by James Glass
Suicide risk is elevated in veterinary professionals. Veterinary surgeons, veterinary nurses and technicians, as well as students training in these occupations, are an at-risk population, with those working in the professions approximately 4-5 times more likely to die by suicide than the general population. Suicidal behaviour more broadly remains poorly understood and, for this specific population, the links between individual mental illness, subsequent behaviours and their suicide risk, are considered complex.
Within these careers there is evidence of links and interaction between professional work, personality factors and mental health. A recent review highlighted a range of risk factors associated with poor mental health and high rates of suicide among veterinary staff: financial debt, excessive workload, challenging case, interpersonal conflicts, performing euthanasia and easy access to lethal means.
Major risk factors identified for suicide risk in veterinarians focused on several career-specific issues including negative effects of workload in undergraduate training, work-related stress, individual psychological morbidity, stigma around help-seeking behaviour, and ready access to and knowledge of methods of suicide. Others give prominence to high achieving students, a demanding course that stifles emotional development, the isolation of general practice, and performing euthanasia, thereby altering views on the sanctity of life.
Although these factors affecting risk have been much debated and are well-intentioned, they have often been opinion-led, rather than evidence-based. Therefore, there remains a lack of clear evidence for predisposing factors and associated risks, providing no clear path to develop effective interventions for veterinarians at risk of suicide.
A recent study highlighted the dangers of relying on popular opinion and anecdotes which, without clear evidence to substantiate them, risk becoming “taken-for-granted truths”. A current review of the psychological instruments employed in 78 reported studies of mental ill-health among veterinary professionals found a wide variety of different measures. Almost one third of studies included less reliable, researcher-designed, single-item questions, and only 6 papers were categorised as high quality. Varied methods, an array of different measures, and inconsistencies in scientific approaches all raise barriers to advancing understanding.
In a current online study among veterinary professions, we sought to map our measures to the Integrated Motivational-Volitional (IMV) Model of Suicidal Behaviour. The IMV model focuses on the risk and protective factors associated with suicidal thinking, as well as the distinct factors which can govern the transition from that suicidal thinking to attempting suicide or dying by suicide. A central tenet of the motivational phase of the IMV model reflects the link between experiences of defeat/ humiliation and feelings of entrapment as key drivers for the emergence of suicidal ideation and intent. Within the volitional phase, factors such as exposure to suicide, impulsivity and fearlessness about death are considered important factors in the transition from suicidal ideation to suicidal behaviour.
In developing this study, we sought to use evidenced scales and measures which were concise, reliable, and accessible. For example, in assessing participants experience of self-harm, suicidal ideation, and suicide attempts, we used four questions derived from a large national UK adult study. These questions have been widely used in veterinary professional studies over the last 20 years, allowing us to draw comparisons with previous work.
Alongside these established measures, we selected some adapted to make them accessible and useful in this specific study population. Having been more widely studied among the military and in healthcare, moral injury is a developing focus within the veterinary professions where ethical dilemmas and challenges at work may impact wellbeing. Weekly numbers of euthanasia cases, along with frequency of unacceptable occasions, have been used as rudimentary measures of moral injury. As there is currently no screening instrument for moral injury valid in UK samples, we included a military-focused moral injury scale with the language specifically adapted to reflect veterinary professionals and their work. Using a scale with validated properties, while carefully revising the wording to reflect the veterinary population, helps to maintain accuracy while ensuring we explore participants’ relevant experiences as we seek to identify key evidence-based risk factors for suicide in veterinarians.
Efforts to explore veterinary suicide risk based largely on opinion and anecdote – those “taken-for-granted truths” – is a concern when the results are informing work targeted at suicide prevention and wellbeing in an under-researched population. It is incumbent on us as researchers to ensure we seek to prepare thorough studies, using researched, proven measures. Only then can we hope to gather reliable data to inform the evidence-based answers which will inform development of effective interventions.
Suicidal Behaviour Research Laboratory 