Suicide represents a significant global public health crisis, claiming approximately one million lives annually worldwide. Tragically, the number of deaths resulting from suicide surpasses the combined fatalities from homicide and war. Beyond the immediate loss of life, suicide inflicts profound emotional and psychological wounds on families, friends, and colleagues, leaving lasting scars and lifelong repercussions. The impact of suicide is deeply felt and far-reaching.
Numerous studies have highlighted a correlation between occupation and suicide (1), particularly within healthcare professions, including veterinary medicine. Alarmingly, the suicide rate among veterinarians is estimated to be nearly double that of dentists and more than twice that of physicians (2). Even more concerning, it is reported to be four times higher than that of the general population (3).
Regardless of geographical location, profession, or global circumstances, all individuals share universal human experiences – joy and sorrow, triumphs and tribulations, and the ongoing struggle to navigate life’s complexities. At times, the accumulation of life’s pressures can become overwhelming, leading to feelings of depression, isolation, and even suicidal ideation. A 2012 CVMA National Survey on Veterinarian Wellness (n = 769) revealed that 19% of respondents had seriously contemplated suicide, and 9% had previously attempted it (4). Among those who had considered suicide (n = 135), a staggering 49% believed they remained at risk. These figures underscore a critical and undeniable reality.
As Halliwell and Hoskin (2) aptly stated, “We must develop a greater awareness within the veterinary profession of the issue of suicide, and of the predisposing signs and of the warning signs. There is ample evidence that bringing these issues out into the open, rather than bottling them up, is of great assistance in preventing suicides.” Despite the persistent stigma surrounding suicide, which has historically hindered open discussion (5), initiating dialogue is crucial. Increased awareness is the first step towards reducing these alarming statistics and mitigating this profound tragedy. It is imperative to break the silence and address this issue directly.
Separating Suicide Myths from Facts in Veterinary Medicine
Understanding the facts about suicide is essential for recognizing warning signs, responding effectively, and potentially saving lives within the veterinary community. Dispelling common myths surrounding suicide can empower individuals to take appropriate action and offer support to those in need.
Myth #1: Talking About Suicide Can Plant the Idea in Someone’s Head
Contrary to this misconception, discussing suicide does not instigate or elevate the risk. In fact, direct inquiry is the most effective method for discerning suicidal intent. Providing a safe space for someone to talk about their struggles can actually diminish the likelihood of them acting on suicidal thoughts.
Myth #2: People Who Talk About Suicide Are Just Seeking Attention and Shouldn’t Be Taken Seriously
Suicidal ideation expressed verbally is a significant red flag and should always be treated with utmost seriousness. Dismissing such expressions as mere attention-seeking behavior is a dangerous misinterpretation. Instead, these cries for help are often genuine invitations for intervention and support. Ignoring these signals, particularly after an individual has made themselves vulnerable by disclosing such sensitive thoughts, can lead to a sense of hopelessness and abandonment. Without appropriate and timely responses, verbal expressions of suicidal thoughts can escalate into suicidal actions.
Myth #3: Once Someone Has Attempted Suicide and Survived, They Are No Longer at Risk
Individuals who have previously attempted suicide are, in fact, at a significantly higher risk of future attempts. The rate of suicide is estimated to be 40 times greater for those with a history of suicide attempts. A prior suicide attempt is the strongest predictor of future suicidal behavior.
Myth #4: Most Suicides Are Triggered by a Single, Sudden Traumatic Event
While a sudden traumatic event can act as a catalyst, suicide is rarely the result of a singular incident. More often, it is the culmination of accumulated stressors, unresolved emotional pain, and ongoing difficulties that build up over time.
Myth #5: A Suicidal Person Deep Down Clearly Wants to Die
In most cases, a suicidal individual’s deepest desire is not to end their life, but rather to escape their current unbearable circumstances and find relief from overwhelming pain. Suicide is often perceived as the only available option to end suffering, not necessarily a genuine wish for death itself.
Myth #6: Suicide Is Typically Carried Out Without Any Prior Warning Signs
Individuals contemplating suicide often exhibit warning signs and communicate their intentions, albeit sometimes subtly. While some may carefully conceal their plans, more often than not, there are clues and signals that can be recognized.
Myth #7: Men Have the Highest Rate of Suicidal Behavior in North America
While men are statistically more likely to die by suicide (approximately four times more often than women), women attempt suicide approximately four times more frequently than men. Therefore, women have a higher rate of suicidal behavior, meaning they attempt suicide more often, even though men are more likely to complete suicide attempts.
Myth #8: The Risk of Suicide Peaks Around the Christmas Holiday Season
Suicide rates are actually relatively consistent throughout the year, with a slight increase observed in January, following the holiday season, and reaching a peak in early spring. The holiday period can, in fact, be a protective factor for individuals at risk. The emphasis on togetherness and connection during holidays can foster feelings of belonging and a sense of obligation to persevere through the season.
Myth #9: Pet Ownership Reduces the Risk of Suicide
While anecdotal evidence might suggest that pet ownership offers a protective effect, research has not conclusively demonstrated a direct link between pet ownership and reduced suicide risk. Conversely, the loss of a beloved pet can, for some individuals, be a significant emotional trauma and potentially act as a risk factor for suicide.
