Introduction
As in the 2 previous wellbeing studies, veterinarians were presented a list of 12 current topics in the profession and asked to rate their importance from “not important” to “critically important.” As in prior studies, stress, student debt and suicide were rated as critically important by nearly all respondents.1,2
In addition to examining the wellbeing, mental health, and burnout status of veterinarians and veterinary support staff, the studies also continued to search for approaches or techniques that were predictors of higher levels of wellbeing, lower burnout, and lack of serious psychological distress.
Materials and Methods
Survey
A survey of working veterinarians was conducted. Practicing veterinarians were invited to pass along a link to a separate survey to a full-time veterinary support staff member. Questionnaires were developed and pretested with veterinarians and support staff to gather feedback on content, terminology, and understanding. After refinement, the questionnaires and research protocol were submitted to the Advarra Institutional Review Board, Columbus, Md, for review and received a letter of exemption.
The AVMA provided a random sample of 20,000 email addresses from its database of working US veterinarians. An email signed by Dr. Jose Arce, AVMA president, and Dr. Janet Donlin, AVMA executive vice president and CEO, was sent to these email addresses on September 13, 2021, alerting recipients to the upcoming survey and encouraging them to participate.
Subsequently, Kynetec, a market research firm, sent an email to all 20,000 email addresses plus 12,011 unduplicated US veterinarians in Kynetec’s own database with an invitation to participate and a link to the online survey. Up to 4 reminders were sent to nonresponders over a 3-week period. Veterinarian and veterinary support staff respondents each were given the opportunity to opt into a drawing for twenty-five $100 gift cards as an incentive to participate, which included 50 gift cards in all. The survey closed on October 17, 2021.
Respondents were asked to complete several instruments and questions for the measurement of mental health, wellbeing, burnout, and other factors. Given the presence of the COVID-19 pandemic during 2020 to 2021, questions about the personal and work impacts of the pandemic were included in both the veterinarian and staff surveys. In addition, several questions were included about the work environment and leadership3 to learn more about their potential impact on stress and burnout. Instruments used included the following:
Kessler 6—As in earlier studies, mental health was assessed with the Kessler Psychological Distress Scale,4 by which respondents assigned a numeric score ranging from 0 (none of the time) to 4 (all of the time) to 6 items. A sum score of 13 or higher was used to determine the presence or absence of serious psychological distress.
Wellbeing index—Wellbeing, or the way individuals feel about their lives compared with the best or worst possible lives they can imagine, was evaluated with an index based on 3 questions widely used to measure wellbeing5,6 and scored on a scale from 0 to 10. Veterinary support staff responded to a single wellbeing question, the widely used Cantril ladder,5 which was was scored on a scale from 0 to 10. The other 2 questions were scored from 1 to 5. All scales were transformed into scales ranging from 0 to 10 (eg, 1 to 5 was transformed using (x – 1) X 2.5. The scales were then averaged, and the average scores were used to divide participants into the 3 groups (0 to 3.99, 4 to 6.99, and 7 to 10). As is customary in wellbeing research, respondents were subsequently categorized as flourishing (scores of 7 to 10), getting by (scores of 4 to 6), or suffering (scores of 0 to 3).
Mayo Clinic Physician Burnout and Wellbeing Scale—To measure burnout, the Mayo Clinic Physician Burnout and Well-being Scale7 was used, as developed by physicians at Mayo Clinic in Rochester, Minnesota. Respondents were asked to answer yes or no to 7 questions, with the number of “yes” answers indicating their level of burnout. Low burnout was classified as having a score of 0, 1, or 2; moderate burnout was classified as having a score of 3 or 4; and high burnout was classified as having a score of 5, 6, or 7.
Big Five personality assessment—The 2017 Merck Animal Health Veterinary Wellbeing Study included an assessment of respondents on the Big Five personality traits: neuroticism, extroversion, agreeableness, openness, and conscientiousness.8 Neuroticism and extroversion are the 2 personality characteristics most associated with wellbeing. Both extroversion and neuroticism were measured in the present veterinarian study, and all 5 were measured in the veterinary support staff study.
