When Caring Hurts: Dealing with Depression in Veterinary Medicine
Depression is one of the most common mental health disorders in the United States.1 Although the cause is not known, research suggests that depression develops from a combination of physiologic, genetic, environmental, and biologic factors.
What makes depression so prevalent in the veterinary community? According to an AVMA study,2 1 in 6 veterinarians have considered suicide since graduation. This study did not involve support staff but surveyed more than 10,000 practicing veterinarians.
The study found that 6.8% of male veterinarians and 10.9% of female veterinarians have serious psychologic distress, compared with 3.5% of adult men and 4.4% of adult women who do not work in the veterinary community. The study also showed that 24.5% of male and 36.7% of female veterinarians have experienced depressive episodes since graduation, which is approximately 1.5 times the prevalence in US adults. The study suggested that veterinarians are 3 times more likely than the US national mean to consider suicide, and that 1% to 1.5% of veterinarians have attempted suicide since graduation. The results are similar to those from mental health surveys of veterinarians in other countries, including Australia, New Zealand, and the United Kingdom, thus suggesting that depression in the veterinary community is a global epidemic.
Stress and Depression
Veterinary technicians know that workplace stress is not limited to veterinarians. Burnout is cited in the NAVTA 2016 Demographics Survey as one of the top 6 most significant problems that credentialed veterinary technicians face.3 Those of us who work in this field are likely to become stressed and overwhelmed owing to the volume and nature of the work. It often feels like the world is on our shoulders—no time to rest, eat, or use the bathroom; constantly ringing phones; very ill pets; very upset and high-strung owners; and what seems like little appreciation and support from owners, coworkers, family members, and friends. We have often had to cancel plans in our personal life to take care of a sick animal, thus leading to resentment of those things we once cared for so highly: animals, their well-being, their family, and the field of veterinary medicine. The lines of work–life balance are often blurred, and the stress from the workday, workweek, work month, or even work year is taken home with us. Busy, stressful days can lead to bad eating and sleeping habits, thus leaving staff feeling overtired, overworked, and underappreciated.
Chronic stress can lead to other conditions,1 such as depression, anxiety, other psychiatric disorders, musculoskeletal disorders, insomnia, cognitive impairment (inability to remember), substance abuse, employee absenteeism, and work errors. If we are not taking care of ourselves, how can we take care of others? If we are constantly putting our physical and emotional health on the back burner, how can we ensure that we will be around to care for our patients as deeply as we once did? If we cannot care for ourselves, how can we be sure we are giving 100% to our patients? If we cannot take care of each other as a community, who will?
Feelings of depression can easily be brushed aside as resulting from the nature of our work. “It’s just compassion fatigue,” or, “I know, I’m burnt out, too,” are statements that can make someone believe that it is normal to feel overwhelmed and empty. The “nature” of a job does not have to, and should not, make someone feel as if they are constantly empty, lost, saddened, angry, unhappy, overwhelmed, anxious, or afraid. We should not feel like we are burdened by the weight of the world sitting on our shoulders. We will have days when we are unhappy and sad or when it feels like nothing is going right, but chronicity is the important factor. Constantly taking work home (physically and emotionally) or being unable to enjoy life at home or outside of work because of experiences at work is a sign that the issue may be more serious. What is termed “compassion fatigue” or “burnout” can actually be depression (TABLE 1).
TABLE 1 Know the Difference: Burnout, Compassion Fatigue, or Depression4
Signs of depression include feelings of sadness, hopelessness, and worthlessness; low energy; inability to concentrate; irritability, anger, and hostility; loss of interest in once-loved activities; changes in appetite and sleep patterns; thoughts of harming oneself and/or others; reckless behavior (including substance abuse, promiscuity, speeding, and gambling); and feeling like a burden to others.1 Talk or plans of suicide and complete behavior changes (for instance, someone who was always a pessimist suddenly becoming a very happy optimist and vice versa) are major warning signs and should not be taken lightly or brushed aside.
Recommendations for Those Struggling
Many resources are available if you think you are struggling with burnout or something of a more serious nature. Your feelings about yourself, your skills, employer, and job should not be swept aside. The job description of a veterinary technician encompasses a variety of roles that can be overwhelming. We may be veterinary technicians, laboratory technicians, radiology technicians, pharmacy technicians, customer care representatives, grief counselors, and other support staff, but wearing many different hats throughout the day can be daunting to those who are overworked and feel unappreciated. Many technicians complain about the lack of pay for the number of skills we possess, but the truth is, with depression, $1000 an hour will not help fill the void of feeling empty, alone, and hopeless. BOX 1 lists some simple measures to help you take care of yourself, mentally and physically, but treatment of true depression often requires external help (TABLE 1). If you recognize the signs of depression in yourself, remember that professional assistance exists to help you, and don’t be afraid or embarrassed to seek it.
