Introduction
The psychological impacts of disasters, like pandemics, are varied and influenced by the event’s severity and chronicity, as well as available support systems, and can exacerbate existing psychological problems.1–3 Veterinarians are frequently recognized as a group that experiences higher rates of depression, anxiety, and suicidal ideation compared to the general population; recognized profession-specific stressors include the demands of veterinary practice and a high debt-to-income ratio.4–8 Additionally, veterinarians who are female, younger, and have fewer years of professional experience have been reported to be at greater risk for experiencing psychological distress.4,6–9 Organizational cultures that put veterinarians in situations where they feel morally distressed or do not promote work-life balance and reasonable autonomy are also recognized psychological stressors.5–11 It is important to understand how new and unique stressors from disasters like the COVID-19 pandemic impact groups already under stress, such as veterinarians. COVID-19 provided an opportunity to not only explore how veterinarians were impacted by pandemic stressors but also address knowledge gaps about the coping behaviors veterinarians use, their attitudes and beliefs surrounding mental health help seeking and resources, and how this can inform the development of meaningful interventions that build resilience.
Coping and resilience can mitigate the negative outcomes of stress.1,5–8,12 Coping is a continuous process of appraising a stressor and responding to it by approaching and addressing the issue or through avoidance.13–15 Coping can occur at the individual or organizational level, and strategies can vary on the basis of personal and cultural factors.3,6,7,15 Successful coping strategies enable a person to manage stress without experiencing distress while maintaining long-term health. Resilience is a person’s capacity to recover from stressful situations.12,16 Greater resilience is recognized as protective against fatigue, burnout, and psychological distress.12,16 Levels of resilience can vary for an individual over time and by circumstances.12,16,17 Those who experience repeated environmental and psychological stressors without adequate recovery time can experience reduced resilience and broad physiologic changes associated with chronic stress; the cumulative burden of these stressors is referred to as allostatic load.16,18,19 To develop a resilient veterinary workforce, it is important to understand effective coping strategies as well as factors that contribute to greater resilience and attend to issues of allostatic load.
In June of 2020, a multidisciplinary team comprising mental health researchers, social workers, veterinarians, and epidemiologists came together to assess stressors that veterinarians experienced during COVID-19; explore coping behaviors veterinarians used; investigate veterinarians’ knowledge, attitudes, and beliefs surrounding mental health resources; and share resources available to support veterinarians. The purpose of this paper was to explore pandemic-related challenges that impacted veterinarians, how they coped with these challenges, which coping strategies were associated with greater resilience, and what served as incentives and barriers to performing healthy coping behaviors.
Materials and Methods
The Potomac Regional Veterinary Coping, Resilience, and Challenges (CRC) Survey (Supplementary Appendix S1) was created and contained up to 59 questions, depending on branching logic, that collected information about responder demographics; professional and personal stressors experienced during COVID-19; job satisfaction; COVID-19 workplace changes and challenges; sources of COVID-19 information; anxiety, depression, social support, and discrimination; mental health–care knowledge, attitudes, and beliefs; coping behaviors; incentives and barriers to performing health coping behaviors; resilience; awareness of existing mental health resources; and the types of mental health resources of greatest interest to veterinarians. When developing the survey, validated psychometric tools were used when possible.20–30 Most survey items were developed by the survey team or adapted from other sources.9,31–33
Resilience was assessed using the 10-point Connor-Davidson Resilience Scale (CD-RISC 10).20,34 This scale contains 10 self-rated statements that ask about a person’s perceived ability to adapt to change and their tendency to bounce back after experiencing hardship. It was originally developed to assess resilience in persons receiving treatment for posttraumatic stress disorder and has since been used to assess resilience in diverse populations.34 Scores on this scale can range from 0 to 40, with higher scores indicating greater resilience. The Brief Coping Orientation to Problems Experienced (COPE) Inventory35 was used as a general model, with adaptations made to better measure coping within the veterinary profession during the initial phases of the COVID-19 pandemic. The Brief COPE includes 28 questions that are paired and summed to characterize 14 dimensions of coping. Four coping dimensions were used as they appear in the Brief COPE (emotional support, behavioral disengagement, self-distraction, and acceptance). Eight coping dimensions were reduced from 2 questions to a single item, with 6 utilizing language identical to the Brief COPE (denial, substance use, instrumental support, positive reframing, planning, and religion) and 2 having modifications to the original wording (venting and mind-body). Two coping dimensions from the Brief COPE were not included (active coping and self-blame). Eighteen additional coping questions were created.
