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Suicide Risk for Veterinarians and Veterinary Technicians

Posted on by Randall J. Nett, MD, MPH; Tracy Witte, PhD; Elizabeth G. Spitzer, MA; Nicole Edwards, MS; and Katherine A. Fowler, PhD

A new study, “Suicides and deaths of undetermined intent among veterinary professionals from 2003 through 2014” sheds new light on the issue of suicide among veterinary professions. It is known that veterinarians in the United States and abroad have a higher suicide risk compared with the general population.[1-8] This new study confirms the increased rated of suicide with stronger statistical methods and introduces new data.

Prior to this study, there have only been three studies of suicides among US veterinarians,[2,5,8] and two of these were conducted before 1996. Given veterinary medical education enrollment has transitioned since 1970 from being nearly 90% male to over 80% female [9] these studies might not tell the whole story. This is especially pertinent when considering the well-established sex/gender differences for suicidal behavior. Notably, in the general population men are more likely to die from suicide whereas women are more likely to attempt suicide. [10] Furthermore, the amount of detail available regarding the circumstances of death is limited in the available US studies because they relied solely on review of death certificates, which do not provide comprehensive information regarding the circumstances of death.

The new study provided a comprehensive analysis of data from the National Violent Death Reporting System (NVDRS). The NVDRS contains data collected from participating states from several sources, including law enforcement, medical examiners and coroners, toxicology reports, and death certificates. The study examined the deaths of veterinary professionals and veterinary students whose cause of death was characterized as suicide or undetermined intent. Researchers included undetermined deaths in the study because of the possibility such deaths could potentially be classified as suicides. Researchers also obtained information on psychosocial circumstances of death.

The study:

  • Confirmed (using stronger statistical methods than previous studies of suicide among veterinarians) that suicide is more likely among veterinarians than among the general population — 1.6 times more likely for male veterinarians and 2.4 times more likely for female veterinarians.
  • Identified, for the first time, a higher likelihood of suicide among veterinary technicians and technologists than among the general population — 5.0 times more likely for males and 2.3 times more likely for females. The results for male veterinary technicians and technologists should be viewed with caution because fewer than 20 deaths were identified, which makes the estimates less reliable. Veterinary assistants and laboratory animal caretakers did not have higher likelihood of suicide.
  • Found that poisoning was the most common cause of death among veterinarians. Pentobarbital, a euthanasia solution, was the drug most commonly used. Most pentobarbital poisonings occurred at home.
  • Found that when veterinarians who died from pentobarbital poisoning were excluded from the analysis, the likelihood of male and female veterinarians dying from suicide was not different than that of the general population. This indicates that training on euthanasia procedures and access to pentobarbital are some of the key factors contributing to the problem of suicide among veterinarians. This finding was not true for veterinary technicians and technologists who more often died from opioid poisoning compared with veterinarians.
  • Found that veterinarians were significantly less likely than veterinary technicians and technologists to have a history of a suicide attempt before the fatal incident. Nearly 30% of all decedents had disclosed their suicidal intent before their deaths, 55% had a history of mental health treatment, and 42% were undergoing mental health or substance abuse treatment at their time of death.

Based on the research findings, it will be important to ensure suicide prevention activities are aimed at veterinary technicians as well as veterinarians. In addition, the results indicate the higher likelihood for suicide among veterinarians compared with the general population might be attributable to pentobarbital access. Improving administrative controls for accessing pentobarbital could be a promising suicide prevention strategy among veterinarians. It is important to consider how to control access to pentobarbital without hindering veterinarians’ daily job functions. Requiring a second person’s signature when accessing the drug could have a preventive effect for suicide among veterinarians, while still allowing routine access for clinical purposes. Increased administrative controls could also make it more difficult for a veterinarian to take pentobarbital out of the clinic, given that most pentobarbital-related suicides occurred at home.

It will be important to consider actions that could prevent suicide among all veterinary professionals. An important next step is working with the veterinary community to determine how to implement increased administrative controls for pentobarbital in veterinary clinics. It is also important to consider whether increasing administrative controls for other substances that could be used for suicide, such as opioids, should be pursued in tandem with increased administrative controls for pentobarbital. Administrative controls on substances such as opioids could be an important suicide prevention strategy for veterinary technicians and technologists, who had increased odds of dying by opioid poisoning suicide compared with the general population, although more research is needed to investigate whether opioids were accessed through the workplace.

We welcome your thoughts and suggestions in the comment section below.

If you feel like you are in crisis, please get help right away by calling the Suicide Prevention Lifeline at 1-800-273-TALK (8255).

 

Randall J. Nett, MD, MPH, is the Branch Chief for the Field Studies Branch in the NIOSH Respiratory Health Division.

