https://todaysveterinarypractice.com/table-of-contents-september-october-2020/
Finding Balance, Personal/Professional Development

Suicide: Our Professional Crisis

Most in the veterinary community are aware of the high rate of suicide in the profession. Is it still underrecognized? Is it getting better?

Kate BoatrightVMD

Dr. Boatright is a 2013 graduate of the University of Pennsylvania. She currently works as a small animal general practitioner and emergency clinician in western Pennsylvania at NVA Butler Veterinary Associates and Emergency Center. Her clinical interests include feline medicine, surgery, internal medicine, and emergency. As a freelance writer and speaker, Dr. Boatright enjoys educating veterinary students and colleagues about communication, team building, and the unique challenges facing recent graduates. Outside of the clinic, she is active in her state and local VMAs and serves on the VBMA Alumni Committee. In her spare time, she enjoys running and spending time with her husband, son, and three cats.

Suicide: Our Professional Crisis
Bee Johnson
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This article discusses suicide in the veterinary profession. If you are having thoughts of suicide, please text “Home” to 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255 to connect with a crisis counselor.


Anyone who works in the veterinary field knows that we are a small community. Most also know that our community has a serious problem—suicide.

It has touched most of our members in one way or another. If you have not lost a classmate or colleague to suicide, you probably know someone who has. Studies have repeatedly found significantly higher rates of depression, suicide, and suicide ideation in veterinary professionals when compared to the general U.S. population.1-5 The most recent data show that, depending on their gender, veterinarians are 1.6 to 2.4 times more likely to die by suicide than the general population and veterinary nurses are 2.3 to 5 times more likely.4

Many have asked why this increased risk exists. Theories have included easy access to lethal drugs, the emotional stress caused by regular exposure to death, and the financial stress of a high debt-to-income ratio.

In truth, the issue is multifactorial and likely involves each of these things and more.

As we learn more about the risk factors for depression and suicide, studies have identified which professionals are at the highest risk. Young veterinarians and females are the 2 groups most at-risk for psychological distress, which is a key predictor of suicidal thoughts.2 While research is more limited on the mental health of veterinary support staff, the North American Veterinary Community’s (NAVC) “Amplifying the Voice of the Veterinary Community” survey found these professionals to be at an even higher risk of depression than veterinarians.5

The most recent data show that, depending on their gender, veterinarians are 1.6 to 2.4 times more likely to die by suicide than the general population and veterinary nurses are 2.3 to 5 times more likely.4

Tragedy Leads to Innovation

The high suicide rate in the profession is a top concern of veterinary professionals.2 As awareness of the mental health crisis in veterinary medicine rises, some veterinarians have taken action to protect their colleagues and develop programs to address the issue head on.

In October 2014, following the suicide of Dr. Sophia Yin, a private Facebook group was started by Dr. Nicole McArthur. Her goal was to allow veterinarians a safe and private platform to discuss their lives and provide support to each other. Now, nearly 6 years later, the Not One More Vet group has more than 22,000 members worldwide and has expanded into a 501(c)(3) charity that provides financial support and professional mental health support to veterinarians in need.6

Last year, Dr. Andy Roark encouraged the establishment of a “4-Eyes” system in veterinary clinics in an effort to reduce suicide occurrences.7 This program would ensure that no one could access controlled substances on their own, limiting access to a common means of suicide among veterinary professionals. Multiple studies have shown that self-poisoning is a common method of suicide for veterinary professionals.1,4 Recent data found that pentobarbital was more likely to be used by veterinarians, and veterinary nurses were more likely to have opioids in their system.4 These findings support the 4-Eyes approach as a way to save lives.

Organizational Response

Professional organizations have responded to the concern regarding mental health as well. Wellness tracks are now common during continuing education conferences at the national and state level, including the NAVC’s own annual conference, the Veterinary Meeting and Expo (VMX). The American Veterinary Medical Association (AVMA) has created an online Wellbeing center with numerous resources and offers a Workplace Wellbeing Certificate Program that is free to members (avma.org/resources-tools/wellbeing).

The World Small Animal Veterinary Association (WSAVA) recently released the results of a survey that found poor wellbeing in veterinary professionals to be a worldwide problem.8 In response, the organization’s Professional Wellness Group is working on several projects to address mental health.9 In 2020, they plan to release a compilation of current applicable literature and launch a website to centralize resources available to professionals around the world. In 2021, the group plans to release professional wellness guidelines.