Suicide—As in prior studies, respondents were asked if they had seriously thought about, planned, or attempted to kill themselves in the past 12 months, or ever.
Statistical analysis
Multiple regression analysis was performed to identify which of all surveyed attributes were the most predictive (ie, largest measures of association) with high levels of wellbeing (ie, with flourishing), serious psychological distress, and high levels of burnout. The same predictor variables were used for all outcome measures. The predictor variables were chosen for several reasons. First, standard demographic variables were included to control for them and because age, gender, income, student debt and other effects are intrinsically interesting to understand problems in the veterinary profession. Second, personality variables were included because it is well known that they predict wellbeing and could be confounded with other predictor variables (eg, neuroticism could lead to lower income). The remaining predictor variables were included to examine how various aspects of veterinarians’ lives influence their wellbeing and mental health. Many of these predictors were included in the survey because they showed significant effects in previous surveys, or were selected to examine the influence of newly suggested factors (eg, work environment).
Regressions were based on percentile of maximum possible score scoring.9 Each predictor variable was scored from 0 = lowest possible value to 1 = highest possible value. This scoring allows use of regression coefficients as a measure of effect sizes for measures with different units of measurement. Results were interpreted in terms of the strength of effect sizes, with a focus on effect sizes that were statistically significant at the conventional level of significance (P < .01). Most of the stronger effects were significant using a higher standard of significance (P < .001).
Mean wellbeing scores for veterinarians were compared to employed US adults in the general population as measured in the annual Gallup World Poll.10 Scores of veterinarians on some of the Big 5 personality traits and scores of veterinarian support staff on all five were compared to the general public as measured in the 2016 Panel Study of Income Dynamics.11
Respondents
During the survey period, a net of 2,495 sets of usable responses were collected from veterinarians, representing a response rate of 8%. Responses were weighted on the basis of age, gender, and region of residence to ensure that respondents were representative of US working veterinarians. A limitation of the study was that we do not have information about other characteristics that might differ between respondents and nonresponders. The statistical margin of error at the 95% confidence level was ± 1.94%. The staff questionnaire generated 448 sets of usable responses, with representation among all key practice roles: veterinary assistant, veterinary technician, client service representative, and hospital administrator. Eighty-seven percent of veterinary support staff respondents worked in companion animal (81%) or mixed practice (6%); the remainder worked in food animal, equine, or other. The statistical margin of error at the 95% confidence level for the staff survey was ± 4.63%.
Findings
Wellbeing, mental health, and burnout
As in previous Merck Animal Health Veterinarian Wellbeing Studies, the mean wellbeing of veterinarians in the 2021 study did not differ significantly from the wellbeing of the US general population, as measured in the Gallup World Poll.10 However, there were substantial variations within the profession. Younger veterinarians (< 55) had lower wellbeing than older veterinarians (> 55). Food animal and equine practitioners had higher mean levels of wellbeing than companion animal and mixed practitioners. A higher percentage (56.5%, [1,409/2,493]) of veterinarians were flourishing than veterinary support staff (50.2% [224/448]; Figure 1).
Percentages of veterinarians and practice support staff whose wellbeing scores suggested they were suffering (scores of 0 to 3), getting by (scores of 4 to 6), or fourishing (scores of 7 to 10).
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Percentages of veterinarians and practice support staff whose wellbeing scores suggested they were suffering (scores of 0 to 3), getting by (scores of 4 to 6), or fourishing (scores of 7 to 10).
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Percentages of veterinarians and practice support staff whose wellbeing scores suggested they were suffering (scores of 0 to 3), getting by (scores of 4 to 6), or fourishing (scores of 7 to 10).
