By Gary Evans, Medical Writer

Employee health professionals are probably aware that their colleagues in veterinary medicine are at suicide risk, but there is a striking disparity in terms of gender that is just coming to light. Female veterinarians — the rising demographic in this field of medicine — have a fourfold higher suicide rate than their male colleagues, the CDC recently reported.

Burnout and suicide rates are increasing in medical care, particularly among physicians, but these are the first data that point to the high risk to female veterinarians.

This cutting-edge occupational health information was recently reported by the “disease detectives” in the CDC’s Epidemic Intelligence Service (EIS) at a conference in Atlanta. Although the findings come with several caveats — they are often a broad sweep over large data sets — EIS officers identify trends and emerging issues that can predict future public health problems.

Knowing that U.S. male veterinarians had suicide mortality almost twice as high as the general population, EIS investigators sought to identify the suicide risk in female vets. The issue is critical because more and more women are going into the field. Currently, some 80% of U.S. veterinary students are female, and they currently comprise more than half of practicing vets.

12% suicide rate

The EIS investigators looked at death certificates and life insurance databases for veterinarians who died during 1979-2015 to obtain underlying causes of death. Of the 11,620 people analyzed, 11,047 (95%) were male and 573 (5%) were female. A total of 398 (3%) deaths were attributable to suicide. Of those, 326 (82%) suicide deaths occurred among males and 72 (18%) among females.1

That translates to a 12% suicide rate for female vets, fourfold higher than the 3% rate for men. Though the reasons for the gender difference are not completely understood, it could be that women are more susceptible to the contributing factors that lead to depression, anxiety, and suicidal ideation in veterinary medicine. It’s also possible that, since men have dominated the field over the earlier years studies, more of their deaths may have been attributed to causes other than suicide, says Suzanne Tomasi, MPH-VPH, DACVPM, a CDC EIS officer. It is a troubling finding in any case.

“We know this is a multifactorial problem,” she tells Hospital Employee Health. “Some of the things include the demands of practice that include long work hours and work overload, along with practice management responsibilities, managing client expectations and complaints.”

Though suicide rates are high among physicians who know how to administer fatal doses, veterinarians also have a culture of euthanizing animals to ease suffering.

“Vets have knowledge and training of euthanasia procedures and they are trained to infuse euthanasia as a normal and acceptable method to relieve suffering,” Tomasi says. “They have the pharmacological training to calculate a lethal dose. When they do attempt suicide, it is not just an attempt.”

In addition, the educational debt-to-income ratio for veterinarians is higher than that of most clinicians, she adds.

There has been some suggestion that euthanizing animals on a regular basis may contribute to depression in vets.

“There are some reports that suggest the mental health effects from euthanizing animals as part of the profession could have a long-term [effect],” she says. “It may add to the multifactorial problems that can build up on each other and lead to anxiety, depression, compassion fatigue, and potentially suicidal ideations.”

Efforts to understand and prevent drivers to suicide in female vets are critical as the field continues a demographic shift.

“The profession is definitely trending toward females, and that’s where the concern comes in,” Tomasi says. “Our concern is that as the population of female vets gets bigger, we will continue to see a [suicide increase] if we don’t have suicide prevention resources available to address this problem.”

HCW Overdose Deaths

Healthcare and related fields had the fourth-highest rate of opioid overdose deaths, following only construction, miners, and food service, CDC investigators report. The data help to characterize which jobs may be most at risk for drug- and opioid-related overdose deaths.

“What an individual does for work has a significant influence on their lives outside of work as well as their physical and psychological well-being,” the CDC investigators reported. This study is a first step in understanding what role work plays in the opioid epidemic and provides the groundwork for future research to evaluate the role of work. Additional research is warranted to illustrate how workplace interventions may help in addressing this public health emergency.

In data findings prior to the recent explosion of the opioid epidemic, the U.S. drug overdose mortality rate increased by 137% between 2000 and 2014, largely driven by opioid-related overdoses. The occupational groups with significantly higher proportional mortality ratios (PMRs) included healthcare practitioners and healthcare support, which would include physicians, nurses, dentists, pharmacists, and a variety of support staff. The categories are very broad, and will be subject to further investigation and data refinement.

Among the unanswered questions is the effect of potentially contributing factors like commonly reported healthcare worker injuries, and the longstanding — but largely underground — problem of drug diversion in hospitals. One telling detail is that healthcare-related occupations had the highest PMR for synthetic opioids, including fentanyl. This suggests that — again, before synthetic fentanyl became widely available on the streets — that healthcare workers were overdosing from prescription medications.

“One of our next steps is to partner with states that have more recent data, such as 2016 and 2017,” says Laurel Harduar Morano, PhD, MPH, an EIS officer. “We will dig further into these subgroups. The groups that we looked at are broad, occupational categories. Finding that healthcare practitioners and support [are at risk] is an important finding and really needs further research.”

The next step is refining the data and going beyond death certificates to tighten the focus. For example, the CDC has a number of surveillance programs that would include morbidity information — “people who have survived a drug overdose,” Morano says.

International Aid Workers

International aid workers respond to natural disasters and other events that often are marked by violence and chaos. They provide critical care and bear witness to human suffering. Having done so, they may become vulnerable to post-traumatic stress disorder (PTSD).

CDC researchers identified potential risk factors that make it more likely that an aid worker may experience such symptoms. Based on the analysis, women, people who have children, and those previously treated for mental illness were more susceptible to PTSD.

“Establishing these risk factors allows organizations to identify workers who may need additional support, as well as organizational actions that can help workers cope,” says Blanche Greene Cramer, DrPH, MPH, an EIS officer. “We were looking at workers who would be expatriates in the country where they were working.”

They included people from the United States, Europe, and Australia, who were working in other countries in such groups as Doctors Without Borders.

The data are preliminary, but if the risk groups identified are borne out in subsequent analysis, they could be targeted with PTSD prevention strategies. Organizational support would include “providing medical insurance and evaluation, vacation policies, disability insurance, life insurance, a psychological debriefing after deployment, and psychiatric support systems, counseling services,” Cramer says.

“We have become aware of the importance of allowing personal phone calls from the field, to be able to connect to folks back at home and feel supported by that network,” she adds.

REFERENCES

1. Tomasi S, Fechter-Leggett E, Edwards N, et al. Suicide Mortality Among Veterinarians — United States, 1979–2015. CDC EIS Conference, Atlanta, April 16-19, 2018.

2. Morano LH, Steege A, Luckhaupt S, et al. Occupational Patterns in Drug and Opioid-Involved Overdose Deaths — United States, 2007–2012. CDC EIS Conference, Atlanta, April 16-19, 2018.

3. Cramer BG. Russell S, Hulland E, et al. Trajectories of Post-Traumatic Stress Symptoms among International Humanitarian Aid Workers. CDC EIS Conference, Atlanta, April 16-19, 2018.