Is it Burnout or Depression? | Episode 31 | Reviving Vet Med

Research reveals that veterinarians experience depression more often compared to the average person, and that burnout is affecting between one-third to one-half of veterinary team members. Because there is significant overlap between symptoms of depression and burnout, yet differences in how they are managed or treated, it is important to better understand them.  

In today’s episode, I explain the differences and similarities between depression and burnout, and where to go for help if you believe you might be experiencing either one. In honor of Bell Let’s Talk Day (Canada), I also share my own experience with depression and burnout and how I have been able to manage them in the past.  

Resources

Shanti Project (Veterinary Mental Health Initiative): https://www.shanti.org/programs-services/veterinary-mental-health-initiative/ 

TogetherAll (Canadian Veterinary Medical Association): https://www.canadianveterinarians.net/veterinary-resources/veterinary-health-and-wellness-resources/togetherall/ 

Download

Mental Health Resources for Veterinary Teams: https://revivingvetmed.kartra.com/page/wellnessresources

Online Programs

To learn more about our 4- and 8-week online programs approved for CE credit in jurisdictions that recognize RACE, please visit:
https://revivingvetmed.com/programs/

Newsletter

For more practical pointers and tangible tips related to veterinary mental health and wellbeing, subscribe to our e-newsletter:
https://revivingvetmed.kartra.com/page/newsletter

Questions or Suggestions
Email podcast@revivingvetmed.com

Transcript

Hi, everyone. Welcome to another episode of Reviving Vet Med. In today's episode, we are going to be talking about depression and burnout. And as someone who has lived with depression for years and has also had experiences with burnout, I can attest to how similar these syndromes can be. Because there is significant overlap in how burnout and depression present, yet differences in how they are managed or treated, it is really important to better understand them so that we can be prepared when the symptoms do arise.
 
So in today's episode, we are going to unpack the differences and similarities between depression and burnout and where to go for help if you believe you might be experiencing either one. And in honour of Bell Let's Talk Day here in Canada, I will also share my own experience with depression and burnout and how I have been able to cope in the past and how I manage both of these today. So, with that said, I'm really excited to share this important information with you. So, let's go ahead and get into the episode. 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, burnout was recently classified by the International Classification of Disease or ICD as a workplace phenomenon. So, it's not described as a mental illness, but rather a syndrome that results from chronic workplace stress that has not been successfully managed. We know based on research amongst US Veterinarians that burnout impacts approximately one in three veterinarians and up to one in two vet techs and support team members. The symptoms of burnout present typically according to what is described by the Maslach burnout inventory, which basically measures three different dimensions or symptoms of burnout.
 
The first is emotional exhaustion, which is feelings of depletion or mental exhaustion. Increased mental distance from the job or feelings of negativity or cynicism related to the job, so what some people will refer to as depersonalization. And then a reduced sense of professional efficacy, whereby a person feels that they're not really achieving anything worthwhile on the job. So, if you're wondering if these are symptoms that you might be experiencing, you can consider a few statements that I'm going to mention that would be statements that we would hear individuals say if they were experiencing any of these symptoms. So, the first is emotional exhaustion.
 
So that would sound like "I feel emotionally drained from my work." The second one is for cynicism, which would sound like "I don't really care what happens to some of my patients." And the third is that reduced sense of personal accomplishment, whereby a person might say, "I haven't really accomplished anything worthwhile on this job." So, you can see that these three different dimensions are what characterize burnout, but you don't necessarily have to have all three. You could have one of these symptoms and you would be essentially assessed as having burnout.
 
So the ideology of burnout is that it comes from long term stressors. We typically think of those stressors in the context of work, but there are definitely stressors that we can experience in our home lives as well that can contribute to burnout in the workplace. So, for example, from a lifestyle perspective, working really long hours, having multiple jobs, having responsibilities outside of work, such as caregiving for children or, parents, having an absence of work life separation, where you take work everywhere you go or you never stop working, not taking vacation or days off, not having enough social support systems in place, and not practicing self-care. All of these are factors that can contribute to burnout. And then, of course, we think of burnout factors in the context of our workplace.
 
