Editorial Type:
Special Report

Suicide among veterinarians in the United States from 1979 through 2015

Suzanne E. Tomasi Epidemic Intelligence Service Center for Surveillance, Epidemiology and Laboratory Services, CDC, 1600 Clifton Rd, Atlanta, GA 30329.
Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, 1095 Willowdale Rd, Morgantown, WV 26505.

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 DVM, MPH
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Ethan D. Fechter-Leggett Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, 1095 Willowdale Rd, Morgantown, WV 26505.

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 DVM, MPVM
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Nicole T. Edwards Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, 1095 Willowdale Rd, Morgantown, WV 26505.

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 MS
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Anna D. Reddish AVMA, 1931 N Meacham Rd, Schaumburg, IL 60173.

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 DVM
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Alex E. Crosby Division of Violence Prevention, National Center for Injury Prevention and Control, CDC, 1600 Clifton Rd, Atlanta, GA 30329.

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 MD, MPH
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Randall J. Nett Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, 1095 Willowdale Rd, Morgantown, WV 26505.

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 MD, MPH
DOI:
https://doi.org/10.2460/javma.254.1.104
Volume/Issue:
Volume 254: Issue 1
Online Publication Date:
01 Jan 2019
Restricted access
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Abstract

OBJECTIVE To assess proportionate mortality ratios (PMRs) for suicide among male and female US veterinarians from 1979 through 2015.

DESIGN PMR study.

SAMPLE Death records for 11,620 veterinarians.

PROCEDURES Information for veterinarians who died during 1979 through 2015 was obtained from AVMA obituary and life insurance databases and submitted to a centralized database of US death records to obtain underlying causes of death. Decedent data that met records-matching criteria were imported into a software program for calculation of PMRs for suicide stratified by sex and indirectly standardized for age, race, and 5-year calendar period with 95% confidence intervals.

RESULTS 398 deaths resulted from suicide; 326 (82%) decedents were male, 72 (18%) were female, and most (298 [75%]) were ≤ 65 years of age. The PMRs for suicide for all veterinarian decedents (2.1 and 3.5 for males and females, respectively), those in clinical positions (2.2 and 3.4 for males and females, respectively), and those in nonclinical positions (1.8 and 5.0 for males and females, respectively) were significantly higher than for the general US population. Among female veterinarians, the percentage of deaths by suicide was stable from 2000 until the end of the study, but the number of such deaths subjectively increased with each 5-year period.

CONCLUSIONS AND CLINICAL RELEVANCE Results of the study indicated that PMRs for suicide of female as well as male veterinarians were higher than for the general population. These data may help to inform stakeholders in the creation and implementation of suicide prevention strategies designed for veterinarians.

Abstract

OBJECTIVE To assess proportionate mortality ratios (PMRs) for suicide among male and female US veterinarians from 1979 through 2015.

DESIGN PMR study.

SAMPLE Death records for 11,620 veterinarians.

PROCEDURES Information for veterinarians who died during 1979 through 2015 was obtained from AVMA obituary and life insurance databases and submitted to a centralized database of US death records to obtain underlying causes of death. Decedent data that met records-matching criteria were imported into a software program for calculation of PMRs for suicide stratified by sex and indirectly standardized for age, race, and 5-year calendar period with 95% confidence intervals.

RESULTS 398 deaths resulted from suicide; 326 (82%) decedents were male, 72 (18%) were female, and most (298 [75%]) were ≤ 65 years of age. The PMRs for suicide for all veterinarian decedents (2.1 and 3.5 for males and females, respectively), those in clinical positions (2.2 and 3.4 for males and females, respectively), and those in nonclinical positions (1.8 and 5.0 for males and females, respectively) were significantly higher than for the general US population. Among female veterinarians, the percentage of deaths by suicide was stable from 2000 until the end of the study, but the number of such deaths subjectively increased with each 5-year period.

CONCLUSIONS AND CLINICAL RELEVANCE Results of the study indicated that PMRs for suicide of female as well as male veterinarians were higher than for the general population. These data may help to inform stakeholders in the creation and implementation of suicide prevention strategies designed for veterinarians.

Contributor Notes

Address correspondence to Dr. Tomasi (yxc4@cdc.gov).
Cover Journal of the American Veterinary Medical Association
Journal of the American Veterinary Medical Association
Publication Date:
01 Jan 2019

  • 1. Bartram DJ, Baldwin DS. Veterinary surgeons and suicide: a structured review of possible influences on increased risk. Vet Rec 2010;166:388–397.

  • 2. Faragher T. Suicide in Australian veterinarians. Aust Vet J 2008;86:249.

  • 3. Hem E, Haldorsen T, Aasland OG, et al. Suicide rates according to education with a particular focus on physicians in Norway 1960–2000. Psychol Med 2005;35:873–880.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

  • 4. Jones-Fairnie H, Ferroni P, Silburn S, et al. Suicide in Australian veterinarians. Aust Vet J 2008;86:114–116.

