May 9, 2011
Veterinarians prone to suicide: Fact or fiction?
By: Phyllis DeGioia; Edie Lau
For The VIN News Service
A paper published last year linking British veterinarians to high suicide rates attracted global media attention and raised questions about suicide risk of veterinarians in other parts of the world. But the findings cannot be extrapolated, at least definitively, to the U.S. veterinary population.
American veterinarians anecdotally report dealing with depression, compassion fatigue and suicidal thoughts as well as the suicides of colleagues. Some practitioners reach out to each other while considering suicide and some share their concerns about it within the field, as evidenced by message board discussions at the Veterinary Information Network (VIN), an online community for the profession. VIN has members around the world, but predominantly in North America.
However, little focused research has been conducted to explore the phenomenon comprehensively stateside. Several studies over the decades suggest that veterinary doctors have elevated suicide rates in this country, but those studies have been limited in their approach or scope.
In Britain, veterinarians are four times as likely as the general population to commit suicide and twice as likely as those in other health-care professions, according to Dr. David Bartram, a veterinarian and doctoral student in mental health studies at the University of Southampton's medical school. Bartram is the lead author of the research paper “Veterinary surgeons and suicide: a structured review of possible influences on increased risk,” published March 2010 in Veterinary Record.
Bartram has published two studies about the high risk of suicide among veterinary surgeons in Britain compared with the general population. The first, “Veterinary surgeons and suicide: influences, opportunities and research directions,” appeared January 2008 in Veterinary Record. Bartram’s research indicates that every year, five or six of Britain’s 16,000 veterinary surgeons kill themselves.
In a recent review of the international literature on the subject, Belinda Platt of the Centre for Suicide Research at Oxford University and colleagues found research pointing to significantly elevated rates of suicide among veterinarians in Australia, Belgium, Norway and the United States as well as in the United Kingdom.
In their paper, “Suicidal behaviour and psychosocial problems in veterinary surgeons: a systematic review,” published online Dec. 23 in Social Psychiatry and Psychiatric Epidemiology, Blatt and colleagues referenced six studies examining veterinary populations in the United States that found elevated suicide rates.
Four of the six U.S. studies evaluated subsets of the population. The oldest, from 1977, examined mortality in Illinois veterinarians. The next, published in 1992, looked at deaths among members of the Public Health Service Commissioned Corps. A study from 1995 scrutinized causes of death among California practitioners. The most recent data came from Washington state, which posts records of occupational mortality online.
The two other papers, from 1980 and 1982, studied causes of death and mortality patterns, respectively, among white male veterinarians in the United States.
None of the studies individually makes a conclusive finding about suicide risk for the American veterinary population as a whole. Taken together, they are strongly suggestive. But consensus on increased prevalence remains elusive because of gaps in the data.
Statistics kept by the U.S. government, for example, do not point to any profession as having a higher suicide rate. That is because, unlike in Britain, occupation is not listed on American death certificates, so the U.S. Centers for Disease Control and Prevention (CDC) cannot include it in mortality statistics.
Furthermore, the CDC’s National Institute for Occupational Safety and Health (NIOSH) has not conducted comprehensive independent research on prevalence of suicide by occupation. However, NIOSH does have a database under its National Occupational Mortality Surveillance System from which it calculated proportionate mortality ratios (PMR) for a variety of occupations based on data gathered between 1984 and 1998.
The results suggest the link between high suicide risk and the veterinary profession is real: John Sestito, a senior health scientist at NIOSH, found 1,353 deaths from suicide for white male veterinarians in the period evaluated. (The database had no records for white female veterinarians nor for veterinarians of other races.) The group evaluated had a statistically significant PMR of 162 for the category of suicide and self-inflicted injury. A PMR of 100 is considered average risk; 200 indicates twice the average risk.
Sestito cautioned that a “statistically significantly elevated PMR cannot be interpreted directly as indicating a causal relationship between the industry or occupation and the cause of death.”
If veterinarians as a group truly are more prone to suicide, why would that be?
Bartram, the expert in Britain, could not be reached for comment. But in a March 2010 article in Risk Management Monitor, Bartram offered these possible explanations:
• Those admitted to veterinary school have high-achieving personality types, traits of which may include neurosis, conscientiousness and perfectionism.
• Stress begins during training and continues in practice, with a work environment marked by long hours, high psychological demands, potentially low support from managers and high expectations by clients. Solo practitioners may be professionally and socially isolated.
• Practitioners have ready access to lethal drugs and know how to use them.
• Veterinarians philosophically accept euthanasia as a way to alleviating suffering.