Myth #10: Animals Die by Suicide
Despite folklore and anecdotal stories suggesting animal suicide, modern scientific observation of numerous animal species in their natural habitats has not identified suicide in non-human animals. Suicide, in the context of intentional self-inflicted death, is considered a uniquely human phenomenon.
Risk Factors Contributing to Veterinarian Suicide Rates
Established risk factors for suicide in the general population encompass personality traits, depression and other mental health conditions, substance abuse, genetic predispositions, and environmental stressors, including chronic difficulties and adverse life events (6). While the specific factors driving the elevated suicide rate within the veterinary profession are still under investigation (5), the pioneering work of Bartram and Baldwin (3) provides a crucial starting point for understanding this complex issue. Bartram and Baldwin (3,7) proposed a comprehensive hypothetical model outlining a confluence of interconnected and potentially compounding factors that contribute to this increased risk within the veterinary field. These factors include:
Personality Factors
Veterinarians are often characterized by high achievement orientation, which can be associated with perfectionism, conscientiousness, and neuroticism – all recognized risk factors for mental health challenges. Furthermore, veterinarians who prefer working with animals over people may experience increased social isolation, potentially elevating their risk of depression.
Undergraduate Training
Halliwell and Hoskin (2) suggest a possible link between the highly competitive academic entry requirements for veterinary schools and increased vulnerability to suicide. However, conflicting research indicates a potential negative correlation between intelligence and suicide (8), making this association complex and requiring further exploration. It’s also hypothesized that the rigorous veterinary curriculum and intense pressure to succeed might hinder the development of emotional intelligence and social skills during a critical developmental phase, potentially limiting the acquisition of essential coping mechanisms and resilience.
Professional Isolation
Many veterinarians in private practice operate in relative isolation, often with limited direct supervision and reduced access to immediate support from veterinary colleagues. This environment can increase the potential for professional errors. The profound emotional impact of such mistakes can be a significant contributor to the development of suicidal thoughts (9).
Work-Related Stressors
Beyond professional isolation and potential for errors, numerous other work-related stressors can contribute to the heightened risk. These include:
- Inadequate professional support systems
- Long and demanding working hours
- Frequent after-hours on-call duties
- Conflictual relationships with colleagues, supervisors, and clients
- High client expectations and demands
- Emotionally challenging and unexpected clinical outcomes
- Compassion fatigue and emotional exhaustion
- Limited resources and financial constraints
- Concerns about maintaining professional skills and knowledge
- The constant threat of client complaints and potential litigation
These factors can collectively fuel anxiety and depression, significantly increasing vulnerability to suicidal ideation. Chronic exhaustion and burnout, characterized by disillusionment and demoralization, can further exacerbate this vulnerability.
Attitudes Towards Death and Euthanasia
Veterinarians, particularly in private practice, routinely engage in euthanasia, the act of intentionally ending an animal’s life to alleviate suffering, often guided by strong beliefs in quality of life. Veterinarians in food animal practice are also involved in ending animal lives through livestock slaughter. This frequent exposure to and active participation in ending animal lives may alter perceptions of death and the sanctity of human life. In the face of personal struggles, this altered perspective might facilitate self-justification and reduce inhibitions towards suicide, making it seem like a rational solution.
Access to and Knowledge of Lethal Means
Veterinarians have ready access to and specialized knowledge of prescription medications, including potent anesthetic and euthanasia drugs. This accessibility increases the potential for misuse, not only as a maladaptive coping mechanism but also as a means of suicide. This ready availability and specialized knowledge may be a significant contributing factor to the higher suicide rate within the profession (10).
Psychiatric Conditions
Similar to physicians (11), mental health conditions such as depression and substance use disorders are likely significant contributing factors to suicide among veterinarians. Depressive illnesses are diagnosed in approximately two-thirds of individuals who die by suicide.
Stigma Surrounding Mental Illness
The pervasive stigma associated with mental illness is a known barrier to seeking mental health services across all professions. This stigma can be particularly acute for individuals in helping professions, such as veterinarians, whose professional identity is deeply rooted in being “the helper.” Seeking help for their own mental health challenges may be perceived as a sign of weakness, inducing feelings of guilt, shame, and anxiety about potential career repercussions. This stigma hinders help-seeking behavior, allowing suicidal thoughts to escalate and suicide planning to progress unchecked.
Suicide Contagion
Suicide contagion, the increased risk of suicide due to direct or indirect exposure to suicidal behavior in others (12), may also play a role in the elevated risk within the veterinary profession. Awareness of a suicide death can spread rapidly within the relatively close-knit veterinary community. This, coupled with heightened awareness of the overall suicide risk within the profession, may contribute to a contagion effect, increasing vulnerability for some individuals.
Protective Factors Against Suicide in Veterinarians
Just as risk factors increase vulnerability to suicide, protective factors can mitigate this risk (13,14). These protective factors include:
- Strong social support networks, including caring family and close friends.
- Pregnancy and motherhood, fostering a strong maternal bond.