Recommendations for Those You Think May Be Struggling
People are often afraid to approach a coworker about depression or suicide out of fear of being embarrassed and creating an uncomfortable situation both short and long term. However, if you feel uncomfortable approaching someone whom you are worried about, just imagine how uncomfortable it is for the person who is suffering from depression.
Approaching a coworker or friend and asking how he/she is doing can make a significant difference because people suffering from depression often feel unrecognized. Keeping the number of a suicide hotline nearby is helpful in case someone confides that he/she is having those types of thoughts. If they won’t make the call themselves, you can call to seek guidance. Assuring those who are suffering that things can, and will, change and making plans for the next day so they have a reason to hang on for one more day can make a world of a difference. The first step is always the hardest, but it will make the most difference and can potentially save a life.
Recommendations for Employers
Because of the prevalence of depression and suicidal tendencies in veterinary medicine, it is recommended that employers offer anonymous support to their staff.7 A grief counselor, even to discuss work-related issues/losses, or an employee assistance program that employees can call to make personal, confidential appointments to vent about work or their personal life, can be beneficial. General awareness materials regarding depression and other mental illnesses should be made available to all staff.
It is also encouraged that the staff have fun as a team outside of work. Often, we see our coworkers when they are stressed, and it may be nice to interact in a less stressful environment, where you are unlikely to get interrupted and don’t have to deal with unruly clients and patients or ringing phones. Attend an event together, management included, outside of work, even if you are representing the hospital. Doing this may seem awkward at first, but it provides a more comfortable environment to discuss situations and feelings, promotes team-building, and helps foster trust throughout the team.
The best way to create mental health awareness and ensure that employees are taking care of themselves is to not ignore the problem. Mental health issues should be talked about and discussed openly in one-on-one conversations and as a group, and resources should be provided to all employees. This may help reduce employee turnover and treatment mistakes/oversights, increase employee compliance with company rules, and even improve client satisfaction. Making sure your staff is taken care of will increase overall happiness in the hospital. Creating an open-door policy and providing an understanding and compassionate work environment, not just for pets but also for employees, may help lessen the emotional load for some employees.
Some things to consider:
- Breaks are important. Make sure employees are taking breaks as they need, and encourage employees to “step out” for a few minutes if they are overwhelmed. It may throw a wrench in the day, but it will help make future hours and days more productive. Make sure you are staffed appropriately to cover uninterrupted breaks, even if your state sets no legal guidelines regarding breaks and hours worked. Remind employees that breaks are important, and offer appropriate vacation time to reduce burnout.
- Debrief. After a stressful situation goes awry—for example, a cardiopulmonary–cerebral resuscitation fails—encourage employees to take a minute to clear their heads and sort out their thoughts and feelings. Then discuss, as a team, the strengths and weaknesses of the teamwork. Acknowledge the strengths of each employee, but refrain from singling out those who need to improve. Use these situations as an opportunity to improve the quality of care your patients receive, and offer encouraging words. Building self-confidence in your employees not only benefits them personally, but also helps them perform better in future situations.
- Encourage learning. A day-to-day routine can make employees feel bored. Offer a set time once a week or month to present a case study or discuss a disease, journal article, or new product to encourage employees to keep their brains active and keep them eager to learn and work. Being able to apply what they have learned to real-life situations will make their day interesting and boost their self-confidence, as well as increase the care your patients receive. Doing so may make employees feel like they have purpose, and it may give some employees something to look forward to.
- Make resources easily available. Hotline business cards, magnets, and brochures can allow employees to keep matters confidential and less awkward. Offer employee assistance programs and put the information on how to get in touch with the coordinator in easily accessible areas, such as the employee break room or by the time clock.
- Show that you appreciate your employees. Everyone in the veterinary community is at risk of developing burnout, compassion fatigue, and depression. It does not know any boundaries. A simple “thank you” at the end of the day or incentives will help employees feel appreciated and taken care of. Our job is stressful but should also be worth it. Employees need to feel they make a difference in order to know their worth.
There is no question whether depression is on the rise in veterinary medicine. The only way to combat it is by working as a team and supporting each other. Depression knows no limits, and we should all take care of ourselves and each other. The field of veterinary medicine can only be as great as the people in it.
- Depression. National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services. nimh.nih.gov/health/topics/depression/index.shtml. Accessed May 2016.
- Larkin M. Study: 1 in 6 veterinarians have considered suicide. JAVMA 2015;246(7):707-709.
- National Association of Veterinary Technicians in America. NAVTA 2016 demographic survey results. navta.net/?page=Demographic_Survey. Accessed September 2016.
- Scheidegger J. Burnout, compassion fatigue, depression—what’s the difference? dvm360. May 1, 2015. dvm360.com. Accessed September 2016.
- Depression. Def. b(2). Merriam-Webster. merriam-webster.com/dictionary/depression. Accessed September 2016.
- Helpguide.org; Trusted guide to mental, emotional, and social health. helpguide.org. Accessed July 2016.
- International Employee Assistance Professionals Association. eapassn.org. Accessed September 2016.