Several studies1–10 have found that veterinarians have higher psychological distress and a higher risk for suicide than do members of the general population.1–10 However, little research is available on the mental health of other members of the veterinary workforce, and no studies, to our knowledge, have specifically addressed the experiences of veterinarians, veterinary students, and other veterinary team members (ie, veterinary technologists, veterinary technicians, veterinary assistants, and veterinary nurses) who are LGBTQ+.
The percentage of veterinary professionals who self-identify as LGBTQ+ is unknown, but a 2011 survey of students at the 28 colleges of veterinary medicine in the United States at that time reported that 6.5% of respondents self-identified as LGBTQ+.11 This is higher than the percentage of individuals who identified as gay, lesbian, bisexual, or transgender in a sample of the general population assessed in 2016.12 Given that the LGBTQ+ population is well-represented in the veterinary profession and that previous research13,14 has demonstrated that individuals who identify as LGBTQ+ have a higher risk for negative mental health outcomes (defined as outcomes that include psychiatric diagnoses [eg, depression or suicidal ideation], behavioral outcomes that have potential mental health causes [eg, suicide attempts], and general psychological distress), it is important to assess the mental health of LGBTQ+ individuals who are studying and working in veterinary medicine. Unfortunately, the largest study of negative mental health outcomes among veterinarians conducted to date, a survey administered in 2014,1 did not collect information about respondents' sexual orientation or gender identity. Thus, whether LGBTQ+ veterinarians have a higher risk for these outcomes, compared with their heterosexual, cisgender counterparts, is currently unknown.
Certain experiences of LGBTQ+ individuals are common across environments. For example, the decision to disclose one's sexual orientation or gender identity (ie, the decision to be out) at work or school is a stressor because either option—concealment versus being out—is accompanied by risks and benefits. Individuals who are out in their work or school environment may experience greater positive affect and self-esteem,15 but they also face the risk of harassment and discrimination. Individuals who conceal their identity minimize the risk of negative consequences, but they then live with the fear of being outed and are at risk for psychological distress and depressive symptoms.16,17 Importantly, not all LGBTQ+ individuals can choose to conceal a marginalized identity, and some LGBTQ+ individuals identify with multiple marginalized identities. Thus, it is important to determine whether LGBTQ+ veterinary professionals and students feel safe from harassment and discrimination in their workplaces and schools.
For the LGBTQ+ population, harassment and discrimination are threats to safety and the opportunity to thrive. In 2018 in the United Kingdom, approximately a fifth of LGBTQ+ employees reported being the target of negative comments or behavior despite implementation of the Equality Act of 2010, which protects individuals from discrimination in educational settings and at work.18 In the United States, it is common for LGBTQ+ employees to report discrimination, and although the US Supreme Court recently offered workplace protections for this group, many states still do not provide protections against housing, public accommodation, and lending discrimination related to sexual orientation or gender identity.19 Unfortunately, a similar pattern is seen in colleges and universities in the United States and United Kingdom, where LGBTQ+ undergraduate, graduate, and professional students commonly experience harassment related to sexual orientation or gender identity.20,21 The consequences of acknowledging an LGBTQ+ identity can range from negative comments to missed job opportunities to physical assault, which leads many individuals to conceal their sexual orientation, gender identity, or both.
Concealing one's sexual orientation or gender identity has been linked to heightened psychological distress and a greater risk of depressive symptoms.22–24 Concealment may also require additional expenditures of emotional labor, a term originally developed to describe the experiences of client service professionals.25 Emotional labor can be separated into 2 components: surface acting and deep acting. Surface acting refers to an individual adjusting their displayed feelings (eg, pretending to feel sympathy) while disguising their true feelings (eg, anger, resentment, fear, and exhaustion). Deep acting refers to an individual attempting to conjure up expected feelings, such as sympathy, from within (eg, actually feeling sympathy rather than pretending to feel sympathy). Expending high levels of emotional labor to conform to others' expectations is related to negative mental health outcomes, including emotional exhaustion, a key component of burnout.25 Veterinarians, veterinary students, and other veterinary team members often have professional responsibilities that demand high levels of emotional labor, but members of the LGBTQ+ population who conceal their identity at work or on campus may be required to engage in even higher levels of emotional labor, perhaps leading to emotional exhaustion. Presently, data are lacking on how open LGBTQ+ members of the veterinary community are regarding their sexual orientation and gender identity when in or out of their workplaces and schools and on the mental health effects of being openly LGBTQ+ versus being concealed. In addition, it is unclear whether there is a relationship between an individual's openness about their LGBTQ+ identity and the emotional labor they perform or the emotional exhaustion they experience in the workplace or at school.