This cross-sectional study was approved by the Institutional Review Boards of Virginia Tech (No. 20-826), the Virginia Department of Health (study No. 50238), and DC Health (Institutional Review Board No. 1-00002318). The survey was pilot tested by 6 veterinarians in practice, academia, and government prior to dissemination. Several regional professional networks including the Virginia-Maryland College of Veterinary Medicine alumni network and state veterinary boards and medical associations in Virginia, Maryland, the District of Columbia, and West Virginia helped to disseminate awareness of the CRC Survey and encourage voluntary survey participation. The survey was administered online through a software program (Qualtrics Survey Software; Qualtrics XM) and was open for a period of 13 weeks between June 4 to September 8, 2021.
Statistical analysis
Electronic survey data were cleaned, coded, and imported into statistical software (R version 4.2.0; The R Foundation) for analysis. Blank survey submissions were not included in analyses. Respondents who completed the survey but chose not to respond to certain questions were included in the denominator for descriptive statistics. Frequency tables were generated to summarize responses for individual questions. Free-text responses were reviewed; if a written response clearly fit with one of the provided options for a question, they were recoded to be included with that option in the analysis. CD-RISC 10 items were coded using a 5-point scale (0 to 4), assessed for internal consistency using α, and then summed to provide a resilience score for each respondent. Respondents who left 1 or more items blank for the CD-RISC 10 were not included in resilience analyses because a total scale score could not be calculated. Responses for years as a veterinarian were grouped so that those with less than 5 years of professional experience were grouped as early career, 5 to 19 years of experience were grouped as midcareer, and those with 20 or more years of experience were grouped as late career. The degree to which a coping strategy was used was coded using a 4-point scale (0 to 3) in which 0 represented not performing a behavior and numbers 1 to 3 represented increasing use of a coping strategy (“doing it a little” to “doing it a lot”). Brief COPE dimensions assessed by more than 1 item were summed; summed scores of 1 to 2 represented performing a behavior a little, 3 to 4 performed the behavior a medium amount, and 4 to 5 performed the behavior a lot. Comparative analyses exploring aspects of a person’s work environment and reported coping strategies with resilience were conducted using 1-way ANOVA and linear regression models. The mean and median of resilience scores were evaluated to assess distribution and skewness. Multivariable linear regression was used to examine the relationships between age, gender, career stage, and resilience, with the 30 to 39 year age group, female gender, and midcareer stage used as the reference groups. Effect sizes and P values were reported for analyses. A value of P < .05 was the threshold for selection among multiple variables.36
Results
A total of 331 surveys were submitted. Sixty-eight were blank and excluded from analysis. There were 268 completed surveys. Two of these were submitted by nonveterinarians and were excluded from further analysis, leaving 266 responses meeting inclusion criteria. Items comprising the CD-RISC 10 had excellent internal consistency (α = 0.90).
Survey respondents
Demographically, the 266 veterinarians who participated in the survey (Table 1) were predominantly female (162/266 [61%]), were between 30 and 49 years of age (116/266 [44%]), and identified racially and ethnically as white (186/266 [70%]). The majority worked in suburban environments (155/266 [58%]) in Maryland (128/266 [48%]) and Virginia (63/266 [24%]). Reported years of professional experience ranged from less than 1 year to 30 or more years. When broken out by career stage, 49% (130/266) were midcareer and 40% (106/266) were late career. Veterinarians worked in a variety of workplaces (Table 2), with 85% (226/266) in clinical practice, 27% (72/266) as practice owners, 3% (8/266) as hospital managers, 10% (26/266) had nonclinical roles, and 8% (20/266) categorized themselves as “other,” which included those working in clinical roles in academia, government, and research. Among veterinarians who reported working as clinicians, hospital managers, and practice owners, 63% (147/233) reported working in small animal general practice.
