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THE publication of suicide mortality data among veterinarians in England and Wales in Veterinary Record eight years ago initiated an ongoing discussion as to why the veterinary profession, which is held in high regard by the wider public, had one of the highest incidences of deaths by suicide of any profession (Mellanby 2005).
Following the publication of this paper, a wide range of studies have been undertaken that aim to better understand the wellbeing and mental health status of UK veterinarians. These studies include two comprehensive systematic reviews, which reported the prevalence of suicide and suicidal behaviour among veterinarians, together with prospective studies examining the incidence of veterinary suicides in other countries (Hawton and others 2011, Platt and others 2010, 2012b). The results of cross-sectional surveys of mental health disorders among UK veterinarians have also been published (Bartram and others 2009b). Other studies have focused on exploring defined mental health risk factors, such as alcohol misuse, among veterinarians (Bartram and others 2009a, Mellanby and others 2009). In addition, a recent study reported the findings of a series of interviews with UK veterinarians who had experienced suicidal behaviour or ideation (Platt and others 2012a). This study explored the contributing factors behind suicidal thoughts or behaviour, coping mechanisms and preventive factors. Importantly, these studies have collectively helped to instigate a range of initiatives that aim to improve the wellbeing of veterinarians and veterinary students (Mellanby and others 2010, Pickles and others 2012, 2013).
Despite this progress, there remain a number of gaps in our understanding of wellbeing and mental health among veterinarians. A particularly important deficit in our understanding is the lack of data on the wellbeing and mental health of UK veterinary undergraduates and whether it changes during progression through the veterinary course.
A paper by Cardwell and others (2013) summarised on p 266 of this issue of Veterinary Record describes an attempt to address this knowledge-gap by undertaking a cross-sectional study of wellbeing and mental health in veterinary undergraduates studying at the Royal Veterinary College (RVC). The decision to undertake the study and then publish the findings, was a courageous and enlightened one. By putting this research into the public domain, the RVC has refused to ignore the inconvenient truths about the difficulties faced by veterinary students. In addition, their findings provide a baseline dataset that will be invaluable when assessing the efficacy of interventions aimed at improving student wellbeing and mental health. Crucially, preliminary, and as yet unpublished, data from other UK veterinary schools indicates that the challenges faced by undergraduates at the RVC are not unique and are likely to be highly representative of the difficulties experienced by veterinary students throughout the UK.
While the RVC study is a very important step forward, follow-up studies are now required to fully understand the data reported. The use of historical control groups will invariably make robust interpretation of data difficult, and a key requirement for future studies will be to include control groups of time- and demographically matched undergraduates from a wide range of other courses. This will allow us to understand whether the challenges faced by veterinary students are unique to their profession or simply a feature of high-achieving students attracted to professional courses. In addition, longitudinal studies are urgently needed to examine wellbeing and mental health in applicants who want to become veterinarians; through to graduation and beyond. This approach will enable the profession to understand how the veterinary curriculum influences wellbeing and how experiences after graduation further modify wellbeing. These approaches will allow the profession to have a much richer understanding of factors that promote good mental health and will provide a strong evidence base on which to develop interventions aimed at enhancing the wellbeing of the veterinary profession.
Finally, I would argue that the greatest collective achievement of the expanding literature in this field is that it will probably help reduce the stigma felt by veterinarians with mental health disorders. Studies such as the one by Cardwell and colleagues (2013) are also important in reducing the sense of isolation typically experienced by people facing mental health challenges. It seems highly appropriate that the veterinary profession has responded to growing evidence of a high incidence of suicide among its membership not only by undertaking scientific studies aimed at developing a deeper understanding of the underlying problems, but also by embracing a compassionate and caring approach to those experiencing mental health difficulties. Hopefully, this combined approach will help to improve the mental health and wellbeing of current and future veterinarians.
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