Employers can issue formal nondiscrimination policies; however, a recent meta-analysis26 of 27 studies that systematically reviewed occupation-related outcomes for LGBTQ+ employees found that supportive workplace environments and supportive social relationships in the workplace were more important predictors of outcomes (eg, job satisfaction and psychological strain) than the mere presence of formal nondiscrimination policies. Although we are unaware of any published studies describing the experiences of LGBTQ+ veterinary professionals at work, LGBTQ+ physicians in the United States report experiencing discrimination in the workplace as well as during their medical training.27,28 Thus, it is likely that veterinary professionals who identify as LGBTQ+ also experience harassment and discrimination that has an effect on their mental health while at work or school, but that information has not been collected in past surveys. The experiences of other veterinary team members (eg, veterinary technicians) have also not been included in previous research.
On the other hand, a 2011 survey11 of 28 US colleges of veterinary medicine revealed that > 20% of LGBTQ+ students heard homophobic comments occasionally to very frequently at school. This study did not evaluate effects on mental health or academic outcomes; however, findings from other studies29–32 suggest that exposure to harassment and discrimination hinders the academic performance of LGBTQ+ students.
The present study was developed following a roundtable discussion on wellness hosted by the AVMA in 2016 that established the need to study wellness issues in the LGBTQ+ veterinary community.33 Specifically, the primary objective of our study was to compare the prevalence of negative mental health outcomes (specifically, current serious psychological distress, a previous depressive episode, a previous episode of suicidal ideation, and a previous suicide attempt) among LGBTQ+ veterinary professionals (ie, veterinarians, veterinary technologists, veterinary technicians, veterinary assistants, and veterinary nurses) and students with the prevalence reported in a previous study1 of veterinarians assumed to primarily not be LGBTQ+. On the basis of previous research outside the veterinary profession, we expected that LGBTQ+ veterinary professionals and students would have higher rates of these negative mental health outcomes. We also sought to compare the experiences of LGBTQ+ veterinary professionals with those of LGBTQ+ veterinary students on a variety of outcomes related to workplace or school climate and identity disclosure. Given the lack of prior research on this topic within the veterinary profession, we did not have a priori hypotheses regarding differences between the experiences of LGBTQ+ veterinary professionals and LGBTQ+ veterinary students. Finally, we sought to examine relationships between workplace or school climate and identity disclosure and a variety of negative mental health and work- and school-related emotional outcomes. We expected that indicators of negative or unsupportive climates at work and school would be associated with higher psychological distress, work or school daily stress, and emotional labor. For the veterinary professionals, we also expected these variables to be associated with higher emotional exhaustion and lower job satisfaction.
Pride VMC provided funding for the raffle used to incentivize participation and the Broad Spectrum Veterinary Student Association and British Veterinary LGBT group assisted with participant recruitment. The authors thank Dr. Lisa Greenhill for assistance with developing the survey questionnaire.
The authors declare that there were no conflicts of interest.
Lesbian, gay, bisexual, transgender, queer, questioning, and asexual
Qualtrics Survey Software, Provo, Utah.
Clinical and Translational Science Institute, University of California-San Francisco. Confidence interval for a proportion. Sample size calculators. Available at: www.sample-size.net/confidence-interval-proportion/. Accessed May 2, 2019.
Social Science Statistics. Z score calculator for 2 population proportions. Available at: www.socscistatistics.com/tests/ztest/default2.aspx. Accessed Dec 10, 2019.
SPSS Statistics, version 24, IBM Corp, Armonk, NY.
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