Demographic summary of 266 veterinarians who responded to an anonymous online cross-sectional survey, the Potomac Regional Veterinary Coping, Resilience, and Challenges Survey, conducted between June 4, 2021, and September 8, 2021, to gather information about veterinarians’ stressors experienced during COVID-19; job satisfaction; COVID-19 workplace changes and challenges; sources of COVID-19 information; anxiety, depression, social support, and discrimination; mental health–care knowledge, attitudes, and beliefs; coping behaviors; incentives and barriers to performing health coping behaviors; resilience; awareness of existing mental health resources; and the types of mental health resources of greatest interest to veterinarians.
| Characteristic | No. (%) of respondents |
|---|---|
| Total respondents | 266 (100.0) |
| Gender | |
| Male | 40 (15.0) |
| Female | 162 (60.9) |
| Nonbinary | 1 (0.4) |
| Prefer not to answer | 1 (0.4) |
| No response | 62 (23.3) |
| Age (y) | |
| 20–29 | 7 (2.6) |
| 30–39 | 60 (22.6) |
| 40–49 | 56 (21.1) |
| 50–59 | 40 (15.0) |
| 60–69 | 34 (12.8) |
| ≥ 70 | 7 (2.6) |
| No response | 62 (23.3) |
| Race and ethnicity | |
| White | 186 (69.9) |
| Black or African American | 7 (2.6) |
| Asian | 6 (2.3) |
| Hispanic, Latino, or Spanish origin | 3 (1.1) |
| Othera | 6 (2.3) |
| No response | 58 (21.8) |
| State | |
| Maryland | 128 (48.1) |
| Virginia | 63 (23.7) |
| West Virginia | 29 (10.9) |
| District of Columbia | 19 (7.1) |
| Otherb | 23 (8.6) |
| No response | 4 (1.5) |
| Career stage | |
| Early career | 26 (9.8) |
| Midcareer | 130 (48.9) |
| Late career | 106 (39.8) |
| No response | 4 (1.5) |
aOther racial and ethnic groups included American Indian or Alaskan Native, Middle Eastern or North African, Native Hawaiian or other Pacific Islander, Mediterranean, and multiethnic. bOther states included North Carolina, Pennsylvania, California, Georgia, Ohio, Delaware, Massachusetts, and Kansas, with 6 respondents identifying more than 1 primary location.
Workplace characteristics reported by the survey respondents described in Table 1.
| Characteristic | No. (%) of respondents |
|---|---|
| Total respondents | 266 (100.0) |
| Current rolea | |
| Clinical veterinarian | 226 (85.0) |
| Practice owner | 72 (27.1) |
| Hospital manager | 8 (3.0) |
| Nonclinical veterinarian | 26 (9.8) |
| Otherb | 20 (7.5) |
| Current and primary workplace | |
| Small animal practice | 183 (68.8) |
| Mixed animal practice | 20 (7.5) |
| Equine practice | 11 (4.1) |
| Food animal practice | 2 (0.8) |
| Shelter practice | 6 (2.3) |
| Otherb | 44 (16.5) |
| Practice typec | |
| General practice | 176 (66.2) |
| Specialty practice | 28 (10.5) |
| Otherd | 29 (10.9) |
| No response | 33 (12.4) |
| Work location | |
| Suburban | 155 (58.3) |
| Rural | 50 (18.8) |
| Urban | 48 (18.0) |
| Othere | 9 (3.4) |
| No response | 4 (1.5) |
aRespondents could select more than 1 role. bOther roles included research, academia, industry, government, and graduate study. cThis question was only shown to those who selected “clinical veterinarian,” “practice owner,” or “hospital manager” for their current role. dOther practice types included emergency medicine, shelter medicine, species-exclusive practices, and combinations of practice types. eOther work locations generally involved travel to different locations.
Pandemic changes and challenges
Most veterinarians (201/266 [76%]) reported working 40 or more h/wk, with 29% (78/266) working 50 or more h/wk; 21% (56/266) reported working less than 40 h/wk, and 2% (5/266) reported working “other” hours, such as having flexible work schedules. About half of respondents (138/266 [52%]) reported that their work hours increased during the pandemic, 38% (101/266) reported that their hours stayed the same, and 9% (23/266) reported that their work hours decreased.
