For years, experts have questioned whether spending time on social media is helpful or hurtful to mental health. I use social media (i.e., Linkedin, Facebook, and Twitter) for my business, to stay engaged with followers, share pertinent information, and form new connections. I also use a personal Facebook account to stay connected with friends and family from across the world. After 15 years of living in 6 different cities in Canada and the USA, it is easiest to post pertinent updates on social media rather than connect with individuals on a regular basis. However, the downsides of social media are becoming more apparent and many of us can relate. Scrolling through social media mindlessly can be a major time suck. I recently installed the app Quality Time on my phone and was disgusted with how many times I checked my phone or spent time on social media during the day. Having this awareness has helped me pare down on social media usage, or at the very least, use my time more efficiently. Social media use also leads to comparison, which can cultivate feelings of envy and depression. It’s no secret that most of us save our best pictures and favorite features for our social media posts, while leaving our dull or downtrodden moments hidden away. This gives others the false sense that our lives are amazing or even glamorous! People frequently say to me “I’m so jealous of your life and all of the travel you get to do”, but that’s because they don’t see the hours spent packing/prepping, sitting in airports, or spending time alone in hotel rooms. Trust me – it’s not glamorous. There is more research coming out to explain the positives and pitfalls of social media use, which will hopefully guide our decisions when it comes to if and how we engage with others online. The Merck Animal Health Veterinary Wellbeing Survey recently shared that veterinarians using social media for > 1 hour per day have poorer mental health and wellbeing as assessed by validated scoring systems. Conversely, other studies investigating social media use among young adults and the general adult population have found conflicting results when it comes to the duration of social media use and mental health. Which is why recent studies have begun to investigate the subtler nuances of how people are engaging on social media and how that impacts wellbeing. For example, a recent study compared active social media use such as messaging a friend or commenting in a group to passive social media use including scrolling through and liking posts. Results from more than 700 adults showed that passive social media use was associated with a 33% increase in depressive symptoms, whereas active social media used was associated with a 15% decrease in depressive symptoms. So, whether you are just sitting and scrolling through posts rather than reading, commenting, and engaging with other users appears to play a big role in the mental health effects.  Rather than try to manage the way in which they use social media, some people have chosen to forego the use of social media altogether. I have several friends and family members who have deleted their Facebook accounts to break free from the time suck / comparison trap of social media, sometimes on the advice of a mental health provider. Studies seem to support this: in Denmark, people who took a week-long break from Facebook had improved life satisfaction and positive emotions in comparison to those who continued using Facebook. These effects were greater for heavy Facebook users and those who used Facebook passively. Perhaps a social media hiatus (or vacation) is something each of us could consider to improve our mental health? I am not opposed to social media and am grateful to have it for the professional and personal uses I stated above. However, I do think the way in which it is used has the biggest impact on our mental health and wellbeing. As such, I would urge anyone using Facebook, Linkedin, and other social media tools to consider the following five strategies to foster active use: Share posts that are meaningful (i.e., pertinent life updates) rather than random food pics or unnecessary rants Engage with others by commenting on their posts or sharing posts that you feel others would benefit from Send messages to friends and loved ones to maintain connections with people in distant time zones whom you cannot readily call Search for local events to attend in person and invite others to join you for face-to-face connection time   Find, create, or join closed groups where you can engage with other like-minded individuals in a meaningful way Finally, if you have not done the exercise of logging your phone or social media app time, I urge you to become aware of your usage by installing a time monitoring app such as Quality Time, Offtime, or Moment. Awareness is the first step in realizing that a change is needed to foster health and wellbeing. Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals. Starting in 2019, Marie will be offering personalized wellness sessions to those who work in the veterinary profession.  To sign up for newsletters containing information regarding these sessions, please click here. More information about Marie and her other offerings can be found at www.criticalcarevet.ca.        

