Why Are Veterinarians Dying By Suicide? | Episode 22 | Reviving Vet Med

When we learn that a fellow veterinarian has died by suicide, almost always the first question asked is “why?”. While there is rarely an obvious answer in each individual’s situation, there are risk factors for suicide that warrant discussion, as well as careful consideration of what we can do to prevent suicides in the future.   

In this episode, and in honor of World Suicide Prevention Day on September 10th, I share what we know about veterinarian suicides based on recent studies, as well as the uncertainty that remains in every suicide situation. Reminders and resources for preventing suicides among all veterinary professionals are included.  

If you are concerned about a friend or colleague, or if you are having thoughts of self-harm or suicide, please call the USA National Suicide Prevention Lifeline (1-800-273-8255), Canada Suicide Prevention Service (1-833-456-4566), or 911.

Blog Posts
Why we need to be careful how we talk about suicides among veterinary professionals: https://marieholowaychuk.com/2020/02/19/why-we-need-to-be-careful-how-we-talk-about-suicides-among-veterinary-professionals/
Let’s Do Our Part to Prevent Suicide Among Veterinary Professionals: https://marieholowaychuk.com/2021/09/01/lets-do-our-part-to-prevent-suicide-among-veterinary-professionals/
When do coping strategies become harmful for veterinary care providers?: https://marieholowaychuk.com/2021/08/04/when-do-coping-strategies-become-harmful-for-veterinary-care-providers/ 

Related Articles

Suicide among veterinarians in the United States from 1979 through 2015 (JAVMA 2019): https://avmajournals.avma.org/view/journals/javma/254/1/javma.254.1.104.xml
Suicides and deaths of undetermined intent among veterinary professionals from 2003 through 2014 (JAVMA 2020): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933287/ 

Suicide Intervention Training

QPR (AVMA): https://www.avma.org/resources-tools/wellbeing/qpr-suicide-prevention-training
ASK (VetFolio): https://www.vetfolio.com/courses/ask-suicide-prevention-training 

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https://revivingvetmed.com/programs/

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Transcript

Hi, everyone. Welcome to another episode of Reviving Vet Med. In today's episode, we will be discussing the topic of suicide. So, I'd like to share a disclaimer before we get started here. If you yourself are having thoughts of self-harm or suicide, or if you know of a friend, colleague, or family member who is, then please call the USA National Suicide Prevention Lifeline at +1 802738255.

If you're in Canada, there's the suicide prevention service at +1 (833) 456-4566. And no matter where you are, of course, in Canada or the U.S, you can always call 911. So, as we get started on today's topic, the reason for this podcast episode is because September 10 is World Suicide Prevention Day. So, this time of year is always a reminder for me to reflect on the topic of suicide in the veterinary profession.

This is something that is at the forefront of many individuals' minds. It's been brought up in mainstream media throughout the pandemic and, even before. And I think it absolutely warrants revisiting. Now, the question people often ask when they learn that someone has died by suicide or when they hear about the statistics about veterinarian suicide is, why? Why are veterinarians dying by suicide at higher rates than the general population?

Or why did that person decide to end their life? And of course, we will never know the answer to this question in many or most instances. And I hesitate, in some regards, to share this episode because I firmly believe that what's so much more important than asking why? Is asking what? What can we do to prevent more suicides?

What can we do to prevent this statistic from worsening in the future? And so, I do share information answering what question in my episode number seven. So please do look for that. And if that's something that you would rather listen to in lieu of this episode, then go for it. Otherwise, let's go ahead and address this question of why.

This is the Reviving Vet Med podcast, and I'm your host, Dr. Marie Holowaychuk. My mission is to improve the mental health and well-being of veterinary professionals around the world. So, we know based on work investigating the cause of death among veterinarians in The United States, specifically in research that was looking at data between 1979 and 2015, that male veterinarians are 2.1 times more likely to die by suicide, and female veterinarians are 3.5 times more likely to die by suicide, both in comparison to the general population. And the biggest question certainly that I get asked when I share this statistic, especially with individuals outside of the profession who, are really surprised often to hear this statistic is why. And the short answer is not simple.

You know? There is not always an obvious answer. And often, when you hear something that you think is obvious, like, you know, the person was in financial trouble or that they had a really bad incident with a client at work, I can guarantee you it is not that simple. That suicide is an incredibly complex situation and result of a multitude of factors that ultimately lead to that endpoint. So, I do think that there are risk factors that warrant discussion and understanding, and that is going to be the focus of our conversation today.