So some different research factors include not having control in the workplace. So, we see this a lot in the emergency setting where we can't really control what's gonna walk through the door. Having a very demanding workload, and we've certainly seen this on the rise in the context of the pandemic and the caseload increases, not feeling recognized or rewarded for the work that you're doing or having unclear expectations where you don't really know what it is that you're supposed to be doing. Workplace toxicity, which is something we've talked about before, whereby if there is incongruent communication or if there are negative attitudes that are not being held accountable, there's conflict in the workplace that goes unaddressed, all of these things that can culminate in workplace toxicity. We have research in the US and companion animal practices whereby all members of the veterinary team, whether they be veterinarians, vet techs, or assistants, are all at higher risk of burnout.
 
Values and congruence is another factor that is associated with burnout. So, if you value, for example, a lot of time with your clients, high touch points, high communication, high quality medicine, and you find yourself working in a practice whereby it's low touch points, high caseload, get them through the door, you know, maybe lesser quality medicine, that that is going to be a predisposing factor for you for burnout. And then, of course, not feeling that you have sufficient resources. So that could be in the context of medication shortages, or staffing shortages, or not having equipment, or technology that is working properly. All of these things are factors that can be contributed can contribute to burnout.
 
Now, depression, in contrast, is classified as a mental health disorder, and this has an estimated lifetime risk of affecting about one in ten people. The symptoms of depression are low mood, feelings of hopelessness or guilt, reduced ability to experience pleasure, and sometimes physical symptoms like headaches or GI disturbances, as well as an inability to concentrate or work. Now research demonstrates that job stress can be a major cause of depression even leading to absenteeism from work. And we know that depression is considered a symptom of habitual burnout, which is the fifth of the five stages of burnout. We talked about recovering from habitual burnout in episode 12, so I urge you to check that out if you haven't yet had the chance to listen to it.
 
But the idea being that depression very much coincides with this stage of habitual burnout, whereby burnout becomes essentially entrenched in people's lives and they feel like they're not able to escape it or recover from it. Now, the reason I decided to talk about burnout and depression on this podcast is that there are a lot of controversial results and studies as to how we differentiate burnout from depression. There's research demonstrating that symptoms of burnout and symptoms of depression can overlap by more than 30%, depending on which scoring system is used. And this is especially true with emotional exhaustion, so that symptom of, you know, inability to care or be concerned with our patients and our work, that very often presents with a sense of low mood or fatigue or loss of energy, which, of course, can look very much like depression. In addition, what complicates this is that work related risk factors for burnout are also predictors for depression.
 
So, for example, not feeling supported, having a high workload, experiencing moral stress. All of these things can predispose a person to depression as well. So, it can be very difficult to trace steps backwards to say, well, this happened and this happened, so I must be experiencing burnout because those things could very well be contributing to depression too. Individual risk factors for depression, such as past depressive episodes, are also predictors of burnout. So, the flip side is true, whereby we might think, well, this must be depression because I've been here before.
 
But in those situations, you could also be at risk of burnout based on the research that has been put out there and what we know about the crossover between burnout and depression. So, some also argue the flip side that while these symptoms overlap, that depression is predominantly low mood and loss of interest or pleasure, whereas burnout is this demoralization, emotional fatigue, and irritability. So, you could potentially look at these in terms of what is the predominant symptom here, what how are my signs really eliciting themselves, and, you know, make a diagnosis or make an assumption based on that. But again, overall, burnout really is, you know, so often overlapping with depression that it can be hard to, you know, unlink the two of them. So, I can share with you my personal experience with burnout and depression.
 
And, really, you know, I myself have had these moments in my life where I've been very uncertain and confused as to what I am experiencing. So, I started experiencing depression and depressive episodes when I was in my residency program. To be honest, it probably happened sooner than that, but that's certainly when I started to really recognize that that might be what was happening. And there was a lot of overlap, of course, with burnout, because in an emergency and critical care residency, I mean, you're working these incredibly long hours, you're on call, you're trying to prepare for boards, you're juggling, you know, all sorts of conflicting things, not the least of which is, you know, trying to balance your finances and make ends meet and everything in just our day to day lives as young adults. And that, you know, really led me to start to pursue mental health support and to really look at having some supports in place and to gain some skills to be able to recognize what I needed to be able to manage my mental health in a positive way.
 