Within the workplace, the most common changes implemented in response to COVID-19 were altering normal processes to limit physical contact (217/266 [82%]), requiring cloth face coverings (214/266 [80%]), and increased cleaning and disinfection (177/266 [67%]). Many veterinarians either agreed or strongly agreed that they were able to meet client expectations using the modified protocols (137/266 [52%]) and that clients were understanding (165/266 [62%]), cooperative (157/266 [59%]), and respectful (131/266 [49%]) of COVID-19 workplace changes, though they also reported that clients were frustrated (151/266 [57%]). Fewer veterinarians agreed or strongly agreed that clients were angry (82/266 [31%]) because of COVID-19 changes. The majority of veterinarians were comfortable with their general knowledge of COVID-19 (209/266 [79%]) and their ability to communicate that information to clients and others (186/266 [70%]). Most veterinarians either agreed or strongly agreed that they were familiar with (168/266 [63%]) and confident in (142/266 [53%]) their practice’s biosecurity and hygiene protocols and that their coworkers were on board with the new policies (141/266 [53%]).
Veterinarians faced many challenges during COVID-19 (Figure 1). The greatest challenges experienced in the workplace included an increased workload; needing to reevaluate workflows, practices, and policies with social distancing in mind; personal protective equipment and other supply chain shortages; client adherence to COVID-19 workplace policies; and employee absenteeism due to quarantine or isolation for COVID-19. The majority of veterinarians identified the following items as “not a challenge”: client demands for SARS-CoV-2 testing in animals (176/266 [66%]), practice revenue (141/266 [53%]), the ability to fulfill continuing education requirements (117/266 [44%]), and employee compliance with COVID-19 workplace policies (110/266 [41%]). Workplace challenges were generally considered “somewhat of a challenge”; increased workload was the only workplace challenge for which the majority responses indicated that this was a “significant challenge.” Frequently reported challenges for veterinarians who were also practice owners and hospital managers were needing to increase the number of staff positions (46/60 [77%]) and increase staff hours (32/60 [53%]). The most frequently reported COVID-19 challenges that veterinarians experienced in their personal lives were separation from loved ones (161/266 [61%]) and caring for a loved one who was ill or unwell (85/266 [32%]).
Frequency of challenges faced during the COVID-19 pandemic as reported by 266 veterinarians who responded to an anonymous online cross-sectional survey, the Potomac Regional Veterinary Coping, Resilience, and Challenges Survey, conducted between June 4, 2021, and September 8, 2021, to gather information about veterinarians’ stressors experienced during COVID-19; job satisfaction; COVID-19 workplace changes and challenges; sources of COVID-19 information; anxiety, depression, social support, and discrimination; mental health–care knowledge, attitudes, and beliefs; coping behaviors; incentives and barriers to performing health coping behaviors; resilience; awareness of existing mental health resources; and the types of mental health resources of greatest interest to veterinarians.
Citation: Journal of the American Veterinary Medical Association 261, 6; 10.2460/javma.22.12.0584
Resilience and coping
Of the veterinarians who completed the CD-RISC 10 (n = 219), the mean score was 29.6 (SD, 6.9), with a median of 30 (IQR = 10). Veterinarians reported using a variety of coping strategies; frequently used coping strategies included acceptance (179/266 [67%]), self-distraction (145/266 [55%]), following a routine (132/266 [50%]), spending time outdoors (124/266 [47%]), positive reframing (119/266 [45%]), and use of humor (111/266 [42%]).
In analyses of demographic factors, being male (2.5 points higher resilience than females; P = .04), age (R2 = 0.05; P = .01), and late career stage (3.3 points higher resilience than those who were midcareer; P < .001) had the strongest associations with greater resilience. Age and career stage were highly correlated. Male respondents were older; 69% (27/39) of males and 33% (53/162) of females were greater than 50 years of age. In multivariable linear regression models examining the influence of gender and either age or career stage on resilience, only > 70 years of age (6.0 points higher resilience than those 30 to 39 years of age; P = .04) or late career stage (2.7 points higher resilience than those who were midcareer; P = .008) remained in the model after controlling for gender and either other age groups or other career stage groups, respectively.
Individual and organizational aspects of the work environment and their associations with resilience are summarized (Table 3); those that had a strong positive association with resilience included feeling invested in one’s work, feeling that one’s work made a positive contribution, enjoying work, feeling invigorated after working with clients, feeling fairly paid, being satisfied with one’s position and promotion opportunities, having supportive relationships with coworkers, feeling empowered to stand up for oneself, having autonomy at work, having a sense of good work-life balance, having an employer who encouraged employees to take time off, and having flexible work hours. Veterinarians who hesitated to take earned time off, often worked longer than scheduled, or felt they had more work than could be completed in a day had lower resilience scores.