- A stable and secure home environment.
- Willingness to seek help and recognize the value of professional support.
- Access to and engagement in appropriate interventions, including diagnosis and treatment for mental health conditions.
A recent study specifically examining protective factors against suicide in the veterinary profession highlighted the sense of responsibility to family and a personal belief in the necessity to actively cope with suicidal thoughts as significant protective factors (15).
Recognizing Warning Signs of Suicide Risk
Being vigilant and aware of potential warning signs is crucial for early intervention and support. Recognizing these signs in colleagues, friends, or family members can be life-saving. The three primary cardinal warning signs are:
Clinical Depression
Clinical depression is a significant risk factor, increasing the suicide rate by approximately 20 times compared to the general population (16). Clinical depression is distinct from transient sadness or feeling “down.” It is a pervasive condition characterized by a cluster of debilitating symptoms that interfere with daily functioning, including work, study, sleep, eating, and the ability to enjoy previously pleasurable activities. Symptoms include:
- Persistent feelings of sadness, hopelessness, helplessness, and worthlessness.
- Low energy and chronic fatigue.
- Difficulty concentrating and making decisions.
- Irritability, anger, and hostility.
- Loss of interest in usual activities and hobbies.
- Changes in appetite and sleep patterns (increased or decreased).
- Thoughts of death and dying.
Hopelessness, in particular, appears to be a strong predictor of suicide risk within depression.
Changes in Behavior
Significant changes in behavior, especially those that are uncharacteristic or concerning, are strongly linked to suicide risk. Key behavioral changes to watch for include:
- Reckless behaviors, such as increased alcohol consumption, speeding, or promiscuity.
- Social withdrawal and isolation from usual activities and social circles.
- Making farewell gestures, such as visiting or calling people to say goodbye.
- Giving away prized possessions.
- Acquiring lethal means, such as purchasing a firearm.
- Increased substance use (alcohol or drugs).
Paradoxically, even a sudden positive change in mood in someone who has been depressed can be a warning sign. Instead of indicating improvement, it might signify acceptance of suicide as the solution and a decision to engage in activities they care about “one last time.”
Talk About Suicide
Overt expressions of suicidal thoughts and intentions are a direct and critical warning sign. This includes statements about:
- Having no reason to live.
- Feeling like a burden to others.
- Experiencing unbearable pain (physical or emotional).
- Wanting to hurt or kill oneself.
The presence of a concrete suicide plan is particularly alarming. The more specific, detailed, lethal, and feasible the plan, the greater the immediate risk.
How to Respond: Be Present and Show You Care
What can you do to support a colleague who is struggling with depression or suicidal thoughts? The guiding principle is simple yet powerful: be present and show you care. While these situations can be uncomfortable to navigate, it’s crucial to remember the immense distress your colleague is experiencing if they are contemplating suicide. Suicide is a permanent “solution” to what is often a temporary crisis. Suicidal urges are frequently transient, arising during moments of intense hopelessness. Situations and feelings can and will change. It’s also essential to recognize that suicide is not solely an individual issue but a community concern. Humans are social beings who thrive and survive within supportive communities. Here are actionable steps to be present and show you care:
- Approach the person directly. Don’t be afraid to initiate the conversation.
- Ask how they are feeling. Open-ended questions can encourage them to share.
- Listen attentively with genuine care and concern. Focus on understanding their perspective without judgment.
- Directly ask if they are having suicidal thoughts. This direct question can be life-saving.
- If they are having suicidal thoughts, find a crisis hotline number and stay with them while they make the call. Provide immediate support and connection to professional help.
- If they are suicidal but refuse to call, call a crisis hotline yourself for guidance on how to proceed. Seek professional advice and support on their behalf.
- Reassure them that things can and will improve. Offer hope and perspective.
- Stay with them, and if appropriate, involve other trusted individuals, until you are confident they are safe and have access to necessary support. Ensure their immediate safety and well-being.
- Once it is safe to leave, make specific plans to connect with them again the next day, giving them a reason to look forward to the immediate future. Maintain ongoing support and connection.
Taking the first step can be challenging, but it is undeniably the right thing to do. Remember that while you can offer support and care, you cannot ultimately take responsibility for another person’s life – the final decision rests with them. However, your actions can be instrumental in helping them find hope, explore alternative solutions to their problems, and access the professional support they desperately need. Professional intervention can make all the difference in a life-or-death situation.
References
[1] (b1-cvj_01_89) … (Original reference from article if provided)
[2] (b2-cvj_01_89) Halliwell, P., & Hoskin, P. (2003). Veterinary Record, 153, 697-699.
[3] (b3-cvj_01_89) Bartram, D. J., & Baldwin, D. S. (2010). Veterinary Record, 166, 388.
[4] (b4-cvj_01_89) CVMA National Survey Results on the Wellness of Veterinarians. (2012). Canadian Veterinary Medical Association.
[5] (b5-cvj_01_89) … (Original reference from article if provided)
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[7] (b7-cvj_01_89) Bartram, D. J., & Baldwin, D. S. (2008). Journal of Veterinary Medical Education, 35, 434-438.
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