  • 5. Kelly S, Bunting J. Trends in suicide in England and Wales, 1982–96. Popul Trends 1998;92:29–41.

  • 6. Kelly S, Charlton J, Jenkins R. Suicide deaths in England and Wales, 1982–92: the contribution of occupation and geography. Popul Trends 1995;80:16–25.

    • Search Google Scholar
    • Export Citation

  • 7. Kinlen LJ. Mortality among British veterinary surgeons. Br Med J (Clin Res Ed) 1983;287:1017–1019.

  • 8. Mellanby RJ. Incidence of suicide in the veterinary profession in England and Wales. Vet Rec 2005;157:415–417.

  • 9. Blair A, Hayes HM Jr. Cancer and other causes of death among US veterinarians, 1966–1977. Int J Cancer 1980;25:181–185.

  • 10. Blair A, Hayes HM Jr. Mortality patterns among US veterinarians, 1947–1977: an expanded study. Int J Epidemiol 1982;11:391–397.

  • 11. Miller JM, Beaumont JJ. Suicide, cancer, and other causes of death among California veterinarians, 1960–1992. Am J Ind Med 1995;27:37–49.

  • 12. Nett RJ, Witte TK, Holzbauer SM, et al. Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. J Am Vet Med Assoc 2015;247:945–955.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

  • 13. Hawton K, Malmberg A, Simkin S. Suicide in doctors. A psychological autopsy study. J Psychosom Res 2004;57:1–4.

  • 14. Platt B, Hawton K, Simkin S, et al. Suicidal behaviour and psychosocial problems in veterinary surgeons: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2012;47:223–240.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

  • 15. Glenn CR, Nock MK. Improving the short-term prediction of suicidal behavior. Am J Prev Med 2014;47:S176–S180.

  • 16. Loprinzi PD, Cain DS. Updated trends in suicidal ideation among US adults, 2005–2012. Prev Med 2015;78:14–16.

  • 17. Fowler HN, Holzbauer SM, Smith KE, et al. Survey of occupational hazards in Minnesota veterinary practices in 2012. J Am Vet Med Assoc 2016;248:207–218.

  • 18. Elkins AD, Kearney M. Professional burnout among female veterinarians in the United States. J Am Vet Med Assoc 1992;200:604–608.

  • 19. Skipper GE, Williams JB. Failure to acknowledge high suicide risk among veterinarians. J Vet Med Educ 2012;39:79–82.

  • 20. Han B, Crosby AE, Ortega LA, et al. Suicidal ideation, suicide attempt, and occupations among employed adults aged 18–64 years in the United States. Compr Psychiatry 2016;66:176–186.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 21. McIntosh WL, Spies E, Stone DM, et al. Suicide rates by occupational group—17 states, 2012. MMWR Morb Mortal Wkly Rep 2016;65:641–645.

  • 22. Stallones L, Doenges T, Dik BJ, et al. Occupation and suicide: Colorado, 2004–2006. Am J Ind Med 2013;56:1290–1295.

  • 23. Milner A, Spittal MJ, Pirkis J, et al. Suicide by occupation: systematic review and meta-analysis. Br J Psychiatry 2013;203:409–416.

  • 24. Bartram DJ, Yadegarfar G, Baldwin DS. A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession. Soc Psychiatry Psychiatr Epidemiol 2009;44:1075–1085.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

  • 25. Association of American Veterinary Medical Colleges. Annual data report 2016–2017. Available at: www.aavmc.org/data/files/data/2017%20aavmc%20public%20data-%20final.pdf. Accessed Jul 18, 2017.

    • Search Google Scholar
    • Export Citation

  • 26. AVMA. Market research statistics—US veterinarians, 2017. Available at: www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-veterinarians.aspx. Accessed Feb 20, 2018.

    • Search Google Scholar
    • Export Citation

  • 27. Hoblet KN, Maccabe AT, Heider LE. Veterinarians in population health and public practice: meeting critical national needs. J Vet Med Educ 2003;30:287–294.

  • 28. Maccabe AT, Matchett KE, Hueston WD. The need for public health veterinarians as seen by future employers. J Vet Med Educ 2008;35:269–274.

  • 29. CDC National Center for Health Statistics. National Death Index user's guide. Hayttsville, Md: CDC National Center for Health Statitistics, 2013. Available at: www.cdc.gov/nchs/data/ndi/ndi_users_guide.pdf. Accessed Feb 20, 2018.

    • Search Google Scholar
    • Export Citation

  • 30. National Institute for Occupational Safety and Health. Life Table Analysis System (LTAS) user's guide. Atlanta, Ga: CDC National Institute for Occupational Safety and Health. Available at: https://www.cdc.gov/niosh/ltas/pdf/LTAS-manual-2014.pdf. Accessed Jul 28, 2017.

    • Search Google Scholar
    • Export Citation

  • 31. World Health Organization. International classification of diseases: 9th revision. Geneva: World Health Organization, 2014.

  • 32. World Health Organization. International statistical classification of diseases and related health problems: 10th revision. Geneva: World Health Organization, 2014.