As an advocate for health and wellbeing among veterinary care providers, I often lecture and blog about the importance of sleep hygiene. (Hint: this has nothing to do with the cleanliness of your bed sheets, but everything to do with the activities you do to help fall asleep each night.)  Among my top recommendations for improving sleep hygiene: turn off technology 1-2 hours before bedtime in an effort to reduce exposure to blue light (suppresses melatonin release); spend 20-30 minutes outside every day to help regulate the circadian rhythm (sleep-wake cycle); exercise for 30 minutes each day (to help the body feel ready for rest by the time bedtime rolls around); and establish a bedtime routine that you perform every night (to help the mind and body know that it is time to wind down and relax in preparation for sleep). I am constantly researching and learning new things about sleep hygiene and, as a veterinarian and pet owner, I have often wondered: do people who struggle with their sleep have pets in their bedroom that keep them up at night? I am clearly not the only person to question this, as researchers at the Center for Sleep Medicine at the Mayo Clinic in Arizona began to investigate sleep struggles among pet owners in 2015. Researchers surveyed 150 consecutive human patients with sleep disorders by questionnaire or interview and found that 49% were pet owners and 41% of pet owners had multiple pets. More than half of those pet owners (56%) allowed their pets to sleep in the bedroom. Interestingly, 20% described their pets as “disruptive”, whereas 41% perceived their pets as “unobtrusive or even beneficial to sleep”. I happen to agree with the latter of the two groups: my Standard Poodle “Faith” slept with me every night, on my bed until her arthritis got worse and she preferred to sleep on her bed on the floor of my bedroom. After she passed away, her presence in the room was missed and my sleep felt very disrupted – much more so than when she was alive and sharing the bedroom with me! So, how does the presence of pets in the bedroom affect people who don’t have sleep disorders? A recent study performed by the Mayo Clinic helped to answer this question. Between August and December 2015, researchers evaluated the sleep of people and dogs sleeping in the same bedroom to determine the impact on sleep. There were 40 healthy adults (without sleep disorders) and their dogs (no puppies < 6 months old). Adults and dogs wore accelerometers, which are devices that track movement and can gauge sleep quality. The study participants were 88% women (average 44 years old) and the dogs were an average of 15 kg and 5 years old. Human and canine participants wore the accelerometers for 7 nights during which time sleep efficiency was calculated. Sleep efficiency is essentially the amount of time spent asleep as a percentage of the amount of time spent in bed and includes the time between going to bed and falling asleep, middle-of-the-night awakenings, and waking up earlier than an alarm. A normal sleep efficiency for adults is > 85% and anything > 90% is considered very good. So, if you go to bed at 11 PM and fall asleep within 30 minutes, wake up once to pee, and then fall back asleep within 30 minutes until your alarm goes off at 7 AM, you have a normal sleep efficiency.     The human participants in the Mayo Clinic study spent an average of 7.9 hours in bed, while sleeping for 6.7 hours: the equivalent of an 81% sleep efficiency. During the human’s corresponding sleep time, dogs spent an average of 6.9 hours sleeping, 1 hour active, and 2 minutes playing (no doubt at the most inopportune time ). The dogs had an average sleep efficiency of 85%. Perhaps the most interesting finding from this study is that the sleep efficiency of the human participants was lower if their dog slept on the bed, as opposed to if the dog was simply in the room. Which makes sense, as middle-of-the-night awakenings and difficulty falling asleep are often caused by partners, pets, or children coming into or out of the bed through the night. So, while people with a single dog in their bedroom can maintain good sleep efficiency, the dog’s position on or off the bed seems to make a difference. As such, as much as it can be nice to snuggle with your dog before and after falling asleep, if sleep is a struggle for you, perhaps this sleeping arrangement might need to be modified. Finally, I have yet to find a study investigating the consequences of having a cat in the bedroom that lays on your head, purrs loudly in your ear, or makes biscuits on your back at all hours of the night…but I would venture to say that if your cat is keeping you up at night (and reducing your sleep efficiency) that it would be best to keep him or her out of the bedroom! Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals. Starting in 2019, Marie will be offering personalized wellness sessions to those who work in the veterinary profession.  To sign up for newsletters containing information regarding these sessions, please click here. More information about Marie and her other offerings can be found at www.criticalcarevet.ca.        