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Veterinarians suffering from serious psychological distress increased from 6.4% (183/2,874) in 20192 to 9.7% (243/2,491) in 2021. As with wellbeing, the prevalence of serious psychological distress was highest in younger veterinarians and lowest in older veterinarians (Figure 2). However, serious psychological distress increased in all age cohorts from 2019 to 2021. As in previous studies, a smaller percentage of veterinarians working in food animal and equine practices had serious psychological distress than veterinarians working in companion animal or mixed practices. A higher percentage (18.1% [81/448]) of veterinary support staff experienced serious psychological distress than veterinarians.
Percentages of veterinarians with serious psychological distress by age. Letters next to each column indicate a statistically significant (P < .05) difference between categories.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Percentages of veterinarians with serious psychological distress by age. Letters next to each column indicate a statistically significant (P < .05) difference between categories.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Percentages of veterinarians with serious psychological distress by age. Letters next to each column indicate a statistically significant (P < .05) difference between categories.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
In spite of an increase in serious psychological distress among veterinarians from 2019 to 2021, there was no increase in the prevalence of suicide ideation or suicide attempts within the prior 12 months among veterinarians.2 Prevalence of suicide ideation in the prior 12 months was higher among veterinary support staff than among veterinarians (11% vs 7%) and prevalence of suicide attempts in the past 12 months was also higher among veterinary support staff (0.053% vs 0.022%).
Nearly a third of veterinarians (30.5% [760/2,491]) and half of veterinary support staff (49.6% [222/448]) were classified as having high burnout on the Mayo Clinic Physician’s Burnout Scale. Among veterinarians, burnout was higher among younger veterinarians than older ones and the differences were statistically significant. Interestingly, the mean burnout scores of veterinarians (3.1/7) were the same in the 20192 and 2021 wellbeing studies, in spite of the pandemic and a higher prevalence of serious psychological distress in 2021.
Impact of COVID-19 pandemic
Like other Americans, veterinarians were impacted by the coronavirus pandemic that began in early 2020. Seventy-eight percent (1,338/1,712) of veterinarians and 81% (363/448) of veterinary support staff said their clinics were shorthanded due to employee absences caused by the pandemic. Fifty-one percent (873/1,712) of veterinarians and 46% (206/448) of veterinary support staff said they worked more and longer hours than they would have otherwise. Respondents also indicated that working during the pandemic significantly increased their exposure to the disease. A multiple regression analysis of all three Merck Animal Health Veterinarian Wellbeing Studies (2017, 2019, and 2021) suggested that the pandemic was an important contributor to the increase in percentage of veterinarians suffering from serious psychological distress. It also contributed to burnout and lower wellbeing. Given the panel structure of the data, any differences that are unique to 2021 can be attributed to the pandemic, and the pandemic clearly had negative impacts given responses to the 2021 study. Such inference is not conclusive but highly suggestive.
Role of personality
Veterinarians scored higher in neuroticism and lower in extroversion (more introverted) than employed adults in the general population.11 Neuroticism and extroversion are the 2 personality characteristics most associated with wellbeing.12 Individuals that score high in neuroticism tend to be worriers and more vulnerable to stress than people lower in neuroticism. They also are less likely to cope well with long work hours.13 In each of the Veterinarian Wellbeing Studies,1,2 neuroticism has proven to be the strongest predictor (ie, predictor with the largest negative regression coefficient) of low wellbeing, serious psychological distress, and high levels of burnout. Interestingly, veterinarian support staff on average scored even higher in neuroticism than veterinarians (Figure 3). For veterinarians and veterinary support staff members high in neuroticism, managing stress well is particularly important because multiple regression analysis showed respondents with high levels of neuroticism were more likely to have negative associations with stressful situations (COVID-19, long work-hours, and stressful work culture).