• Exposure to suicides among colleagues may result in “suicide contagion.”
The premise that veterinary medicine as a career carries a heightened risk for suicide is as controversial as it is provocative.
Ronald Maris, director of the Center for the Study of Suicide and Life-Threatening Behavior at the University of South Carolina, states on his website: "Occupation is not a major predictor of suicide and it does not explain much about why the person commits suicide."
In an interview with the VIN News Service, Maris elaborated, “The problem with any kind of professional suicide rate is that other factors are more important than the profession; it’s a false correlation.”
Maris maintained that it’s not access to controlled substances that increases the likelihood, but factors such as whether a person is alcoholic, depressed, an older white male, or has marital problems. Maris believes that people in lower social classes, such as laborers, have higher suicide rates than do professionals, but that individual risk factors are still the main determinant.
“It’s probably true that medical professions have elevated rates but when you go into specialists (specific disciplines such as veterinarians) you often find that it doesn’t hold up,” Maris said. “There probably is something to personalities being drawn to certain professions,” he added, “although I haven’t seen any definitive literature.”
Mixed opinions and incomplete research on the subject notwithstanding, some are taking a proactive approach to the issue.
At the start of every school year, Corissa Lotta, a psychologist with the University of Wisconsin who works with Personal & Wellness Support Services at the School of Veterinary Medicine, speaks to the incoming class of veterinary students about adjustment and staying healthy during school. As part of that talk, she mentions substance abuse and suicide in the profession. She knows there is a fine line between awareness and scaring the students.
In her presentation, Lotta discusses common difficulties in the field such as compassion fatigue, overwork, stress, substance abuse, burnout, depression, relationship distress and suicide.
The timing of Lotta’s talk seems none too soon. According to “Predictors of depression and anxiety in first-year veterinary students: a preliminary report,” published in the Journal of Veterinary Medical Education in 2006, 32 percent of the first-year veterinary students tested were experiencing clinical levels of depressive symptoms and elevated anxiety scores. As Bartram observed, stress begins early in the profession and continues from there.
Dr. Michele Gaspar, a veterinarian pursuing a master’s degree in counseling at Loyola University Chicago, plans to specialize in helping veterinarians in the areas of compassion fatigue, burnout and life and career satisfaction.
Gaspar has worked in two level-one trauma hospitals in Chicago that have significant psychiatric caseloads. She believes that suicides in veterinary medicine run the gamut as in every other field. Veterinarians have the same stresses and mental health issues that the general public does, Gaspar said — but one thing they and other health-care workers such as doctors, dentists, pharmacists and nurses have that the broader public doesn’t is access to controlled substances.
And veterinarians, unlike other health care professionals, have access to euthanasia solution, she noted.
But what drives veterinarians to suicide is no different from what drives anyone to that dark end, Gaspar maintains. "The straw that breaks the camel’s back is that the person feels there are really no other options," she said. "Suicidal people typically have a variety of multiple traumas, some small and some large, and one breaks the camel’s back. .... It (alone) may not be significant but it may have pushed someone over the edge. Marriage is bad, finances are bad, then job is lost — it spirals the person. Or things are not going well on multiple levels and then there's a romantic breakup or a death in the family. It’s multiple hurts and disappointment.”
What of the idea that something in the psychological makeup of veterinarians predisposes them to suicide? Along with Bartram, Gaspar and Lotta consider that a valid supposition.
“Vets tend to be perfectionists,” Gaspar said. “There is an introversion in the profession that is often masked by extroversion. We have a lot of workaholics who don’t have strong support systems, and those people are particularly at risk.”
She continued: “What we need to pay attention to is that a lot of us in helping professions soldier on. We hide things that are bothering us; we don’t readily disclose. A lot of suicides look like there was no indication until you look more closely.”
According to Lotta, health-care providers in general tend to be driven perfectionists who are fearful of incompetence. They’re self-sacrificing, define themselves by their accomplishments and have an exaggerated sense of responsibility.
In her presentation to first-year veterinary students, she says: “In … some ways, the very traits that will make you dedicated veterinarians – including your passion and compassion – can also make you more vulnerable.”
The American Veterinary Medical Association, on a web page devoted to peer assistance and wellness, addresses the profession’s suicide risk in this delicately worded statement: “It is ... of tantamount importance that state wellness programs have immediate access to suicide prevention resources and referrals. While the data do not indicate that veterinary professionals have a higher occurrence of suicide compared with other professions, the veterinary community is not immune.”
Continue here to read personal stories of veterinarians grappling with suicide, and for information on prevention and assistance.
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