I was a bit taken aback a few weeks ago when I received a comment on one of my blogs accusing me of “discriminating against male veterinarians”. Having not been accused of sexism before and considering myself a “lover of all beings”, I was confused and concerned by this claim. After engaging in a “virtual” conversation with the individual, I discovered that he felt that my blogs focused more on struggles felt by women compared to men, and he wanted me to be sure to know that male veterinarians are struggling just the same. Of course, I apologized for my oversight and scanned through my last year of bi-weekly blogs to see if this was indeed the case. While I cannot say that I agree with his claim, I admit that I can only really speak to my perspective and experience, which is that of a female veterinarian. That said, it got me thinking…are men really struggling as much as women in the veterinary profession? When you consider the research investigating mental health among adults, there are some notable sex-related differences. According to the World Health Organization, overall rates of psychiatric disorder are almost identical for men and women; however, prominent gender differences are found in the patterns of mental illness. These differences occur particularly in the rates of common mental disorders such as depression and anxiety. Women are particularly susceptible to these disorders, which affect approximately 1 in 3 people. Unipolar depression, predicted to be the second leading cause of global disability burden by 2020, is twice as common in women. On the other hand, alcohol dependence, another common disorder, is more than twice as likely to affect men compared to women. In developed countries, approximately 1 in 5 men and 1 in 12 women develop alcohol dependence during their lives. But what about the stats when it comes to veterinarians in particular? While studies consistently describe moderate levels of stress reported equally by male and female veterinarians, those same studies suggest that female vets are more likely to report burnout compared to male vets. Likewise, several studies investigating the mental health of veterinarians suggest that women are more likely to report psychological distress and depression than men. But do these findings mean that women are struggling more with their mental health? Or are they simply a reflection of women’s willingness to disclose their struggles more than men? I think there are probably a lot of men out there who would rather not admit they are struggling, especially given the stigma that veterinarians have around mental health. In the UK, male veterinarians are 3 times more likely and female veterinarians 4-6 times more likely than the general population to die by suicide. But is that to say that female veterinarians are suffering more than men or rather that women in veterinary medicine are proportionately more likely than women in other professions to die by suicide? I don’t have the answers to these questions, but it is grounds for an interesting discussion. Recently, the Merck Animal Health Veterinary Wellbeing Study published findings from more than 3,500 survey responses from veterinarians working in the USA. The study measured wellbeing with an index based on three standard questions that were scored on a scale of 0 to 10. Veterinarians were then allocated to three categories: flourishing (scores of 7-10), getting by (scores of 4-6), and suffering (scores of 0-3). On average, male vets scored higher in wellbeing than female vets. Interestingly, vets who were married or in a relationship (not single) and working in food animal (not other veterinary practice) had higher wellbeing scores, and (I’m generalizing here) I know more male than female veterinarians who fall into these categories. So, is it gender or other factors that determine a veterinarian’s wellbeing? While these statistics suggest that perhaps female veterinarians really do struggle more with their mental health and wellbeing compared to male vets, I acknowledge it is not cut and dry. In other words, just because you are a woman in veterinary medicine does not mean you will have mental health problems, and just because you are a man in veterinary medicine does not mean you will have it easier when it comes to your mental health and wellbeing. There are clearly many factors at play. The Merck Animal Health study found that participating in healthy activities not related to work such as traveling, reading for pleasure, spending time with family, socializing with friends, having a hobby, exercising regularly, and being in a relationship, were strongly associated with higher levels of wellbeing. So, while the research is ongoing when it comes to veterinarian mental health, in the meantime, regardless of sex, we can all benefit from spending more time partaking in activities unrelated to veterinary medicine. Ukulele lessons, here I come! Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals. Starting in 2019, Marie will be offering personalized wellness sessions to those who work in the veterinary profession.  To sign up for newsletters containing information regarding these sessions, please click here. More information about Marie and her other offerings can be found at www.criticalcarevet.ca.        