Mean scores of practice support staff, veterinarians, and the general population on neuroticism and extroversion, 2 of the Big 5 personality traits. Support staff and veterinarian scores are from the 2021 Merck Animal Health Veterinarian Wellbeing Study and Veterinary Support Staff Study. The general population scores are from the Panel Study of Income Dynamics.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Mean scores of practice support staff, veterinarians, and the general population on neuroticism and extroversion, 2 of the Big 5 personality traits. Support staff and veterinarian scores are from the 2021 Merck Animal Health Veterinarian Wellbeing Study and Veterinary Support Staff Study. The general population scores are from the Panel Study of Income Dynamics.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Mean scores of practice support staff, veterinarians, and the general population on neuroticism and extroversion, 2 of the Big 5 personality traits. Support staff and veterinarian scores are from the 2021 Merck Animal Health Veterinarian Wellbeing Study and Veterinary Support Staff Study. The general population scores are from the Panel Study of Income Dynamics.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Attitude toward the profession
As in previous editions of the study,1,2 less than half of veterinarians (47% [1,174/2,477]) said they would recommend the profession to a friend or family member. In response to an open-ended question, respondents rated the high cost of becoming a veterinarian relative to the income plus the stress involved as primary reasons.2 The 2021 study also asked respondents if they regretted becoming a veterinarian; 18% (454/2,484), or nearly 1 in 5, said “yes.” When asked how likely they were to leave the profession within the next 2 years, only 4% (43/1,087) of those < 55 said they were “very likely” to leave veterinary medicine. On the other hand, 31% (139/446) of staff members said they were very likely to leave employment in veterinary medicine within the next 2 years.
Individual Strategies to Promote Wellbeing
A major focus of the 2021 Merck Animal Health Veterinarian and Staff Wellbeing Studies was to identify practices, techniques, or behaviors used by those with high levels of wellbeing and good mental health (lack of serious psychological distress) that were not found prominently in respondents with low wellbeing, high levels of burnout, or serious psychological distress. In multiple regression analysis, the 2 techniques most predictive of high wellbeing, low burnout, and absence of serious psychological distress were the following: having a healthy coping mechanism for dealing with stress (P > .001) and working in a practice or job with a healthy work culture (P > .001).
A coping mechanism for stress
Veterinary medicine, like human medicine, is an inherently stressful profession. Stress levels of veterinarians have been shown to be higher than those of the general population.14 Many factors have been cited for these elevated stress levels, including ethical dilemmas, client financial limitations affecting pet care, work overload, client complaints, and mistake making.15 On a daily basis, veterinarians deal with sickness and death and often emotionally distraught or financially strapped clients. Stress will be there. The important thing is to have a dependable way to cope with it. In multiple regression analysis, having a healthy coping method was the strongest predictor of high wellbeing, low burnout, and no serious psychological distress in the 2021 wellbeing study. Differences were substantial. Only 34% (82/243) of veterinarians with serious psychological distress said they had a healthy method for coping with stress, compared to 81% (1,811/2,247) of veterinarians without serious psychological distress. Respondents without serious psychological distress were much more likely to strongly agree that they had a healthy method for dealing with stress. A much smaller percentage of veterinary support staff members than veterinarians said they had a healthy coping mechanism.
Healthy coping methods may differ by individual, and a stress management plan should be individualized. Within positive psychology research, there have been a number of self-care exercises that have been suggested to promote mental wellbeing, including gratitude exercises, healthy relationships, meditation, regular exercise, and healthy eating.16–18
Healthy work-life balance
The importance of a healthy balance between work and nonwork permeates the findings of all of the Merck Animal Health Veterinarian Wellbeing Studies. In the present study, 39% (978/2,487) of veterinarians were not satisfied with the amount of free time they had, and another 30% (756/2,487) were only somewhat satisfied. More than half (51% [1,275/2,486]) said they were working more hours than they would like.
