For many of us, taking care of others is our (often more than) full-time job, but what about ourselves? And what about when our “day jobs” start affecting the rest of our lives? When this happens, a number of mental health challenges can result, including compassion fatigue, burnout, depression and anxiety.
Compassion fatigue and burnout occur mainly in response to the work that one does, and their effects are generally limited to the workplace. Depression and anxiety tend to have more global effects on one’s life, and can occur either as a result of compassion fatigue or burnout, or independently. It is also important to recognize that depression1,2 and anxiety2 are risk factors for suicide, and as such, requires our attention as we try to understand and reduce the elevated rate of death by suicide reported in veterinarians.
What is Depression?
Depression is defined as a feeling of low mood, or decreased interest or enjoyment, that lasts longer than two weeks and involves additional symptoms, such as changes in sleep habits, eating habits, energy levels, ability to focus and perception of self.3
The signs of depression can include:4
- a sad mood most of the day and nearly every day;
- diminished pleasure and/or interest in activities that used to be enjoyable;
- a change in appearance or weight;
- sleeping more or less than usual;
- feelings of moving slowly or agitation;
- low energy levels, chronic feelings of exhaustion;
- inappropriate feelings of guilt and worthlessness;
- problems with concentration and/or decision-making;
- repetitious thoughts of death (suicidal thoughts).
What is Anxiety?
Anxiety is an emotion that many of us experience on a day-to-day basis. Anxiety can be viewed as an extension of worry—we worry about our patients, our finances, our children and so on. Knowing where the line is between normal anxiety and anxiety disorder can be difficult. What differentiates “normal” feelings of anxiety from anxiety disorder is that in the case of anxiety disorder, the magnitude of the emotion interferes with everyday living; the anxiety lasts longer, impacts the way one functions, and is experienced when there is no threat to a person.4 Anxiety disorder and depression are frequently experienced together, and what might begin as anxiety disorder can lead to depression.4
The signs of anxiety disorders can include the following physical and psychological signs:4
- shortened attention span and difficulty concentrating
- feelings of fear, hesitation, a sense of bad things to come or danger
- feelings of removal or detachment from oneself
- worry that is disproportionate and/or inappropriate
- rapid heart rate and/or breathing, tremors, dizziness and sweating
Depression and Anxiety in the Veterinary Population
The mental health of vets is a growing area of research, and a clear picture of the industry is just beginning to emerge. A 2009 United Kingdom report found that 26% of veterinarians meet the diagnostic criteria for anxiety, and an additional quarter of respondents fell into the borderline category.5 For depression, about 6% meet the diagnostic criteria and a further 14% were borderline.5 In Australia, the rates of depression, anxiety, stress and burnout were found to be significantly higher than in the general population.6
In 2014, the Centers for Disease Control and Prevention conducted a study investigating the mental health of vets in the United States.7 This study found that 7% of male and 11% of female vets experience serious psychological distress; these values are significantly higher than those of the general population. Additionally, 24.5% of male and 36.7% of female respondents indicated experiencing episodes of depression since graduating from vet school; these values are higher than those reported in the lifetime of the general population.7 These statistics are a concern and draw attention to the need for further research in this area, and the development of support and assistance strategies.
The factors that contribute to depression and anxiety in vets have not been fully investigated. However, attempts have been made to try to understand the factors that increase a vet’s risk of death by suicide. Given the relationship between depression and suicide, it’s appropriate to consider that the same factors that put one at risk for death by suicide could increase the likelihood of depression and anxiety. The following are factors that have been suggested as possible contributors to the mental health challenges veterinarians face:
- Work-related stressors. This is a large group of factors that contains items that might feel out of one’s control. It includes the hours worked, the strains of working with clients, insufficient support from colleagues, depletion of emotional resources, poor patient outcomes and disillusionment with veterinary medicine. 8 While these stressors exist for most veterinarians, how each individual is affected differs.
- Individual factors. This can include family obligations (e.g., providing care for children or aging parents), relationship difficulties, personality factors, alcohol or drug abuse, and family history.8
- Poor coping strategies.8 Veterinarians receive high-quality and rigorous training in caring for their patients, but little instruction on how to care for themselves. As such, often vets are left without the necessary resources to combat the work-related stressors they face.
- The stigma surrounding mental illness.8,9 The stigmatization of mental illness in society has been found to decrease one’s tendency to seek support,8 which in turn might increase suicidal planning.8,9 It’s also particularly challenging when one belongs to a profession that helps others and in which asking for help can be perceived as weakness.9 Going Forward It might seem like knowing about the extent to which the profession suffers from mental health challenges does little more than raise concern for oneself or colleagues. However, it does much more than that. Awareness of the prevalence of such challenges should increase the likelihood that they are placed on the “differential diagnosis” list when you or a colleague is struggling. Further, it highlights the need for preventative strategies to be put into place, such as striving to improve work-life balance, taking vacations, prioritizing one’s own health and exercising.
Ways to Support Colleagues Who Might Be Struggling
Invite them to share their experiences.9 This is a simple first step; ask your colleague how he or she is doing. It might be helpful to share an observation about a change in behavior if one has prompted your question.
Listen without assessment or judgment.4 Our tendency is to try and fix other people’s problems. After all, that’s what we do all day for our clients. However, in the case of supporting a struggling colleague, the best approach is to listen to what he or she is telling you in an open and non-judgmental fashion. Refrain from telling the person what to do, or that it will pass. There is tremendous value in simply allowing someone to share their experience.
Suggest the person seek professional help, if appropriate.4 There are a number of support pathways that can be pursued to get help with mental health challenges, including family physicians, counselors, psychiatrists and help lines.
1. AVMA Wellness and Peer Assistance, https://www.avma.org/ProfessionalDevelopment/ Personal/PeerAndWellness/Pages/default.aspx
2. National Suicide Hotline, http://www.suicidepreventionlifeline.org/
1. Hawton, K., Malmberg, A., Simkin, S. Suicide in doctors: a psychological autopsy study. J Psychosom Res, 57(1): 1-4, 2004.
2. Center, C., Davis, M., Detre, T., et al. Confronting depression and suicide in physicians: a consensus statement. J Am Med Assoc, 289(23) 3161-3166, 2003.
3. National Institutes of Mental Health website. Major Depression Among Adults. Available at: http://www.nimh.nih. gov/health/statistics/prevalence/majordepression-among-adults.shtml Accessed November 2015.
4. Mental Health First Aid Canada, Mental Health Commission of Canada, 2011.
5. Bartram, D.J., Yadegarfar, G., Baldwin, D.S. A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession. Soc Psych Psych Epid, 44(12): 1075-1085, 2009.
6. Hatch, P.H., Winefield, H.R., Christie B.A., et al. Workplace stress, mental health and burnout of veterinarians in Australia. Aust Vet J, 89(11): 460-468, 2011.
7. Nett, R.J., Witte, T.K., Holzbauer, S.M. et al.Prevalence of risk factors for suicide among veterinarians – United States 2014. Morbidity and Mortality Weekly Report, 64(5):131-132, 2015.
8. Bartram, D.J. and Baldwin, D.S. Veterinary surgeons and suicide: influences, opportunities and research directions. Vet Record, 162(2): 36-40, 2008.
9. Stoewen, D.L. Suicide in veterinary medicine: let’s talk about it. Can Vet J, 56:89-92, 2015.