And the first risk factor that I want to address is mental illness. So, we know based on statistics that more than ninety percent of people who die by suicide have a mental illness concurrently. Very often, it's depression, which inherently puts them at higher risk, and it may be other mental illnesses such as bipolar disorder, or various other, illnesses as well. Now recent studies here in Canada have demonstrated higher incidences of depression and anxiety amongst veterinarians compared to the general population, but we haven't seen these statistics across all veterinarian populations. So, I think that the jury is still out in terms of whether veterinarians do have a higher incidence of mental illness, which would put them at risk.

Again, some recent studies in certain demographics such as here in Canada suggest that might be the case. Regardless of that, that statistic of more than ninety percent is astounding. And what that says to me is when you do hear that a person has died by suicide, regardless of whether they're in the veterinary profession or not, the first thing that I would think of is that the person very likely had mental illness that complicated their situation and put them at risk, essentially, of suicide. Another risk factor is a history of suicide attempts. So, this is a really, really important thing to consider.

If you know someone in your life or you work with someone who has previously attempted suicide, anyone with a previous suicide attempt has a higher lifetime risk of dying by suicide. So, it's a risk factor that does not go away and is something that we must always, always keep in mind and always be cognizant of. The third risk factor that I wanna talk about is exposure to suicide. So, this is something that I think is really, really important for us to discuss, especially in the context of the veterinarian per the veterinary profession. You know, there is so much information out there and, you know, as I said in the introduction, there are mass media articles and conversations in veterinary chat groups and other things that are bringing up suicide.

And, you know, I even hesitated to record a podcast this month on suicide knowing that I would also be bringing it up in the process. And the reason there's concern with that is because every time we mention suicide, talk about suicide, or refer to suicide, if there is an individual who is at risk or who is having thoughts of suicide, it may put them at risk. And this is especially true in certain situations whereby the individual knows someone close to them who has died by suicide, or they are, exposed to a suicide that is widely publicized. So it might be, you know, a very well-known person in the media, could be a celebrity, could be a veterinarian who was well known. This exposure can set off what we refer to as a phenomenon of suicide contagion.

And this has been documented, historically. There was, evidence that when Marilyn Monroe, for example, died by suicide decades ago, that there was actually an increase in suicide among the general US population. And so there can be suicide contagion because of seeing someone else die by suicide, especially when it's not known or when the cause is oversimplified. I see this of a special concern in veterinary medicine because so often, I feel as though suicide amongst veterinarians is very much oversimplified where I've seen articles referencing, you know, veterinarians dying by suicide because of clients, or because of how hard the job is. And an oversimplification like that can lead an individual who's having thoughts of suicide to sort of ponder, you know, well, I'm experiencing that.

And so, if that person was experiencing the same thing and this was where they ended up, is that where I'm going to end up as well? Versus recognizing that it's incredibly multifactorial and complex, and that there's no one thing that ultimately leads to a person dying by suicide. So, individuals who are at risk, and are exposed to suicide are especially prone in the absence of protective factors. So, for protective factors would be familial support, access to mental health care, other forms of support system, etcetera. So, this is why help seeking is so very important.

So, another risk factor that warrants discussion is substance use. This is especially true for individuals who have preexisting mental illness because substance use can put them at higher risk of suicide. And I have to say, we don't talk a lot about substance use in the veterinary profession. And I think this is something that absolutely warrants more discussion. I've, written a blog about alcohol use among veterinarians.

And what was really interesting to me was a study investigating the cause of death among US Veterinarians dying by suicide a couple of years ago found that more than fifty percent of veterinarians had alcohol in their system, and more than forty percent of veterinarians had benzodiazepines in their system. So, again, those are pretty startling numbers to me, which suggests that with some of these other factors I've mentioned, with the addition of substance use, that that could inherently put an individual, at risk as well. Now this brings us to another point, which is really important and relevant to veterinarians, and that risk factor is access to means. So, I'm not gonna get into, the information around firearm access. I know that's a very heated topic, especially, amongst my American colleagues, but I will speak to access to means in the context of veterinarians accessing pentobarbital or euthanasia solution.

And so that study that I mentioned previously looking at alcohol and benzodiazepines, also determined that most of the veterinarians who died by suicide did so by poisoning, and most of those were due to pentobarbital. And, concernedly, the majority of those pentobarbital ingestions or injections took place at home. So, this really raised a lot of red flags regarding access to pentobarbital, you know, how clearly easy it is to access and to remove from the premises, for potential misuse. And this led to campaigns. You probably remember Dr. Andy Roark in 2020, launched the four eyes campaign.

This was a movement to really urge, practices to make essentially a rule or a guideline that pentobarbital could only be accessed if two individuals were present. And that way, if one person is at risk, there is another person who is there to essentially maintain accountability and safety and make sure that the amount drawn up is the amount that's needed and that there is appropriate disposal and that, you know, the rest of the pentobarbital solution goes back into the locked area. So, I am a big supporter of the four eyes system, and I do think that this warrants more conversation and more discussion in relationship to the number of suicides that we're seeing amongst the veterinary professional population. Now stigma is another risk factor that I think is really, really important for us to talk about. And stigma is something that I, as an individual, feel very strongly about.