And I've continued since then to have flare ups of my depression throughout my life, whether that be in response to difficult stressful circumstances. Again, depression very much can come on in response to difficult or stressful circumstances. So, whether it be the ending of a relationship or the loss of a pet or a loved one, or just difficult life circumstances that we can face, whether they be work related or otherwise. And, you know, at different times in my life, I have found different ways of managing and coping. Very often, I try to manage with mental health professionals or coaches or others who can offer their support and their strategies and skills to help me get through it.
 
And I have, at other times, needed to rely on medication to help me through those difficult moments as well. So, it is really dependent on the circumstance and how quickly I feel that I will be able to rebound and also how I am doing in response to the coping strategies and skills that I already have in place. So for example, if I feel as though I've maxed out all of my strategies then, and I'm still, you know, feeling that, you know, inability to experience joy or inability to motivate myself, to do the work that needs to be done, to do the work that needs to be done, that medication might be a good option for me there. Now there's also circumstances, for example, when I was postpartum, after I had had my daughter, where I could not enact a lot of the skills that I would typically use and the strategies to boost my mental health. So, I was exhausted, I wasn't sleeping, I wasn't able to get the regular amount of sleep I need on a regular basis.
 
I was also not able to exercise because I was recovering from childbirth. I wasn't getting outside as much as I would normally do. I wasn't getting out of nature. I wasn't able to meditate because I was so busy trying to get sleep at any moment that I could. And, you know, with the severity of my mental health system symptoms at that time and my inability to put those support strategies in place, it was very much decided between me and my physician that, medication would be the best route for me in that situation.
 
So again, you can see how it's really something that you need to discuss with your healthcare provider. Now in the context of burnout, I have had many experiences in my life where I have felt very similar symptoms to depression, but that I really felt were related to the work that I was doing, whether it was spending too much time on call, whether I hadn't taken vacation in a while, whether there was work related toxicity or conflict that wasn't being dealt with that was really eating me up, whether I was resource dry at work and feeling like I was doing the work of three different people, any number of different situations at work whereby I felt like these were all situations that could lead me to be experiencing burnout and would drive me then into that state of emotional exhaustion or cynicism, you know, in those situations. And so, you know, I have the knowledge and expertise now to really look at my situation and be, you know, discerning about what do I need to let go of, what do I need to change here so that I'm not experiencing this anymore? And all that to say, it's still something that I'm working on because, you know, even as recently as this fall, I had some experiences of burnout and depression that were really overlapping and I couldn't tell, was this because I'd had a very difficult summer and fall, and was this because I was very busy with work, or because I was exhausting myself as a solo parent?
 
You know, there's so many different factors that are, you know, inextricably linked to each other. And at the end of the day, it took conversations with my physician and my mental health professional to really come to the realization that it was likely both of these, that were going on in conjunction with each other. So, all that to say, it's not that you either just have depression or you just are experiencing burnout, you very well could be experiencing both at the same time, especially if you are in that fifth stage of habitual burnout. Now, I've talked a lot about speaking to a mental health professional. I've mentioned medication as well.
 
I want to make sure that you know all the different ways that you, as a veterinary professional, can access mental health support. So, I urge you, first and foremost, to connect with your employer to know whether you have some sort of employee assistance program. So very often, practices and organizations now have employee assistance programs whereby they outsource mental health support to a third-party provider whom you can call. It remains anonymous and confidential. You let them know what your struggles are.
 
They link you up with a mental health professional, and then you have the option to pursue sessions with that mental health provider. So, these sessions are typically free up to a certain number covered by your practice or organization, so take advantage of those. I've certainly taken advantage of them when I have had access to those in in various jobs that I've had, and I urge you to do the same. Some of you might also have extended health benefits, either through your employer or through your spouse's health insurance or through your own health insurance. So, pay close attention to what the mental health provider benefits are.
 