Aspects of the work environment and their associations with resilience reported by the survey respondents described in Table 1.
| Aspects of work environment | Direction of relationship | P value | R2 |
|---|---|---|---|
| I feel empowered to stand up for myself. | Positive | < .001 | 0.18 |
| I am satisfied with my current position. | Positive | < .001 | 0.17 |
| I feel invested in my work and take pride in doing a good job. | Positive | < .001 | 0.13 |
| I feel invigorated after working with clients. | Positive | < .001 | 0.12 |
| I have a good balance between my work life and personal life. | Positive | < .001 | 0.11 |
| I am satisfied with promotion opportunities available to me. | Positive | < .001 | 0.10 |
| My employer encourages me to take time away from work. | Positive | < .001 | 0.10 |
| I can determine the amount of work I do. | Positive | < .001 | 0.10 |
| I decide how I structure my work. | Positive | < .001 | 0.08 |
| I enjoy the work I do. | Positive | < .001 | 0.08 |
| I am paid fairly and adequately for my work. | Positive | < .001 | 0.08 |
| My work makes a positive contribution. | Positive | < .001 | 0.07 |
| I have flexible work hours. | Positive | < .001 | 0.07 |
| I have a friendly and supportive relationship with my coworkers. | Positive | .001 | 0.07 |
| I decide how my work gets done. | Positive | .023 | 0.03 |
| I am often intensely focused on my work, and time goes by quickly. | Positive | .067 | 0.02 |
| My supervisor/boss treats me with respect and values my work. | Positive | .308 | 0.01 |
| I often learn something new at work. | Positive | .136 | 0.01 |
| I trust my colleagues. | Positive | .376 | 0.00 |
| A coworker or supervisor is creating a negative work environment. | Negative | .313 | 0.00 |
| I often need to work longer than the scheduled length of my shift. | Negative | .023 | 0.04 |
| I hesitate to take earned time off from work for my own medical appointments, family commitments, or vacations. | Negative | .002 | 0.06 |
| I feel like there is more work to do in a day than I can reasonably complete. | Negative | .001 | 0.06 |
Coping strategies and their associations with resilience are also summarized (Table 4); those that were positively associated with resilience included engaging in physical activity or hobbies, getting emotional support, accepting one’s circumstances, using humor, positive reframing, eating healthier, expressing feelings, making time for mind-body practices, following a routine, maintaining sleep hygiene, and spending more time outdoors. Denial, behavioral disengagement, and use of alcohol or other drugs were negatively associated with resilience. Veterinarians who were seeking mental health support by seeing a counselor, psychologist, or therapist; seeing a psychiatrist or other health-care provider; or taking prescription medication also had lower resilience scores.
Coping strategies and their associations with resilience reported by the survey respondents described in Table 1.
| Coping strategy | Direction of relationship | P value | R2 |
|---|---|---|---|
| I’ve been looking for something good in what is happening (positive reframing). | Positive | < .001 | 0.18 |
| I’ve been spending more time outdoors or looking outdoors (outdoor activities). | Positive | < .001 | 0.09 |
| I’ve been following a routine (self-care). | Positive | < .001 | 0.09 |
| I’ve been expressing my feelings (expressing feelings). | Positive | < .001 | 0.08 |
| I’ve been eating a healthier diet (change in diet). | Positive | < .001 | 0.08 |
| Acceptance (Brief COPE dimension). | Positive | < .001 | 0.07 |
| I’ve been working on or pursuing hobbies (eg, baking, gardening, arts/crafts; hobbies). | Positive | .002 | 0.06 |
| I’ve been maintaining my sleep hygiene (self-care). | Positive | < .001 | 0.06 |
| I’ve been taking walks or engaging in other forms of exercise (physical activity). | Positive | .007 | 0.04 |
| Emotional support (Brief COPE dimension). | Positive | .031 | 0.03 |