Personality also plays a role here. Individuals with personalities high in neuroticism are not only more vulnerable to stress, but also don’t handle long work hours as well as people with lower levels of neuroticism.13
In all 3 Merck Animal Health Veterinarian Wellbeing Studies, respondents with serious psychological distress were consistently much less engaged in healthy, nonwork activities compared to those not distressed, suggesting a correation (Figure 4). Author Ruth Whitmann, after reviewing numerous studies, suggested that time spent socializing with friends was one of the most important factors and stated that “Study after study shows that good social relationships are the strongest, most consistent predictor there is of a happy life.”19
Percentages of veterinarian respondents with and without serious psychological distress who reported that they participated in various types of healthy activities that mental health professionals typically recommend to prevent or mitigate psychological distress. For all activities except meditation and yoga, percentages were significantly (P < 0.05) different between those with and without serious psychological distress.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Percentages of veterinarian respondents with and without serious psychological distress who reported that they participated in various types of healthy activities that mental health professionals typically recommend to prevent or mitigate psychological distress. For all activities except meditation and yoga, percentages were significantly (P < 0.05) different between those with and without serious psychological distress.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Percentages of veterinarian respondents with and without serious psychological distress who reported that they participated in various types of healthy activities that mental health professionals typically recommend to prevent or mitigate psychological distress. For all activities except meditation and yoga, percentages were significantly (P < 0.05) different between those with and without serious psychological distress.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Professional financial advice
A higher percentage of young veterinarians experienced low wellbeing and serious psychological distress compared to older veterinarians. Previous Merck Animal Health Veterinarian Wellbeing Studies have found that major contributors were high levels of student debt and other financial pressures.1,2 In the present study, engaging with a financial adviser was predictive of higher levels of wellbeing and lack of serious psychological distress. Only 5.5% (68/1,184) of respondents who hired a financial planner suffered from serious psychological distress compared to 14.1% (173/1,230) of those without professional financial counsel. Those veterinarians with a financial adviser paid off student debt faster and were more likely to not carry costly credit card balances.
There are both virtual and in-person resources available to veterinarians to help manage finances. The AVMA provides a library of resources on its website at https://www.avma.org/resources-tools/personal-finance. The Veterinary Information Network Foundation offers resources to veterinarians burdened with student debt at vinfoundation.org/resources/student-debt-center/. Other web-based resources are available (eg, avma.org/membership/SAVMA/financing-your-veterinary-medical-education and vmae.org/veterinary-debt-initiative).
Fee-based financial planners are advisers who charge only for their professional services and are not affiliated with firms whose goal is to sell investment vehicles or other services. Fee-based financial planners can be found through the National Association of Personal Financial Advisors (NAFPA.org).
Organizational Strategies to Promote Wellbeing
The Merck Animal Health Veterinarian Wellbeing Study demonstrated that there were many actions that employers could take to reduce stress for employees and improve access to mental health resources.
Reduce stigma through communication
The stigma associated with mental illness is a barrier to those needing help. In the Merck Animal Health Veterinarian Wellbeing Study, 70% (1,468/2,087) of veterinarians said they believe that mental health treatment helps veterinarians lead normal lives. A majority (58% [1,221/2,099]) said they would feel comfortable discussing mental health topics with other veterinarians. However, among those suffering from serious psychological distress, only 22% (53/241) said they would feel comfortable taking time off to seek treatment, and only 25% (57/229) felt their employer or practice partners would be supportive. Further, 59% (143/243) of distressed veterinarians and 65% (53/81) of distressed veterinary support staff said they needed mental health treatment in the past year but did not get it (Figure 5). For veterinarians, that was a higher percentage than in previous wellbeing studies.
Percentages of veterinarians and support staff with serious psychological distress who wanted mental health treatment or counseling but did not receive it.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Percentages of veterinarians and support staff with serious psychological distress who wanted mental health treatment or counseling but did not receive it.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Percentages of veterinarians and support staff with serious psychological distress who wanted mental health treatment or counseling but did not receive it.
Citation: Journal of the American Veterinary Medical Association 260, 12; 10.2460/javma.22.03.0134
Creating a safe environment where employees feel comfortable speaking up if they are feeling stressed or overwhelmed and empowering employees to seek assistance when they need it, even if it means taking time off during work hours, could potentially help break down barriers to treatment.
