It should be noted that the following is a compilation of information pertaining to depression and suicide in the veterinary profession. The author is not a mental healthcare provider and has no claims to such capabilities. All information herein is information cited or personal opinions on addressing such mental healthcare issues.

The Numbers

In Australia, veterinarians are four times more likely to commit suicide than the general population.¹ In Canada, one in five veterinarians have seriously considered suicide; one in 10 vets have attempted to take their own lives.² In Norway, male veterinarians have the highest rate of suicide over all other occupations studied in a 40-year time span.³ Studies in America and the UK support these alarming statistics within the veterinary profession. What we know is that veterinarians around the world have above average rates of suicide. What we still need to investigate is the cause.

The Cause

Veterinary medicine is a stressful profession, but many other professions are associated with high levels of stress. So what is it about the veterinary profession that causes those stressors to manifest into compassion fatigue, burn-out, and even depression? There is much discussion about the type of people who become vets, the lack of mental wellness development during veterinary education, the isolation many practitioners face, the moral/ethical dilemmas in day-to-day practice, and the constant exposure to traumatic situations and death that veterinarians have to experience.

Veterinarians, as a whole, are considered a very "type A" person. We strive to do the best, be the best, and inconsistencies or imperfections are very unsettling to most veterinarians. Though this is an area for further thought and research, the low ability to alter personality type means we won't discuss this in any further detail.

Academically, extremely high admission requirements (selecting the above type of persons) in addition to a rigorous, fast-paced academic program may limit emotional intelligence growth.⁴ This is exacerbated by lack of coping mechanisms or mental resiliency training. Studies in the USA show that one-third of first-year veterinary students exhibit symptoms consistent with clinical depression.³ Luckily, this is an area that we can address. Thorough examination of current veterinary academic programs to lessen stress, as well as addition of emotional/mental wellness programs to enhance students' resiliency to stress may aid in decreasing burnout. Even better, these same skills, learned and practiced in school, will continue to aid the practicing veterinarian well into their professional years.

Many veterinarians, especially those in rural areas, may feel isolated and lack support from their professional peers. Without support or good mentorship and little experience in the field, recent graduates may be more prone to professional mistakes which can take a high emotional toll.⁵ These emotional stressors, along with the additional ones discussed below, add together to cause burnout in the profession. Burnout is due to repeated, ongoing stresses within the work environment and while it is not a recognized form of depression, it can contribute towards depression.⁶

The remaining suspected causes contributing to burnout, suicide, and depression in our profession will all be discussed as work stressors. Long working hours, exhaustive on-call responsibilities, unanticipated patient outcomes, concerns of litigation and many other stressors in day-to-day practice can take an emotional toll, which can even manifest physically. Yet, all of these concerns are experienced by other health care professionals, so why are veterinarians still twice as likely to commit suicides as dentists?

We suspect that it is due to the ethical dilemmas of practice. Veterinarians are responsible for the health of their animal patients, but are beholden to the wishes and decisions of their human clients. Furthermore, those wishes and decisions are often edited based on financial concerns of the client. This can lead to another stressor highly specific to our profession: euthanasia. Many different studies are cited exhibiting evidence that euthanasia is a very active stressor in the veterinary profession.³

Now that we have discussed likely causes of burnout and depression within our profession, what can we do to address and prevent it? First and foremost, I should mention that I have no professional training in mental health and these discussions are my opinion only. Furthermore, if you feel like you personally may be at risk of depression or suicide please reach out to a mental health professional. That being said, there are many different areas that we can and should be addressing to help protect our profession.

Why not address it in our schools? Admittedly schools have a very full curriculum, but what could be more important than teaching mental wellness and self-care? Discussing this topic in schools, and even more importantly, teaching students how to guard their mental health could aid in the prevention of disease. Isn't that what we as doctors try to do every day? Prevent disease? Let's start with ourselves.

Support groups: Isolation and loneliness can be devastating. But in this day and age there are many forms of communication. Facebook, VIN, and LinkedIn are just a few amid many social networking sites. Recently, a private veterinary facebook group called "Not One More Vet" was created. You can read an interview with one of the creators in the June publication of DVM360 or linked below.⁷ It is an online community targeted at the prevention of any additional veterinary suicides. There are only two rules for joining the group, first is that you must be a veterinarian and I'll refer you to the article to see the second rule. Here, veterinarians from around the world discuss their common day-to-day stressors, from difficult bosses or catty receptionists, to abusive clients, and devastating patient outcomes. The posts are seen only by other veterinarians, the population of Facebook at large cannot see the posts, and it has become a safe place to express doubts, concerns, and difficulties. Perhaps even more importantly than the ability to express one's thoughts in a safe place is the caring, understanding, and encouraging responses from the people in the group. While none of the members are professionals in the mental health field everyone is willing to be a shoulder to lean on or an open ear.

Further resources for addressing the stressors of mental health have been compiled by various state, regional, or national veterinary associations. Recently, the AmericanVMA had a group of young leaders within the field of veterinary medicine create an online resource page addressing wellness with many resources on mental wellness, work-life balance, compassion fatigue, and others. The U.K. has a support website called VetLife which provides a variety of resources to aid veterinarians in mental, physical, or even financial well-being. These are programs or resources that often already exist but need to be better shared with the profession at large.

Ultimately there is no doubt that our profession is stressful and that repeated stressful events may lead to depression or even suicide. Yet there is something that can be done. Reach out to your colleagues, your boss, your students, your mentees, and your mentors. Reach out to your friends near and far. Reach out to ask if someone is doing ok or reach out to tell someone you are not ok. We are a profession based in care and compassion, it is time we start utilizing those traits on ourselves.

References

1.  Jones-Fairnie H, Ferroni P, Silburn S, Lawrence D. Suicide in Australian veterinarians. Aust Vet J. 2008;86:114–116.

2.  Miller L. CVMA news: wellness of veterinarians: CVMA National Survey results. Can Vet J. 2012;53:1159–1160.

3.  Bartram DJ, Baldwin DS. Veterinary surgeons and suicide: a structured review of possible influences on increased risk. Vet Rec. 2010;166:388–397.

4.  Stoewen DL. Suicide in veterinary medicine: let's talk about it. Can Vet J. 2015;56(1):89–92.

5.  Mellanby RJ, Herrtage ME. Survey of mistakes made by recent veterinary graduates. Vet Rec. 2004;155:761–765.

6.  Scheidegger J. Burnout, compassion fatigue, depression - what's the difference? DVM360 Magazine. 2015 May; accessed online.

7.  Wooten S. Not One More Vet: Veterinary peers discuss suicide, offer safe place for dialogue. DVM360 Magazine. 2016 May; accessed online at: http://veterinarynews.dvm360.com/not-one-more-vet-veterinary-peers-discuss-suicide-offer-safe-place-dialogue