Maybe you have coverage for social work sessions or psychologist sessions or counselling sessions, whatever it might be, but you wanna take advantage of that as well. Very often too, we have support through our Veterinary Medical Association benefits. So, for example, here in Alberta, where I live and I'm registered as a veterinarian, we have an employee assistance program. So, we can contact the employee assistance program that is available to all of the Alberta VMA members, and through that, I have access to a mental health professional for up to four sessions. So, again, it's something I've utilized for various different reasons, and I urge you to check that out if you are a member of a veterinary medical association, especially a state or provincial VMA, to really take advantage of those resources that they're offering.
 
Now, there's also online support, so a lot of people are using services mental health provider. These are very convenient. They're often very affordable. You have access to different professionals, and you can often access them via, to different professionals, and you can often access them via text messaging, email, video calls, voice calls. And it is my understanding that you can purchase these in different packages.
 
So if you have a certain budget that you wanna stay within, you can purchase packages within that budget, and then you can access the mental health professional according to what your package includes. So, I urge you to check those out too. And as well as veterinary professionals, there is a new resource that is available for us, which is through the Shanty Project, which is the Veterinary Mental Health Initiative. And the Veterinary Mental Health Initiative is a support system that is available to veterinarians and vet techs and was created to make mental health support available for everyone in our profession, recognizing that, you know, veterinarians and especially vet techs don't get paid an exorbitant amount of money, and very often it's hard to budget for mental health support. So if that's something that you are interested, I will link to that in the show notes, and I know that they run their programs on a regular basis, so you can connect with them and hopefully sign up for the next cohort of programming that is available.
 
And then last but not least, for those of you who are in Canada listening and who are members of Canadian Veterinary Mental sorry, the Canadian Veterinary Medical Association, we have a lovely resource that we have access to for free called Together All. And Together All is an online resource that is basically anonymous peer support forums. So, counter to what you might find online when you join some of our veterinary forums, you know, on Facebook and other platforms, Together All is moderated by mental health professionals. So, they are watching for particular trigger words or concerning dialogue that is being exchanged so that they can jump in as a mental health professional to say, hey, you know, do you need to have a conversation? Did you know that these resources are available?
 
So it isn't just about going in and venting and sharing and potentially harming other individuals, you know, by triggering them with some of what you are sharing, but to be in a space that is moderated and is, you know, really well looked after in terms of safety, to ensure that you can connect with your peers and have these conversations and also know that if anything should show up that is of concern to a mental health professional, that they will be there and ready to intervene. So, you know, in summary, there is a lot to unpack here in the context of burnout and depression. And at the end of the day, it may be very difficult to separate the two, or at the end of the day, you might be experiencing both at the same time, and that's certainly been the case for me at different points in my life. And I urge you to connect first and foremost with a mental health professional to get the support that you need through any of those resources that I shared. And further to that, there are many other strategies and tools that are available.
 
I talk about a lot of these on the podcast, so I urge you to check out my other episodes if you haven't already. And of course, stay tuned for future episodes where I will continue to share tools and resources for improving your mental health and well-being. Well, that's it for this episode of Reviving Vet Med. Thank you so much for listening. I really hope you found this episode helpful and that you gained new insight into the overlap and differences between depression and burnout.
 
If you enjoyed this episode, please take a moment to send it to a friend or a colleague. And, of course, please subscribe to the Reviving Vet Med podcast so that you can get these episodes as soon as they drop. I'm excited to share with you as well that I have formally scheduled all of my online programs for the coming year. I offer four- and eight-week programs related to burnout prevention, boundaries, and workplace well-being. If you have interest in any of those topics, please visit my website marieholowaychuk.com to learn more and to sign up for those wait lists so that you can be the first to register when they open.
 
I want to thank my amazing assistant Jamie for producing this episode, and I want to thank you for listening through to the end. Until next time, time, take care of yourself. Bye now.