Most veterinarians and a growing percentage of the public are aware of the startling statistics previously reported regarding suicide in the veterinary profession. With media sharing news of veterinarians dying by suicide every month, it might not be surprising to hear claims that veterinarians are between 2 and 4 times more likely than members of the general population to have thoughts of or die by suicide. Some studies even suggest that rates of suicide among veterinarians are higher than those of other professions such as dentist or doctors who have been known to die by suicide at alarmingly high rates.     An Executive Report published recently in the Journal of the American Veterinary Medical Association shared the results of the Merck Animal Health Veterinary Wellbeing Study. The authors of the study wanted to survey a large group of veterinarians by way of random sampling to gauge the prevalence of serious mental distress and suicidal ideation among American veterinarians. This contrasts with a previously published and widely publicized Center for Disease Control (CDC) study that was based on voluntary responses to a survey published online.  The survey recipients in the Merck Animal Health Veterinary Wellbeing Study were chosen from a random sample of 20,000 email addresses obtained from the American Veterinary Medical Association’s database of currently working US veterinarians. More than 3,500 usable survey responses were obtained and were statistically assessed to ensure they represented the currently working US veterinarian population. Results from the veterinary respondents were then compared to adult respondents in the National Epidemiology Survey and Alcohol and Related Conditions (NESARC). What did the survey responses reveal about suicide among veterinarians? When presented with a list of issues and asked to indicate how important each one was to the veterinary profession, 52% of veterinarians responding to the Merck Animal Health Survey considered the suicide rate among veterinarians to be critically important. Among all veterinarians responding, 25% said that “at some time in their life, when their mood was at its lowest or they cared the least about things, they had thought about suicide”. As well, 1.6% of respondents reported that they had previously attempted suicide, comparable to the rate reported by the CDC study in 2015. However, when this rate is compared to the NESARC study, it appears that the rate of attempts of suicide among veterinarians is, in fact, lower than that of the adult population (5.1%).  Why do the results contradict what veterinary studies have shown previously? Until this study was published, there was no previous definitive assessment of the prevalence of serious mental health issues among veterinarians. Previously published studies including the CDC study were completed based on voluntary responses to a public domain survey, which could have produced biased responses. In other words, veterinarians with an interest in mental health, perhaps struggling with their own mental health, or with an invested concern regarding suicide due to their own personal experiences, might have been more likely to respond. Any time a survey is completed on a volunteer basis, rather than by random sampling as in the Merck Animal Health Survey, there is a risk of bias in who will respond. Because the Merck Animal Health Survey selected veterinarians randomly from a database of emails and assessed the respondent demographics, they were able to ensure that the respondents represented the currently working US veterinary population.  Is suicide not the crisis it has been made out to be in among veterinarians?  Unfortunately, the Merck Animal Health Veterinary Wellbeing Survey did not provide the type of data needed to calculate the incidence of suicide among veterinarians, despite collecting data on suicidal ideation and attempts of suicide. So, we are still missing current information as to the incidence of North American veterinarians dying by suicide. While this has been assessed in studies in the UK published decades ago, both recent US studies fail to capture this statistic, given that those dying by suicide are not included in the responses garnered by the surveys. What is next when it comes to wellbeing in veterinary medicine? One thing remains clear. While suicide attempts might by lower among veterinarians than the general population, the Merck Animal Health study confirms that veterinary medicine is a stressful profession. Even veterinarians who are mentally healthy and exhibit high levels of wellbeing experience mental health concerns (i.e., depression, anxiety), compassion fatigue, and/or burnout with some regularity.  So, let’s keep the momentum going around initiatives to enhance veterinarian mental health and wellbeing, so that we can ensure that these statistics improve the next time such a survey is completed! If you or someone you know are experiencing thoughts of suicide, please visit www.yourlifecounts.org/need-help/crisis-lines for a number to call in your area.   Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals. Starting in 2019, Marie will be offering personalized wellness sessions to those who work in the veterinary profession.  To sign up for newsletters containing information regarding these sessions, please click here. More information about Marie and her other offerings can be found at www.criticalcarevet.ca.        

