Human development specialist teams up with veterinary college to create mental health screening tool for veterinarians
December 12, 2019
Breathing noisily, a 14-year-old dog stood in the corner of an examination room at the Virginia-Maryland College of Veterinary Medicine’s Veterinary Teaching Hospital.
The dog’s owner, motionless in a chair against the wall, wept openly. Crouched before her, a resident looked directly into her eyes. “You’ve made the right decision,” he said gently. A veterinary student standing by the examination table lowered his head in agreement.
At that moment, the dog approached and licked his owner’s hand. The resident rose and backed away to give them space. The owner rested her forehead on the dog’s head and caressed his sides. A few quiet minutes passed.
Then, with great care, the resident led the dog out of the room, followed by the student.
In human medicine, when a patient is facing death, a chaplain might be brought in and a social worker called to guide the grieving, bewildered family. Likewise, pet owners facing health care decisions for their beloved companions need direction, compassion, and support — as do the caregivers themselves.
In veterinary medicine, ever-intensifying stress and compassion fatigue among practitioners handling case after case have begun to take a heightened toll on clinicians. Within this climate of hard work, suffering and pain, fatigue and despair, veterinary wellness burst into the public consciousness and became an issue of national significance, especially at teaching hospitals.
Responding proactively to a growing body of research and a culturally evolving willingness to acknowledge the need to care for one’s physical and mental health issues, Virginia Tech’s veterinary college has followed in footsteps laid by successful programs at the University of Tennessee, Knoxville — which established the country’s first program in 2002 — North Carolina State University, and The Ohio State University: A veterinary social work program is available to support not only pet owners considering treatment options and navigating end-of-life care for their pets, but also the clinicians who daily encounter health crises and profound grief.
In light of the wide-ranging demands of their work, veterinarians are squarely at risk to experience intense stress, a dangerous situation that, borne out by recent research, has attracted much-deserved attention, followed by an array of restorative mental health resources aimed at reversing the tide.
Five years ago, the Centers for Disease Control and Prevention released the results of the first-ever mental health survey of U.S. veterinarians, which was conducted by researchers with the National Association of State Public Health Veterinarians, Auburn University, and the CDC.
According to an article in the Journal of the American Veterinary Medical Association, respondents were “more likely to suffer from psychiatric disorders, experience bouts of depression, and have suicidal thoughts compared with the U.S. adult population.” In addition, the data suggested that “nearly one in 10 U.S. veterinarians might experience serious psychological distress, and more than one in six might have contemplated suicide since graduation.”
In early September, another study published in JAVMA, “Suicides and deaths of undetermined intent among veterinary professionals from 2003 through 2014,” revealed that male and female veterinarians, in comparison to the general population, were 1.6 times more likely and 2.4 times more likely, respectively, to complete suicide.
In response to such disturbing findings, efforts are already in place at Virginia Tech to both assess mental health needs and forge solutions to ensure the well-being of the campus community.
Among those efforts is a partnership with Jody Russon, an assistant professor in the Department of Human Development and Family Science in the College of Liberal Arts and Human Sciences.
“Veterinarians are more than two times as likely to die by suicide than the general public,” said Russon, a suicidologist who focuses on factors that contribute to suicide and on prevention and intervention practices that should be deployed to address suicidality. The daughter of two veterinarians, Russon points out that a range of realities potentially contributes to this unpleasant statistic, the most significant of which may be that veterinary medicine is the only profession that euthanizes its patients.
As the principal investigator on a research project, “Addressing Suicidality among Veterinary Students,” funded by a seed grant from the Advancing Transdisciplinary Communities in Rural Health Research initiative at Virginia Tech, Russon set out to determine how to best implement a suicide and mental health screening tool into the context of the veterinary college as a means to mitigate suicide.
“The whole goal of this study,” she said, “was to determine if a suicide screening tool would be feasible and acceptable and to identify what barriers might prevent putting such a tool into place, one that could catch suicide ideation early and then allow triage in an effective way.”
Self-identifying as a “community-engaged researcher” who “cannot be an outsider,” Russon enlisted three co-investigators based at the veterinary college: Terry Swecker, director of the Veterinary Teaching Hospital; Jenni Zambriski, an assistant professor of epidemiology in the Department of Population Health Sciences; and Kathy Hosig, an associate professor in the Department of Population Health Sciences and director of the Virginia Tech Center of Public Health Practice and Research.
“The first thing we did was engage a transdisciplinary advisory board that included organized veterinary medicine, practicing veterinarians, research veterinarians, and public health specialists to help us design the way we would conduct this research and design the actual questions in order to receive more responses,” Russon said.
The ensuing step involved preliminary research, interviews, and focus groups with students, house officers, staff, practicing veterinarians, and administrators to explore wellness and health needs as expressed by the veterinary college community.
Using mixed methods, several quantitative questions were asked first, for example, “What is your comfortability asking about suicide? If you were struggling, would you seek help?” These questions were followed by several qualitative questions: “Talk about the stressors at the veterinary college. If there were a screening tool put into place, would you like that?”
Russon noted that the results returned multiple themes, including the frequent mention of programming already in place at the college, such as wellness courses, yoga, and stress-management activities.
“Across veterinary medicine in general, and specifically at the veterinary college,” she explained, “there has been a recurring focus on addressing stress and addressing nutrition, but nothing fully focused on mental health, suicide, and direct prevention strategies.”
Just as Russon had anticipated, an even stronger theme surfaced, one that could be considered a barrier to implementing a screening process.
“Because no one is immune to the stigma of mental illness, one of the core themes we detected in our qualitative interviews was this concept of mental toughness,” Russon said. “If we show vulnerability, our struggles, we may be perceived as being too weak or not having the grit to succeed in this intense profession. Or, we would perceive ourselves as not having the grit to deal with this difficult profession.”
Beyond potentially undermining the successful deployment of a screening tool, this prevailing attitude may already destabilize the effectiveness of the college’s use of QPR training with incoming students.
“Students put on a front,” Russon said. “They save face, which undermines the identification of their struggles.”
In response to this deep-seated culture of mental toughness, Russon’s most significant recommendation is that screening should be conducted by the veterinary college’s social worker and kept confidential. She also advised that faculty and staff be called upon to collectively normalize the screening tool among students in an effort to offset the stigma.
“Although we cannot force everyone to complete the screening tool,” she said, “we can create a culture in which it is acceptable to complete this wellness screening.”
Along with the strong themes that surfaced, Russon was pleased that the majority of the interviewees revealed positive perceptions.
“Students, faculty, staff, and administrators were overwhelmingly excited about and accepting towards this kind of intervention and screening tool,” she said. Put plainly, most respondents said that the tool was important and a good idea.
Having presented these preliminary results to the veterinary college in early November, Russon said that the next course of action is to secure funding to implement the screening tool at the college.
“The tool under consideration is very comprehensive,” she said. “It asks about nutrition, sleep, depression, anxiety, suicidality, relationships, safety behaviors, access to means, and a variety of different considerations.”
Following the tool’s implementation and testing, the research team will then determine if the tool promotes help-seeking behavior or reduces the amount of mental health distress during the course of the year. If successful, the tool will be expanded and disseminated to other veterinary colleges that may be interested.
“Suicidality often occurs later in one’s veterinary career,” Russon said, “so the idea is that early intervention is essential. If we teach people that it is acceptable to struggle and receive help, that they can be helped in an effective and confidential way, then maybe different strategies will be used later in life.”
Excerpted from a longer article written by Juliet Crichton and Sarah Boudreau, a student in the MFA program in creative writing in the Department of English