It's something that I talk a lot about. And the reason I do is because our stigma around mental health influences whether we access mental health treatments or services. And we know based on a previous study serving veterinarian attitudes towards mental illness that almost fifty percent of US Veterinarians somewhat or strongly disagreed with the statement that people are generally caring and sympathetic to people with mental illness. So, this is incredibly concerning to me, and I know it was incredibly concerning to many because what it means is that almost fifty percent of US Veterinarians at the time held a stigma that suggested that if they reveal that they had a mental illness, that people would, in general, not be caring or sympathetic. And, of course, what that means is that they are going to be less likely to disclose their mental illness and even less likely to seek help.

So, we know that stigma is a huge contributor to individuals seeking help. And we know that when a person is at risk of suicide, help seeking is one of the only things that can be, you know, of good benefit aside from those other supports that I spoke about. And, of course, another risk factor is these distressing or difficult life events or circumstances. So, this can be anything from divorce to job loss to financial difficulties, complicated grief over the loss of a loved one, a pet, a distressing situation. All of these can have an impact, but hear me when I say this, these are often not present alone.

And so, I have been very distressed in the past when I have learned of colleagues of mine dying by suicide, and the information gets released. And, you know, people are asking the question of why, and it gets chalked up to, you know, well, we learned that, you know, they had, they were in a lot of financial trouble. They had a lot of student debt or, you know, we learned that they were dealing with a really difficult situation at work. And I do really see a danger in this. And these recent social media campaigns related to clients and their impact on veterinary mental health and suicide, for me, are incredibly detrimental because they're oversimplifying a very complex problem.

And if we simply look at these situations and we say, well, that's it. You know? If it's up to our clients, if our clients could just be nicer and treat us better, then all of our problems would go away, and we would no longer have, you know, veterinarian suicide. And I'm being a bit facetious on the flip side where I'm now oversimplifying what I'm seeing, but I wanna drive this point home that this it's just not that simple. That despite what the media or individuals in our profession are trying to portray in terms of blaming euthanasia, angry clients, student debt, etcetera, for the high rate of suicide among veterinary professionals, it is not the result of one problem, event, or issue.

It's a very, very complex situation. And moving forward, it doesn't matter about the why. What matters is what. What can we do for ourselves and our teams to prevent suicides among veterinary professionals moving forward? And I'm gonna leave you with this in closing.

I urge you, if you have not already taken some form of suicide intervention skills training to please, please do so. Make it your mission that before the end of this month, that you are going to do this. And if you can, do it with your entire team or the team of individuals whom you work most closely with. And the two forms of suicide intervention skills training that I would recommend are both free, and they're both available online. The first is the QPR training that is hosted by the American Veterinary Medical Association.

QPR stands for question, persuade, refer. So, this is, you know, it will take you, one to two hours to complete this training. And the training basically arms you with the skills to be able to question someone who you think you that might be at risk, persuade them that help is available, hope is here, you know, don't give up, we can we can do this, we can get through this, and then refer them to the person or people who can help them. QPR, question, persuade, refer. And I'll link to that, in the show notes.

And the other suicide intervention skills training that is readily available online is from VetFolio, originally developed by Banfield a few years back, and it's called ASK, which is assess, support, know. So similar layout to this one is modified from, a pediatric, suicide intervention tool, available for humans and also available online. This one uses more veterinary specific examples and videos. And, again, it's something that I recommend that you do with another person or with your team just so that you can feel safe, that you can have someone else there, that you can ask questions and debrief after you have taken this training. But I can't stress it enough.

This training, I've done a number of different suicide intervention skills training ranging from two hours online to two days of training, and it's incredibly powerful, and it is lifesaving. And I think every single one of us working in this profession, knowing the risk, that we are seeing amongst our team members, that we would arm ourselves with this ability to help. So that's it for this episode of Reviving Vet Med. Thank you so much for listening. I know this topic is a heavy one, but it is very, very important, which is why in light of World Suicide Prevention Day, I did opt to have this conversation with you.

I do have a lot of resources and research articles that I'm going to link to in the show notes. So please visit my website, marieholowaychuk.com forward slash podcast to access this episode and to find those resources. And speaking of accessing this episode and future episodes, I would really appreciate it if you would subscribe to my podcast and if you could leave a rating and review, that will help other people to subscribe as well. Or you can simply share this episode or this podcast with your team members or someone else who you think might benefit from this conversation. I'd like to thank Jamie for producing this episode for me, and I'd like to thank you for listening.

Until next time, take care of yourselves. Bye now.