Work-related stress is a huge contributor to cynicism, exhaustion, and feeling ineffective…and if you didn’t know this already, these are classic signs of burnout.  Stress in the workplace has also been associated with depression and suicide among men and women, which makes recognizing stressors in veterinary practice imperative in the task to improve veterinarian mental health and wellbeing.    A survey conducted in 2015 in conjunction with the Center for Disease Control sought to evaluate practice-related stressors among more than 11,000 veterinarians practicing in the United States.  Participants were provided with a list of practice-related stressors, as well as an option to write others that were not listed.  The 14 practice-related stressors included in the survey were: demands of practice; practice management responsibilities; professional mistakes; clients complaints; dealing with personal, staff, or client grief; expectations from clients to be an expert in all veterinary subject areas; animal deaths; competition with other practices; ethical dilemmas; fear of malpractice litigation; student loan debt; lack of social support; unclear management / work role; and an inability to participate in decisions.  The first in this list (demands of practice) was by far the most prevalent practice-related stressor selected (by more than 60% of veterinarians) and the remainder are listed in descending order from most to least cited by those surveyed.  However, more than 1,500 participants reported that at least one of their practice-related stressors was not included in the list and they subsequently shared their own response.  A recent study analyzed these written responses and published the results in a report outlining a comprehensive list of veterinary practice-related stressors cited by veterinarians currently working in the profession.  While the results of this analysis might seem like just another exhaustive list of what’s wrong with veterinary practice, the hope is that this list will serve as standardized nomenclature so that we can better understand the relationship between practice-related stressors and symptoms of depression, suicidal tendencies, and psychological distress among veterinarians with future studies.  The authors included 15 categories of veterinary practice-related stressors, as well as subcategories and illustrative quotations from participants that were used to provide specific examples. I am certain that when you read these categories and subcategories you will have no trouble coming up with your own specific examples.  They are listed in order from most to least frequent category (subcategory) here: 1. Financial insecurity (low income, cost of maintaining practice, low return on investment, debt, job outlook, retirement)2. Clients (unwilling or unable to pay, unrealistic expectations for treatment, lack of compliance or responsibility for pet, expectations of availability)3. Co-worker or interpersonal issues (lack of support, work environment, abusive or bullying coworkers, unethical practices)4. Work-life balance (being on call) 5. Management issues (lack of support or guidance, abusive or bullying management) 6. Job pressure (too many responsibilities, fear of mistakes or failure, surgery, complexity) 7. Private or public sector (government or state board policies, competition, ethics, access to drugs) 8. Training or staffing (low-skilled staff or lack of training, understaffing) 9. Feelings of inadequacy (knowing how to help but can’t, underappreciated or lack of respect, not knowing how to help, gender bias) 10.  Personal issues (family, illness, boredom or lack of job fit) 11.  Future of the profession (shift of focus to profit, technology or method of advancement) 12.  Stress from animals (compassion fatigue or grief, suffering or owner mistreatment) 13.  Negative public perception (social media and internet) 14.  High personal expectations 15.  Academia   When I look at this list and reflect on my experiences working in private referral and academic practice as an emergency and critical care specialist, I can think of stressful moments that fall within each one of these categories.  Low income (in comparison to human health providers); clients who treat veterinarians in ways they would never dream of treating their physician; working in a toxic environment; spending evenings and weekends on call; feeling unappreciated by administration or management; jumping through hoops to become licensed in different jurisdictions; working with poorly trained support staff; feeling unqualified to provide mental health support; feeling like I do not fit in with the team; worrying about the future of emergency medicine and how hospitals will retain sufficient staff; struggling with cases that require more advanced care that the owners cannot afford; feeling misunderstood by the public (i.e., veterinarians only care about money); believing I must remain up-to-date on all things emergency / critical care; and worrying about meeting benchmarks needed for promotion and tenure.  Veterinarians are not unique in that they have work-related stressors; however, their work-related stressors are unique in that they do not exist in other professions.  Recognizing and naming these stressors is important in taking the next step, which is to determine how these stressors specifically contribute to the mental health and psychological well-being of veterinary team members.  Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals.  Starting in 2019, Marie will be offering personalized wellness sessions to those who work in the veterinary profession.  To sign up for newsletters containing information regarding these sessions, please click here.  More information about Marie and her other offerings can be found at www.criticalcarevet.ca.