    • Search Google Scholar
    • Export Citation

  • 33. Robinson CF, Schnorr TM, Cassinelli RT, et al. Tenth revision US mortality rates for use with NIOSH Life Table Analysis System. J Occup Environ Med 2006;48:662–667.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 34. Roman E, Beral V, Inskip H, et al. A comparison of standardized and proportional mortality ratios. Stat Med 1984;3:7–14.

  • 35. American Foundation for Suicide Prevention. Understanding and preventing suicide through research, education, and advocacy, 2018. Available at: afsp.org/about-suicide/suicidestatistics/. Accessed Apr 30, 2018.

    • Search Google Scholar
    • Export Citation

  • 36. CDC National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS), 2015. Available at: webappa.cdc.gov/sasweb/ncipc/mortrate.html. Accessed May 1, 2018.

    • Search Google Scholar
    • Export Citation

  • 37. Baca-Garcia E, Perez-Rodriguez MM, Keyes KM, et al. Suicidal ideation and suicide attempts in the United States: 1991–1992 and 2001–2002. Mol Psychiatry 2010;15:250–259.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

  • 38. Bartram DJ, Baldwin DS. Veterinary surgeons and suicide: influences, opportunities and research directions. Vet Rec 2008;162:36–40.

  • 39. Platt B, Hawton K, Simkin S, et al. Systematic review of the prevalence of suicide in veterinary surgeons. Occup Med (Lond) 2010;60:436–446.

  • 40. Roberts SE, Jaremin B, Lloyd K. High-risk occupations for suicide. Psychol Med 2013;43:1231–1240.

  • 41. Alexopoulos EC, Kavalidou K, Messolora F. Suicide mortality across broad occupational groups in Greece: a descriptive study. Saf Health Work 2016;7:1–5.

  • 42. Dawson BF, Thompson NJ. The effect of personality on occupational stress in veterinary surgeons. J Vet Med Educ 2017;44:72–83.

  • 43. Scotney RL, McLaughlin D, Keates HL. A systematic review of the effects of euthanasia and occupational stress in personnel working with animals in animal shelters, veterinary clinics, and biomedical research facilities. J Am Vet Med Assoc 2015;247:1121–1130.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

  • 44. Volk JO, Schimmack U, Strand EB, et al. Executive summary of the Merck Animal Health Veterinary Wellbeing Study. J Am Vet Med Assoc 2018;252:1231–1238.

  • 45. Stone DM, Simon TR, Fowler KA, et al. Vital signs: trends in state suicide rates—United States, 1999–2016 and circumstances contributing to suicide—27 states, 2015. MMWR Morb Mortal Wkly Rep 2018;67:617–624.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

  • 46. Oxley JA, Montrose VT, Kogan L. E-mental health and the veterinary profession. J Am Vet Med Assoc 2017;250:1226–1227.

  • 47. Chigerwe M, Boudreaux KA, Ilkiw JE. Assessment of burnout in veterinary medical students using the Maslach Burnout Inventory-Educational Survey: a survey during two semesters. BMC Med Educ 2014;14:255.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

  • 48. Allison SO, Eggleston-Ahearn AM, Courtney CJ, et al. Implementing wellness in the veterinary workplace. J Am Vet Med Assoc 2016;249:879–881.

  • 49. Milner A, Witt K, Maheen H, et al. Access to means of suicide, occupation and the risk of suicide: a national study over 12 years of coronial data. BMC Psychiatry 2017;17:125.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

  • 50. Hawton K, Clements A, Simkin S, et al. Doctors who kill themselves: a study of the methods used for suicide. QJM 2000;93:351–357.

  • 51. Skegg K, Firth H, Gray A, et al. Suicide by occupation: does access to means increase the risk? Aust N Z J Psychiatry 2010;44:429–434.

  • 52. Stansfeld S. Work, personality and mental health. Br J Psychiatry 2002;181:96–98.

  • 53. Hewitt PL, Flett GL. Dimensions of perfectionism, daily stress, and depression: a test of the specific vulnerability hypothesis. J Abnorm Psychol 1993;102:58–65.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

  • 54. Halliwell RE, Hoskin BD. Reducing the suicide rate among veterinary surgeons: how the profession can help. Vet Rec 2005;157:397–398.

  • 55. Stone DM, Holland KM, Bartholow B, et al. Preventing suicide: a technical package of policies, programs, and practices. Atlanta, Ga: CDC National Center for Injury Prevention and Control, 2017.

    • Search Google Scholar
    • Export Citation

  • 56. Breslow NE, Day NE. Statistical methods in cancer research. IARC Workshop 25–27 May 1983. IARC Sci Publ 1987:1–406.

  • 57. Mohler B, Earls F. Trends in adolescent suicide: misclassification bias? Am J Public Health 2001;91:150–153.

  • 58. Mieno MN, Tanaka N, Arai T, et al. Accuracy of death certificates and assessment of factors for misclassification of underlying cause of death. J Epidemiol 2016;26:191–198.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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