, Not sure, Comment |
• I have seriously considered or attempted suicide. | Yes, No, Not sure, Comment |
• I have a family history of alcoholism or addiction. | Yes, No, Not sure, Comment |
| Executive directors survey | |
• Veterinarians are under increased stress over the past 10 years. | Yes, No, Not sure, Comment |
• Veterinarians have a serious problem with burnout. | Yes, No, Not sure, Comment |
• I personally know of one or more veterinarians who has committed suicide within the past 3 years. | Yes, No, Not sure, Comment |
• Suicide is a significant concern for veterinarians. | Yes, No, Not sure, Comment |
• Our state has an active veterinary wellness program. | Yes, No, Not sure, Comment |
| Alabama licensed veterinarian survey | |
• I have had a problem with significant clinical depression. | Yes, No, Not sure, Comment |
• If you have had a problem with depression were you treated for depression? | Yes, No, Not sure, Comment |
• I have seriously considered suicide since starting veterinary school. | Yes, No, Not sure, Comment |
• I have attempted suicide since veterinary school. | Yes, No, Not sure, Comment |
• I believe suicide rates are higher among veterinarians than among other professions or groups. | Yes, No, Not sure, Comment |
• I am not sure I made the right career choice to enter veterinary medicine. | Yes, No, Not sure, Comment |
• I am happy being a veterinarian. | Yes, No, Not sure, Comment |
• I am currently planning to leave veterinary medicine. | Yes, No, Not sure, Comment |
• I am aware of the veterinary wellness program in Alabama. | Yes, No, I've been a participant. |
SCAVMA=Student Chapter of the American Veterinary Medical Association
Statistical analysis was performed by using the online statistical significance calculator provided by Professional Research Consultants, Inc.
Results
SCAVMA Survey
Fifty-eight survey questionnaires were completed by veterinary students. Responses revealed that 88% believed that “veterinary medicine is very stressful,” 19% indicated that they had been diagnosed with a mental illness (depression, anxiety, bipolar disorder, and so forth), and 13% had “seriously considered or attempted suicide.” In addition, 40.7% had a family history of alcoholism or addiction.
Executive Directors Survey
Of the 50 executive directors of state veterinary associations invited to participate, 22 completed the survey. Of these 22 executive directors, 96% believed increased stress has been placed on veterinarians over the past 10 years, 95% believed that there is a serious problem with burnout, and 40% knew of one or more veterinarians who had committed suicide over the previous three years. However, only 37% believed that suicide was a significant concern for veterinarians, and 54% indicated that their state had an active veterinary wellness program.
Survey of Licensed Veterinarians in Alabama
Of a total of 1,455 licensees, 701 veterinarians completed the questionnaires (57% men and 43% women). A total of 66% indicated that they had been clinically depressed, and 68% of these respondents had received treatment. Among men and women, there was no difference between which gender was more likely to suffer from depression and receive treatment (68% and 65%, respectively). Twenty-four percent (20% of men and 27% of women) stated that they had considered suicide since starting veterinary school. One man and two women reported that they had actually attempted suicide. Only 11% of respondents believed that suicide rates were higher among veterinarians than among other groups. Regarding career choice, 10% of respondents (7% of men and 15% of women, p<.01) were unsure whether they had made the right choice to enter veterinary medicine. Moreover, 4% stated that they were not happy being veterinarians, and 1% were currently planning to leave veterinary medicine. Fifty-four percent of respondents were aware of the veterinary wellness program in Alabama, 44% had never heard of it, and 2% had participated in the program.
Discussion
Suicide is the eleventh most common cause of death in the US, and health professionals, particularly veterinary professionals, are at a higher risk than the general population. The subject is awkward, which may prevent it from being adequately addressed.
The most striking findings of the data from the surveys reported in this article were that while two thirds of veterinarians (66%) in Alabama admitted that they had suffered from clinically significant depression and 24% have considered suicide since starting veterinary training, only 11% believed that suicide was a significant concern for veterinarians. Only 37% of executive directors of veterinary associations believed that suicide is a significant problem. The high rate of family history of alcohol or drug addiction (41%) among veterinary students was remarkable since family history of addiction is one of the most significant risk factors in developing addiction.4
Mental disorders are extremely common in the general population and veterinary professionals are obviously not exempt from them. Problems such as alcoholism, drugs addiction, depression, and compassion fatigue seem to be common among veterinarians. It would be helpful if veterinarians were willing to accept psychiatric treatment but there is often resistance and a failure to accept assistance.
The majority of states have substandard wellness programs, if any programs at all, (e.g., only 44% of executive directors indicated they had an active wellness program in their state), and so the task of dealing with troubled veterinarians falls onto regulatory boards, which are primarily legal entities and are typically not equipped to handle mental illness problems well. Because boards' responses regarding licensees with substance abuse and other psychiatric illnesses are often perceived as punitive, health professionals are reluctant to seek help and individuals close to them, such as family and staff, are inclined to protect and shelter them.5
There are no studies reporting the outcomes experienced by veterinarians who have been subject to disciplinary proceedings from veterinary boards, but there is a striking study that examined the outcomes experienced by physicians who were disciplined, rather than supported and treated, for psychiatric problems. The study reported an extremely high suicide rate, which was hundreds of times higher than that among the general population (20% killed themselves over 10 years).6 In comparison, and supporting the concept of wellness programs, later studies have shown that physicians in trouble with psychiatric problems, when supported and referred for treatment and monitored as a condition of continued licensure, do very well and have extremely low (<1%) suicide rates.7
Wellness programs, especially if they are confidential assistance programs, have been shown to be effective in addressing these concerns. The goals of wellness programs should be to encourage early intervention before overt impairment and thereby assist the board in protecting the public as well as affording the veterinarian the opportunity to receive supportive competent care.
The American Medical Association (AMA) announced in 1954 that alcoholism should be considered a disease. Later, the AMA recognized the high frequency of mental and substance-related disorders affecting physicians and, in the 1970s and with the publication of an article titled “The Sick Physician,”8 a policy of early detection and support for troubled doctors was encouraged. The AMA maintains an active department dedicated to physician health and has conducted an international conference on physician health every 18 months for the last several decades.9 Unfortunately, there has been no such movement among the veterinary profession. The AVMA discontinued its veterinary wellness committee years ago and currently has little to offer troubled veterinarians.
As evidenced by a recent article and previous published reports10,11,12 regarding the high rate of suicide among veterinarians and our surveys, the veterinary profession is lagging behind other health care professions in providing support for “wounded colleagues.” Both MDs and dentists have some level of national support or coordination. Veterinary medicine has none.
There is a critical need for action. For action to be effective, it clearly needs to be undertaken with the involvement of all of the agencies concerned with veterinary medicine, including SCAVMA, the American Association of Veterinary State Boards (AAVSB), the Association of American Veterinary Medical Colleges (AAVMC), and the AVMA, if this ticking time-bomb is to be defused.
Acknowledgments
We wish to acknowledge the support and assistance of the Alabama Board of Veterinary Medical Examiners, which encouraged our work, facilitated the distribution of surveys, and is genuinely interested in the health and well-being of veterinarians.
References
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Information & Authors
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Published In
Journal of Veterinary Medical Education
Volume 39 • Number 1 • Spring 2012
Pages: 79 - 82
PubMed: 22433743
Copyright
© 2012 AAVMC.
History
Published online: 1 January 2012
Published in print: Spring 2012
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