The World Small Animal Veterinary Association (WSAVA) recently released the results of a survey that found poor wellbeing in veterinary professionals to be a worldwide problem.8

Strategies to Improve Personal Wellbeing

A community approach to wellbeing is critical to success. Having the support of colleagues who understand the immense burden that this profession places on an individual is irreplaceable. But no matter how much community support there is, every individual must take responsibility for their own mental health. The first step in doing this is to ask for help.

The emotions surrounding depression and burnout are overwhelming. Working through these feelings to move to a more positive mental state often requires the help of trained professionals, such as therapists or psychiatrists. There is no shame in seeking the help of these professionals or in reaching out to your colleagues for support. You may be surprised to find out how many of them are experiencing, or have experienced, these same feelings. Once you have surrounded yourself with a community of support, you can begin the work of improving your personal wellbeing.

In the 2020 Merck Animal Health Veterinary Wellbeing Study, several predictors of positive mental health were identified, including enjoyment of work, work-life balance, spending time with friends and family, having a family, being older, and being satisfied with compensation.2

One of the most difficult things for many veterinary professionals to achieve is establishing a successful work-life balance. A key skill that must be developed to achieve this is boundary setting. We must learn to say no. We need to train our clients that we will not be available at all hours of the day and that we will not tolerate abusive behavior toward our teams. We must set boundaries for ourselves in how much of our time outside of work we give to worrying about patients or ruminating over case outcomes.

Self-care is an essential part of positive mental health. For many, self-care brings to mind a healthy diet, exercise, and getting enough sleep. While these things are certainly important for both the body and mind, self-care goes far deeper. It is essential to remember that you are more than a veterinarian or a veterinary nurse. Effective self-care relies on the ability to nurture the many other parts of ourselves. Find activities outside of the veterinary profession that you enjoy and that replenish you, then invest your time in them.

Other activities that can help to improve personal wellbeing include:

  • Seeing a trained mental health professional if you are struggling.
  • Creating a stress management plan.2 Learn how you respond to stress and develop strategies for successfully navigating difficult times before they happen.
  • Investing time in relationships with family and friends.
  • Utilizing wellness resources developed by the AVMA and other professional organizations.
  • Studying mindfulness or meditation to improve your self-awareness and emotional control.

What Comes Next?

When I graduated from veterinary school in 2013, mental health and wellbeing in the profession were rarely discussed. The fact that we’re talking about and studying the issues is great. But it’s not enough. The Merck study showed that wellbeing overall was unchanged since 2017, despite an increased awareness of mental health concerns and improved attitudes toward those with mental illness.2

We talk about the role of veterinarians in One Health and the need for an interdisciplinary approach to medicine. Let’s embrace that idea for our own professional health and open ourselves to the expertise of mental health professionals. Let’s use the data we have gathered on risk factors and at-risk groups to develop targeted solutions.

Our professional community is filled with people who care about each other and want to make a difference. Those who have experienced the loss of a friend or colleague and those who have experienced suicide ideation or survived a suicide attempt will continue to share their stories. I have hope that future studies will show an improvement in our professional mental health.

References

1. Tomasi SE, Fetcher-Leggert ED, Edwards NT, et. al. Suicide among veterinarians in the United States from 1979-2015. JAVMA 2019;254(1):104-112.

2. Merck Animal Health. Merck animal health veterinary wellbeing study II. vetwellbeing.com. Accessed May 15, 2020.

3. Nett RJ, Witte TK, Holzbauer SM, et al. Risk factors for suicide, attitudes toward mental illness, and practice-related stressors amount US veterinarians. JAVMA 2015;247(8):945-955.

4. Witte TK, Spitzer EG, Edwards N, et al. Suicides and deaths of undetermined intent among veterinary professionals from 2003 to 2014. JAVMA 2019;255(5);595-608.

5. NAVC. Amplifying the Voice of the Veterinary Community. navc.com/download/2020_NAVC_Voice_of_the_Vet.pdf. Accessed December 2019.

6. Not One More Vet. nomv.org. Accessed June 1, 2020.

7. Roark A. What do we do about suicide? It’s time to limit access to means. drandyroark.com/what-do-we-do-about-suicide/. Accessed May 15, 2020.

8. Carroza A. Starting a global dialogue about mental health in veterinary medicine. dvm360.com/view/starting-a-global-dialogue-about-mental-health-in-veterinary-medicine. Accessed June 10, 2020.

9. Professional Wellness Group. Annual report 2019. wsava.org/wp-content/uploads/2020/05/PWG-Report-2019.pdf. Accessed June 22, 2020.

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