| I’ve been making time for mind-body practices (eg, meditating, mindfulness, behavioral activation strategies, loving-kindness practices, yoga; self-care). | Positive | .026 | 0.03 |
| I’ve been using humor to cope with the situation (humor). | Positive | .020 | 0.03 |
| I’ve been trying to come up with a strategy about what to do (planning). | Positive | .094 | 0.02 |
| I’ve been trying to find comfort in my religion or spiritual beliefs (spiritual). | Positive | .102 | 0.02 |
| I’ve been using a variety of stress management techniques. (eg, progressive muscle relaxation, diaphragmatic breathing; self-care). | Positive | .144 | 0.01 |
| I’ve been getting help and advice from other people (instrumental support). | Positive | .221 | 0.01 |
| I’ve been engaging in a virtual support group (support group). | Negative | .411 | 0.00 |
| Self-distraction (Brief COPE dimension). | Negative | .766 | -0.01 |
| I’ve been trying to consume less COVID-19 news or updates (news consumption). | Negative | .056 | 0.02 |
| I’ve been seeing a psychiatrist or other health-care provider for psychiatric care (professional mental health or medical care). | Negative | .047 | 0.02 |
| I’ve been using alcohol or other drugs to make myself feel better (substance use). | Negative | .034 | 0.03 |
| I’ve been seeing a counselor, psychologist, or therapist (professional mental health or medical care). | Negative | .007 | 0.04 |
| I’ve been refusing to believe that it has happened (denial). | Negative | .016 | 0.04 |
| I’ve been taking prescription medication to help with my mental health (professional mental health or medical care). | Negative | < .001 | 0.08 |
| I’ve been eating a less healthy diet (change in diet). | Negative | < .001 | 0.09 |
| Behavioral disengagement (Brief COPE dimension). | Negative | < .001 | 0.15 |
COPE = Coping Orientation to Problems Experienced Inventory.
Incentives and barriers to performing healthy coping behaviors
Veterinarians reported a variety of incentives that motivated them to perform healthy coping behaviors, including improving their general well-being (169/266 [64%]); decreasing feelings of stress (162/266 [61%]), anxiety (139/266 [52%]), or depression (123/266 [46%]); experiencing a good feeling that came from self-care (155/266 [58%]); improved ability to take care of others (147/266 [55%]); meeting personal goals (139/266 [52%]); increasing resilience (118/266 [44%]); and having greater productivity and engagement at work (110/266 [41%]).
The most common barrier preventing veterinarians from performing healthy coping behaviors was limited time in a day to devote to self-care (177/266 [67%]). Financial barriers to accessing desired resources (57/266 [21%]), limited awareness of self-care resources (35/266 [13%]), limited support from friends and family to engage in healthy behaviors (25/266 [9%]), and other assorted responses (23/266 [9%]) were also reported barriers. Five veterinarians (5/266 [2%]) reported having no barriers to performing healthy behaviors.
Discussion
Survey respondents were broadly representative of veterinarians in the US.37 The greatest number of responses came from Maryland, although Maryland reported having 3,821 licensed veterinarians and registered veterinary technicians (combined).38 By comparison, Virginia,39 West Virginia,40 and Washington DC (V DelVento, DVM, DC Board of Veterinary Medicine, email, June 13, 2022) reported 4,616, 707, and 383 licensed veterinarians, respectively. In Maryland and Washington DC, the Boards of Veterinary Medicine proactively disseminated awareness of the survey to all licensed veterinarians, and this strategy may have had a positive influence on response rates. While the number of veterinarians responding to the survey varied between states, the Potomac region is a contiguous area. Study of veterinarians in this region is valuable because a diverse range of veterinarians (ie, small- and large-animal clinicians and nonclinical veterinarians) and work environments (ie, rural or urban) are represented.