Another technique study authors recommend is inviting a local mental health professional to address the practice team from time to time to make sure that employees know how to recognize distress in themselves and others and to understand what resources are available in the local community. In addition, there are several telebehavioral health services that can be accessed via phone or the internet. Some of these are available outside of normal work hours as well. One source of these services is E-counseling.com.
Provide insurance and EAP
Two resources that could be valuable to individuals wanting counseling or treatment are health insurance that provides coverage for mental health treatment and an Employee Assistance Program (EAP). An EAP is a program that helps assist employees with personal and/or work-related problems that may impact their job performance, physical or mental health, or emotional wellbeing. While once rare in veterinary medicine, EAP programs are now available to employers through third-party benefit providers. For example, Veterinary Hospital Managers Association and Alera Veterinary, an employee benefits provider, offers EAP services through a third party.
Most importantly, it is important that employees know whether or not they have insurance coverage or access to an EAP. Although 53% (1,315/2,482) of respondents in the Merck Animal Health Veterinarian Wellbeing Study said their medical insurance covered mental health treatment, 38% (946/2,482) said they did not know whether or not they had coverage. Similarly, 37% (167/448) of veterinary support staff didn’t know. Seven percent (31/448) of staff respondents and 2% (54/2,482) of veterinarian respondents indicated they did not have any kind of health insurance. Likewise, 31% (762/2,484) of veterinarians reported that their employer provided an EAP, 44% (1,084/2,484) said their employer did not provide an EAP, and 26% (639/2,484) didn’t know. For veterinary support staff, 36% (159/447) said their employer had an EAP, 32% (144/447) said no, and another 32% (144/447) said they didn’t know.
Foster a healthy work culture
In an effort to determine the potential impact of the work environment on wellbeing, mental health, and burnout, the 2021 Merck Animal Health Veterinarian Wellbeing Study examined 15 different factors related to leadership and work conditions. In multiple regression analysis, 4 factors emerged that defined a healthy culture:
There is a strong sense of belonging to a team
There is a high degree of trust in the organization
There is candid and open communication among team members
Sufficient time is allotted for each appointment to provide high-quality patient care
The impact was significant. Having a healthy work culture was second only to a healthy coping mechanism in predicting high wellbeing, low burnout. and lack of serious psychological distress. That was true both in the veterinarian study and in the veterinary support staff study. Both of those factors were also the strongest predictors of recommending a career in veterinary medicine.
Of the 4 factors, many respondents agreed that their work environment offered teamwork and trust, but far fewer agreed that good communication and adequate time to provide quality patient care were features of their practice. Establishing a healthy work culture is vital to promoting wellbeing within the profession.
Discussion
While the COVID-19 pandemic contributed to a higher percentage of veterinarians experiencing serious psychological distress, it had a more modest impact on wellbeing and burnout and no measurable impact on suicide ideation and planning. This study revealed that veterinary support staff experienced higher levels of serious psychological distress, lower wellbeing, and higher levels of burnout than veterinarians. Thirty-one percent (139/446) of veterinary support staff said they were very likely to exit work in veterinary medicine within the next 2 years. That does not bode well for a profession with an abundance of openings for staff positions. More than 90% of both veterinarians (91% [2,279/2,491]) and veterinary support staff (93% [418/448]) consider the shortage of qualified support staff to be one of the most critical issues facing the profession.
While wellbeing, mental health challenges, and burnout are important issues for veterinarians and their support staff, they are not unique to veterinary medicine. The wellbeing of veterinarians as a group is nearly identical to that of nonveterinarians.9 Also, burnout seems to be a concern to people in many jobs. According to a recent article, “Around the world, three out of every five workers say they’re burned out. A 2020 U.S. study put that figure at three in four.”20
The most important takeaway from the Merck Animal Health Veterinarian and Staff Wellbeing Studies is there are several techniques that both individuals and employers can adopt to that can potentially improve wellbeing, lower the incidence of serious psychological distress, and reduce burnout. Those techniques are crucial because many veterinarians and staff members have personalities high in neuroticism and low in extroversion, characteristics that contribute to lower resiliency to stress and long work hours.11 Having a healthy coping mechanism for stress should be a priority for anyone working in veterinary medicine. And creating a work climate with high levels of teamwork, trust, communication, and a reasonable work pace should be the goal of every employer.
