Nienke Endenburg 288

WSAVA photo

Neinke Endenburg, a psychologist at Utrecht University veterinary school with expertise in human-animal relationships, chairs the World Small Animal Veterinary Association Professional Wellness Group. At the WSAVA Congress in Toronto in July, Endenburg presented findings of a global survey on the well-being of veterinarians and veterinary technicians/nurses.

As a psychologist at the University of Utrecht veterinary program in the Netherlands, Nienke Endenburg has been following with interest and concern a growing body of research on veterinarians' struggles to maintain their own wellness and the profession's high risk of suicide.

With the research happening largely in the United States, Britain and Australia, Endenburg wondered whether the problem was particular to some countries or more widespread. Recently, she had an opportunity to find out.

A survey she conducted with the World Small Animal Veterinary Association (WSAVA) in 2018 that drew more than 4,000 respondents in nearly 100 countries indicates that diminished well-being in veterinarians is a worldwide phenomenon.

Some countries had only one respondent, but responses came from six continents or geographic regions.

Results Endenburg presented at the WSAVA Congress in Toronto this summer show that whether from Africa, Asia, North America or Europe, veterinarians and veterinary technicians/nurses who responded to the online questionnaire showed comparable results as measured by what is known as the Kessler Psychological Distress scale.

Veterinarians and veterinary staff in Oceania — a geographic region that includes Australia, New Zealand, Micronesia and Polynesia — showed the highest level of well-being, with South America slightly lower than Oceania but better than the other regions.

In career satisfaction, South America scored the highest, followed by Asia, Africa and Oceania. Europe and North America scored the lowest among the regions.

The VIN News Service spoke last week with Endenburg by Zoom online conferencing to learn more about the research. Highlights of the conversation follow.

What was the origin of the WSAVA wellness study?

I've been asking WSAVA a long time for a professional wellness committee, and they said, 'Professional wellness is only a problem in North America, Europe and maybe Australia. It's not a worldwide problem.' I said, 'Do we have studies about that?'

Then they decided they wanted a professional wellness committee and suddenly, I was the chair of it.

The first goal we had is to see if professional wellness is a problem throughout the world, or only in North America, Europe, Australia and New Zealand. And it's everywhere — that's what we found in our survey.

How was the survey conducted?

When designing the survey, we [used an aspect] of the Merck study (Merck Animal Health Veterinary Wellbeing Study conducted in the United States in 2017): We used the Kessler 6 [Mental Health Scale]. It uses simple questions [to gauge] how is your quality of life and how is your professional wellness.

It was an online questionnaire. We started in Asia. We put it out in Singapore [during the 2018 WSAVA convention], and there, people could fill it in at the spot and then we put it online in different languages, and we put a lot of attention to it by Facebook and Twitter.

We surveyed not only veterinarians but also vet nurses, or vet techs. And if you were a member of WSAVA, that would be nice, but if not, you could fill it in anyway, as long as you were a member of the vet team. ... People are really interested in this sort of thing. If you put it out, people are very willing to fill the questionnaire in.

[By the end,] we had 4,251 respondents.

In which languages was the survey presented? How did you decide which to offer?

English, Spanish, Portuguese, Russian, French, Chinese and Korean. Our goal was to get the most respondents, so we looked for [languages understood by] very big [populations]. Russia is very big, China is very big, English is ... And Korean, I don't know. One of our committee members said, 'We really have to [present] it in Korean.'

Since most respondents came to the survey online, wouldn't there be a self-selection bias? In other words, you drew respondents for whom the topic resonated.

Oh absolutely, absolutely. You can't force people to fill in the questionnaire, so there's absolutely a bias. But because we had a huge amount of respondents — there's never been a WSAVA questionnaire that had so many respondents — it's quite OK. ... I think it's a very good [representation of] what veterinarians and vet techs think about their mental well-being.

Suicide is at an epidemic level in the world. What can the survey results tell us about how veterinary well-being compares with that of other professions and in the general population?

That's not really what we measured. ... What we wanted to know is, is [psychological distress] global or is it not global? And which members of the veterinary team are more at stake?

What you see is that it is global. It is everywhere. You also see that in Asia, people don't talk about it. And if you look at North America, their [particular] problem is the debt that they have when they graduate from vet school, that's what we found. And we found that younger people and females and vet nurses are more at stake.

I think females have a problem that they are in a profession where things can happen that you can't predict. In an office job, you know you start at 9 and you finish at 5. You can pick up your children after work. But in a vet clinic, it's very unpredictable. Five minutes before 5, an emergency comes in and you can't say, 'I'm sorry, it's 5 o'clock, I'm closing.' You can't say that. If you're a mother and you have children to pick up from child care, that's a problem.

Which results surprised you?

It surprised me that it was global. Because everyone, before that time, said, 'Asia? No! It's not a problem in Asia, come on! In Asia, things are going OK.' And when we got those results, it was, 'Asia is just like the rest of the world.'

Which results were unsurprising?

That it was [a bigger problem] for younger people. ... Young veterinarians who just graduate are so happy they graduated, and then they get into practice and get into trouble [with their well-being].

When do you expect to submit the findings for publication in a scientific journal?

We're working on the manuscript. We want to do extra analysis. I hope to submit it somewhere in October or November, and you never know when you submit it to a journal when they will accept it, but I hope [it will be] somewhere in the beginning of 2020.

What are your thoughts about the survey findings?

A lot of people have a very, well, a good idea about veterinarians, that it's a great profession and you're always happy and you're hugging animals and oh, how great it is! And for a lot of veterinarians, it's so difficult to say, 'Hey, I'm having problems; it's not going OK with me.' So I think it's good to compare [veterinarians' well-being] to the general population, but it doesn't say everything. Because we don't know that, for instance, in Cambodia and in a lot of different countries, we don't know how many people commit suicide [to get a comparative rate]. And every veterinarian committing suicide is one too many. We should take care of that and see how we can help people with that.