During COVID-19, veterinarians reported an increase in both their workload and the number of hours worked each week, with increased workload being the greatest challenge faced by veterinarians during this time. Working longer hours and greater workloads are well-recognized occupational stressors, which can take time and energy away from restorative nonwork activities and contribute to allostatic load and burnout.5–7 In their personal lives, separation from loved ones was the greatest COVID-19 challenge impacting veterinarians. This separation, combined with or perhaps due to the increased workload, likely exacerbated stressors that veterinarians experienced, as family and friends are well-recognized and important social supports associated with psychological and physical health.4–8,12
COVID-19 prevention measures implemented in the veterinary workplace were similar to those adopted by many other businesses. The need to reevaluate workflows in light of COVID-19 was challenging for veterinarians, but many were able to successfully implement needed changes with employee support and client cooperation. Although veterinarians reported that clients were generally cooperative with and understanding of COVID-19 workflow changes, some clients were frustrated and angry, which could have had implication for reported workplace stress. Moral distress and difficult client relations are known occupational stressors for veterinarians.4–8,10,11 Given that the veterinary profession has unique and specific stressors, some of which are related to the veterinary-client-patient relationship, these data support the need for supportive infrastructure within the workplace during periods of change, such as COVID-19. Supportive activities that build engagement between and across roles, such as regular team huddles, and interpersonal communication training on topics such as conflict resolution, managing trauma reactions, and de-escalation can strengthen resilience and mitigate burnout.41–43
Veterinarians in this study used a wide variety of coping strategies. Consistent with other reports,14,15 we found that generally approach-focused coping strategies (eg, problem-solving, positive reframing, acceptance, and use of emotional support) were associated with greater resilience, while avoidant strategies (eg, behavioral disengagement, denial, distraction, and substance use) were associated with lower resilience. Of note, veterinarians who reported currently utilizing professional mental health support tended to have lower resilience scores, although they also reported this support to be very helpful. This was a departure from the general positive association of approach-focused coping strategies with resilience trend. Veterinarians have been found to be reticent to seek counseling,5,7,9 though studies have shown that use of professional mental health support can strengthen resilience.5,12 With the cross-sectional nature of this survey, it was not possible to determine resilience prior to implementing any of the coping strategies or whether these approaches strengthened resilience over time.
Since veterinarians spent a large proportion of their lives at work and had limited time for self-care, the implementation of effective workplace interventions in addition to individual-level coping strategies is incredibly important.7,8,10,41 Examples of successful organizational-level interventions to alleviate stressors have been described.7,41–43 Within these results (Table 3), workplace characteristics that were mostly under organizational (rather than individual) control and were positively associated with resilience included fair pay, satisfaction with available promotion opportunities, feeling empowered to stand up for oneself, having autonomy with regard to how work is structured and done, being able to determine how much work one does, being encouraged to take time off, and having flexible work hours. Of all the workplace characteristics examined, feeling empowered to stand up for oneself at work and being satisfied with one’s current position were workplace characteristics that made the greatest contributions to resilience (R2 = 0.18 and 0.17, respectively). It is important that veterinary workplaces consider how they can apply these concepts within their organizations to build a more resilient workforce (Figure 2). Existing public and occupational health interventional concepts, such as the primary prevention model and the Hierarchy of Controls model, are likely already familiar to veterinarians and might help them conceptualize the implementation of organizational-level strategies to improve coping and resilience.41
Summary schematic of self-reported individual and organizational factors that contributed to greater resilience of the respondents to the survey described in Figure 1.
Citation: Journal of the American Veterinary Medical Association 261, 6; 10.2460/javma.22.12.0584
In our results (Table 4), positive reframing (looking for something good in what is happening) was the coping strategy that had the largest effect size (R2 = 0.18) on increasing resilience and behavioral disengagement (giving up trying to deal or cope) was the coping strategy with the largest effect size (R2 = 0.15) on decreasing resilience. Other coping strategies had smaller effects on resilience, though they are still important influences on well-being. Several veterinary associations have recognized the importance of linking veterinarians with healthy coping support and now have resources available for their members, including workplace well-being programs, confidential mental health counseling, financial counseling, and other self-care and mental health issues.44,45
Our results showed that veterinarians were largely resilient during COVID-19. Half of the veterinarians in this survey had CD-RISC 10 scores between 25 and 35. CD-RISC scores are influenced by the location where the data were obtained, when they were obtained, and the sample population.12,16,34 US general population sampling has shown the quartile distribution of CD-RISC 10 scores ranging from 0 to 29, 30 to 32, 33 to 36, and 37 to 40,34 indicating scores are not evenly distributed along the 0 to 40 scale, with half of respondents clustering between 30 and 36. This can make interpretation of resilience levels (ie, “low,” “moderate,” and “good”) challenging when CD-RISC 10 scores fall slightly above or below 30, as they generally did in this study. Many studies that utilize CD-RISC 10 to measure resilience report mean scores rather than quartiles; as reported mean scores are often around 30, this can also present challenges. Prior to COVID-19, studies of the US general population showed mean scores of 32.1 (SD, 5.8) and 31.8 (SD, 5.4).34,46 During COVID-19, the CD-RISC 10 mean scores in the US general population were reported to be 28.46 (SD, 7.93)47; veterinary resilience in this study (mean, 29.6; SD, 6.9) was comparable to that of the US general population. CRC respondents had CD-RISC scores that were comparable to or better than those of other health-care workers in Israel (mean, 29.05; SD, 6.28)48 and France (median, 28; range, 17 to 40)49 during COVID-19.