In Times of Crisis
If you suspect someone may be a danger to themselves or others, dial 9-1-1.
To contact the National Suicide Prevention Lifeline, dial 1-800-273-TALK (8255).
Type “mobile crisis” into your computer search engine for assistance with a mental health crisis in virtually every community.
Text “Hello” to 741741 for access to a trained crisis counselor.
References
- 1. ↑
Volk JO, Schimmack U, Strand E, Lord LK, Siren CW. Executive summary of the Merck Animal Health Veterinary Wellbeing Study. J Am Vet Med Assoc. 2018; 252(10):1231–1238.
- 2. ↑
Volk JO, Schimmack U, Strand EB, Vasconselos J, Siren CW. Executive summary of the Merck Animal Health Veterinarian Wellbeing Study II. J Am Vet Med Assoc. 2020; 256(11):1237–1244.
- 3. ↑
Linzer M, Manwell LB, Williams ES, et al., Working conditions in primary care: physician reactions and care quality. Ann Intern Med. 2009; 151(1):28–36, W6–W9.
- 4. ↑
Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003; 60:184–189.
- 6. ↑
Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess. 1985; 49:71–75.
- 7. ↑
Shanafelt TD, West CP, Sinky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc. 2019; 94:1681–1694.
- 8. ↑
Mccrae R, John OP. An introduction to the 5-factor model and its applications. J Pers. 1992; 60(2):175–215.
- 9. ↑
Cohen P, Cohen J, Aiken LS, West SG. The problem of units and the circumstance for POMP. 2010;34(3):315–346. Multivariate Behav Res. https://doi.org/10.1207/S15327906MBR3403_2
- 10. ↑
Gallup World Poll (US). Accessed December 13, 2021. https://www.gallup.com/analytics/349487/gallup-global-happiness-center.aspx
- 11. ↑
Freedman, Vicki A. The Panel Study of Income Dynamics’ Wellbeing and Daily Life Supplement (PSID-WB). User Guide: Final Release 1. Institute for Social Research, University of Michigan; 2017.
- 12. ↑
Anglim J, Horwood S, Smillie LD, Marrero RJ, Wood JK. Predicting psychological and subjective well-being from personality: a meta-analysis. Psychol Bull. 2020;146(4):279–323.
- 13. ↑
Tsuno K, Kawachi I, Inoue A, et al. Long working hours and depressive symptoms: moderating effects of gender, socioeconomic status, and job resources. Int Arch Occup Environ Health. 2019;92(5):661–672.
- 14. ↑
Hatch PH, Winefield HR, Christie BA, Lievaart JJ. Workplace stress, mental health, and burnout of veterinarians in Australia. Aust Vet J. 2011;89(11):460–468.
- 15. ↑
Kipperman B, Morris P, Rollin B. Ethical dilemmas encountered by small animal veterinarians: characterisation, responses, consequences and beliefs regarding euthanasia. Vet Rec. 2018;182(19):548. doi:10.1136/vr.104619
- 16. ↑
Emmons RA, Froh J, Rose R. Gratitude. In: Gallagher MW, Lopez SJ, eds. Positive Psychological Assessment: A Handbook of Models and Measures. American Psychological Association; 2019:317–332.
- 17.
Walsh R. Lifestyle and mental health. Am Psychol. 2011;66(7):579–592.
- 20. ↑
Lapore J. Burnout: modern affliction or human condition. The New Yorker. May 17, 2021. Accessed May 15, 2021. https://www.newyorker.com/magazine/2021/05/24/burnout-modern-affliction-or-human-condition
