CDC study

Research by the U.S. Centers for Disease Control and Prevention on suicide among veterinarians appears in the Jan. 1 issue of the Journal of the American Veterinary Medical Association.

New research from the U.S. Centers for Disease Control and Prevention corroborates and quantifies what the veterinary profession long has suspected: American veterinarians have been more likely to die by suicide than the general population.

Reviewing the causes of death of veterinarians from 1979 through 2015, researchers found that male veterinarians were 2.1 times as likely and female veterinarians were 3.5 times as likely to die by suicide as the U.S. population as a whole.

The study, published in the Jan. 1 issue of the Journal of the American Veterinary Medical Association, resulted from a collaboration between the CDC and the American Veterinary Medical Association.

For years, the veterinary community has been aware that it may have a higher-than-usual risk for psychological distress, including anxiety, depression, suicidal thoughts and suicide. Research published in 2010 found that British veterinarians were four times as likely as the general population to die by suicide. Studies from Australia and Norway also reported higher-than-expected numbers of deaths by suicide among veterinarians. But documentation of the risk among U.S. veterinarians was elusive.

That's no longer the case.

"I am very grateful that we finally have numbers," said Dr. Michele Gaspar, a veterinarian and psychotherapist in Chicago. "There has been a sense ... a feeling, that there's an increased risk for suicide in the profession, and now we certainly have numbers."

Gaspar cautioned that the numbers should not be interpreted to mean that the occupation itself causes suicide. "We know that suicide is a very complicated, multifaceted problem [for which] there are multiple issues at play," she said. " ... I think that [working] in the profession can be one factor."

Other factors include loneliness, relationship stressors, financial stressors and having a susceptible personality type, said Gaspar, who is involved with a confidential support group called Vets4Vets that helps veterinarians with professional, personal and emotional issues.

The CDC study looked at numbers of veterinarian deaths by suicide, as indicated by cause of death listed on death records; suicide deaths by gender; and methods of suicide. The researchers used AVMA obituary and life-insurance databases to identify veterinarians who died during 1979 through 2015.

For the study, researchers examined the records of 11,620 deceased veterinarians, of which 398 had suicide as an underlying cause of death.

Of those, 326 were men and 72 were women. Their median age at death was 57 and 42, respectively. Most worked in clinical medicine; 75 percent worked predominantly or exclusively in companion animal practice. (In 2017, the proportion of veterinary positions predominantly or exclusively in companion animal practice was the same — 75.5 percent, according to AVMA market statistics.)

The most common methods of suicide, the study found, were the use of firearms (45 percent) and pharmaceuticals (39 percent). Women were more likely to die using pharmaceuticals, whereas men were more likely to die using firearms. Overall, the rate of death by pharmaceutical poisoning among veterinarians was nearly 2.5 times that of suicides in the general population in 2016.

The researchers noted that during almost all of the 36 years studied, the proportion of female veterinarians who died by suicide was more than three times the proportion of suicide deaths in the general U.S. population. The exception was during the period of 2000 to 2004, when the gap narrowed.

That wasn't because the number of female veterinarian suicides went down. On the contrary, the number rose. What happened was, the number of suicides in the general population increased, as well. Even then, suicide among female veterinarians stood out.

"Although the U.S. suicide rate increased 30 percent between 1999 and 2016," the study says, "female veterinarians were still more than 2.5 times as likely as the general U.S. population to die from suicide during this part of the study period."

The authors point out that the number and proportion of women in veterinary medicine is on the rise. Women constitute more than 60 percent of U.S. veterinarians today, and more than 80 percent of veterinary students. "Therefore, if the high PMRs [proportionate mortality ratios] for suicide among female veterinarians endure as the number of females in the veterinary profession continues to grow, the number of suicide deaths among female veterinarians could continue to increase," the researchers write.

The study cites a variety of possible work-related factors for suicide identified in research done previously by others: long hours, work overload, practice-management responsibilities, client expectations and complaints, having to communicate bad news, rising costs of veterinary care, performing euthanasia, poor work-life balance, professional isolation, student debt and burnout.

The study also discusses the possibility that veterinary schools select for students who have certain personality traits associated with an increased risk of suicide, such as perfectionism.

“Our findings suggest mortality from suicide among veterinarians has been high for some time — spanning the entire 36-year period we studied,” CDC Director Robert R. Redfield, MD, said in a prepared statement. “This study shines a light on a complex issue in this profession. Using this knowledge, we can work together to reduce the number of suicides among veterinarians.”

The AVMA said in a press release that it is working closely with the American Foundation for Suicide Prevention and other suicidology experts to address the problem. The press release provides links to a variety of programs and resources on topics such as well-being, financial planning and how to help those in distress.

While the CDC study is focused on suicide, Gaspar said strategies for prevention must give attention to mental-health conditions that could but don't necessarily lead to suicide or suicide attempts, such as anxiety, depression, financial stress, burnout and the like. Because whether an individual's psychological distress leads to a serious risk of suicide, the distress itself merits relief, she said.

A study on the state of well-being among veterinarians done in late 2017 and early 2018 found that while veterinarians did not have abnormal levels of serious psychological distress, their sense of well-being was below that of the general public's.

Gaspar said people in the healing professions — veterinarians and physicians alike — tend to resist asking for help. "We consider it a weakness," she said. "And that's the kind of thinking that needs to be reframed in a big way. We are deserving of help, and seeking help is not a weakness."