Multivariable regression analysis of demographic factors showed that age and career stage were positively associated with resilience. After controlling for age and career stage, there was no difference in resilience between males and females. Previous studies of general and veterinary populations have shown higher resilience (or reduced perceived stress) in males.6,9,46,50 Age6,9,46,50 and veterinary career stage17 have also been found to have positive associations with resilience. Veterinarians who are younger and early to midcareer might benefit from additional support to help them develop skills to improve their capacity to recover from stressful situations. Autonomy, work-life balance, fair pay, and other measures of job satisfaction were highly associated with greater resilience; this is consistent with other reports that show these measures are closely aligned with clinician well-being.5–9,11 These factors are generally controlled by organizational leaders, and some veterinarians might have limited ability to influence them. As already mentioned, leaders need to be mindful of the importance of these organizational-level factors when building resilient teams.
This study had several limitations. First, while awareness of the survey was widely distributed throughout the Potomac region, a relatively small number of veterinarians took the time to complete the survey. Dissemination strategies varied between states; response rates seemed to be higher in states where communications were proactively sent to all licensed veterinarians. Additionally, the survey took approximately 30 minutes to complete, which might have limited the number of veterinarians willing to complete the survey. If the veterinarians who completed the survey differed in meaningful ways from other veterinarians in the region, our results would not reflect the general experiences of Potomac region veterinarians. Second, the survey asked about sensitive topics, so responses could have been influenced by social acceptability bias, potentially leading to overreporting of socially acceptable coping strategies and resilience. Lastly, the cross-sectional study design limited our ability to assess the directionality of influence between resilience, certain workplace factors, and coping strategies.
The results of this survey provide a preliminary look at veterinary well-being during COVID-19. Use of a multidisciplinary team to gain a comprehensive understanding of this complex topic was incredibly valuable; this approach is encouraged for future work. More focused and applied research is needed to identify, develop, and test effective organizational interventions. Paraprofessional populations, such as veterinary students and veterinary technicians, experience similar occupational stressors yet are not studied as often as veterinarians and might not have access to or awareness of mental health resources in the same way that veterinarians do. Gaining a better understanding of these paraprofessional groups and the stressors they experience is important. Providing meaningful, evidence-based resources to veterinarians and paraprofessionals will help to support wellness needs of the veterinary profession and help us better provide compassionate care to those who rely on our services.
Supplementary Materials
Supplementary materials are posted online at the journal website: avmajournals.avma.org
Acknowledgments
This study was supported by Cooperative Agreement No. DTNH2215H00494 from the US Department of Transportation, National Highway Traffic Safety Administration (NHTSA), and the Association of Schools and Programs of Public Health (ASPPH). The findings and conclusions of this publication do not necessarily represent the official views of NHTSA or ASPPH. Funding sources did not have any involvement in the study design, data analysis and interpretation, or writing and publication of the manuscript.
The authors declare that there were no conflicts of interest.
The views and information presented are those of the authors and do not represent the official position of the U.S. Army Medical Center of Excellence, the U.S. Army Training and Doctrine Command, or the Departments of Army, Department of Defense, or U.S. Government.
The Potomac Regional Veterinary Challenges, Resilience, and Coping team would like to thank Dr. Cassie Wedd Wagner, Director of Alumni and Referring Practitioner Relations at the Virginia-Maryland College of Veterinary Medicine; the Virginia Veterinary Medical Association; the District of Columbia Veterinary Medical Association; the Virginia Board of Veterinary Medicine; the Maryland Board of Veterinary Medical Examiners; the West Virginia Board of Veterinary Medicine; the District of Columbia Board of Veterinary Medicine; the veterinarians and veterinary students for their assistance with survey development and dissemination; and all of the veterinarians who took the time to complete this survey.
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