Tracy Witte, PhD, is an Associate Professor in the Psychology Department at Auburn University and the Director of the Suicidal Behavior and Psychopathology Research Laboratory.

Elizabeth G. Spitzer, MA, is a doctoral candidate in clinical psychology at Auburn University and is currently completing her pre-doctoral internship at VA Boston Medical Center. 

Nicole Edwards, MS, is a Technical Information Specialist in the Field Studies Branch in the NIOSH Respiratory Health Division

Katherine A. Fowler, PhD, is the Senior Scientist for the National Violent Death Reporting System in the Division of Violence Prevention’s Surveillance Branch, in the National Center for Injury Prevention and Control.

 

 

References

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

2. Blair A, Hayes HM Jr. Mortality patterns among US veterinarians, 1947–1977: an expanded study. Int J Epidemiol 1982;11:391–397.

3. Hem E, Haldorsen T, Aasland OG, et al. Suicide rates according to education with a particular focus on physicians in Norway 1960–2000. Psychol Med 2005;35:873–880.

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

5. Miller JM, Beaumont JJ. Suicide, cancer, and other causes of death among California veterinarians, 1960–1992. Am J Ind Med 1995;27:37–49.

6. Milner AJ, Niven H, Page K, et al. Suicide in veterinarians and veterinary nurses in Australia: 2001–2012. Aust Vet J 2015;93:308–310.

7. Platt B, Hawton K, Simkin S, et al. Suicidal behavior and psychosocial problems in veterinary surgeons: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2012;47:223–240.

8. Tomasi SE, Fechter-Leggett ED, Edwards NT, et al. Suicide among veterinarians in the United States from 1979 through 2015. J Am Vet Med Assoc 2019;254:104–112.

9. Association of American Veterinary Medical Colleges. Annual data report 2016–2017. Available at:http://www.aavmc.org/data/files/data/2017%20aavmc%20public%20data-%20final.pdf. Accessed Oct 16, 2018.

10. Drapeau CW, McIntosh JL, American Association of Suicidology. U.S.A. suicide 2016: official final data. Washington, DC: American Association of Suicidology, 2017. Available at: www.suicidology.org/Portals/14/docs/Resources/FactSheets/2016/2016datapgsv1b.pdf?ver=2018-01-15-211057-387. Accessed Oct 16, 2018.

Posted on by Randall J. Nett, MD, MPH; Tracy Witte, PhD; Elizabeth G. Spitzer, MA; Nicole Edwards, MS; and Katherine A. Fowler, PhD

2 comments on “Suicide Risk for Veterinarians and Veterinary Technicians”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    This summary mentions that psychosocial factors were measured, but it’s not clear what psychosocial factors were assessed or if their association with suicide was fully explored. It’s important to investigate what, if any, stressors associated with veterinary training or practice might be contributing to this problem (e.g., high debt levels, long hours, working with mistreated or otherwise suffering animals). Even if access to dangerous drugs is controlled, this amounts to just taking away the method of suicide (which may be replaced with some alternative method). Public health prevention efforts should also be aimed at early identification and mental health treatment of vets and vet techs at risk for suicide (e.g., exhibiting symptoms of depression) as well as addressing any modifiable occupational stressors that are contributing to the problem.

    We agree that it is important to understand the work-related stressors that contribute to suicides among veterinarians and veterinary technicians. In our analysis (Witte et al. 2019), we reported that 21% of veterinarian decedents and 22% of veterinary technician decedents had a contributing job problem before suicide. We also described how the National Violent Death Reporting System (NVDRS) data is potentially limited by the degree of completeness of certain fields and the degree of knowledge available to friends, family, and colleagues who participate in the death investigation. In other words, a decedent could have been experiencing work-related stressors but did not tell people who participated in the investigation, or the information was not documented during the investigation. NIOSH is currently planning additional studies that will evaluate the work-related factors that contributed to some veterinarians considering suicide.

    We also agree that a comprehensive approach to suicide prevention among all veterinary professionals is important, which includes reducing existing barriers to seeking treatment for those veterinarians and veterinary technicians who are experiencing mental illness. Another potential component of comprehensive suicide prevention is restricting access to pentobarbital. As described in our manuscript, the majority of veterinarian decedents who died from pentobarbital poisoning died at home. This means the drug was removed from a clinic setting and used in a home setting. There is a body of evidence indicating that if you remove a particular method used for suicide, those persons who are contemplating suicide are unlikely to choose another method as a means of substitution. For veterinarians, even if another method is chosen, given the knowledge that veterinarians have for the euthanasia procedure and their ability to calculate a lethal dose, the alternative method chosen could be less lethal. That said, it will be important to monitor the effectiveness of any means safety strategy to determine whether it is having its intended results (i.e. reducing the overall suicide rate in this population).

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