Compassion
Fatigue
Feature | Opinion
When Caring Hurts: Dealing with Depression in Veterinary Medicine

When Caring Hurts: Dealing with Depression in Veterinary Medicine

Depression is one of the most common mental health disorders in the United States.1 Although the cause is not known, research suggests that depression develops from a combination of physiologic, genetic, environmental, and biologic factors.

What makes depression so prevalent in the veterinary community? According to an AVMA study,2 1 in 6 veterinarians have considered suicide since graduation. This study did not involve support staff but surveyed more than 10,000 practicing veterinarians.

The study found that 6.8% of male veterinarians and 10.9% of female veterinarians have serious psychologic distress, compared with 3.5% of adult men and 4.4% of adult women who do not work in the veterinary community. The study also showed that 24.5% of male and 36.7% of female veterinarians have experienced depressive episodes since graduation, which is approximately 1.5 times the prevalence in US adults. The study suggested that veterinarians are 3 times more likely than the US national mean to consider suicide, and that 1% to 1.5% of veterinarians have attempted suicide since graduation. The results are similar to those from mental health surveys of veterinarians in other countries, including Australia, New Zealand, and the United Kingdom, thus suggesting that depression in the veterinary community is a global epidemic.

Stress and Depression

Veterinary technicians know that workplace stress is not limited to veterinarians. Burnout is cited in the NAVTA 2016 Demographics Survey as one of the top 6 most significant problems that credentialed veterinary technicians face.3 Those of us who work in this field are likely to become stressed and overwhelmed owing to the volume and nature of the work. It often feels like the world is on our shoulders—no time to rest, eat, or use the bathroom; constantly ringing phones; very ill pets; very upset and high-strung owners; and what seems like little appreciation and support from owners, coworkers, family members, and friends. We have often had to cancel plans in our personal life to take care of a sick animal, thus leading to resentment of those things we once cared for so highly: animals, their well-being, their family, and the field of veterinary medicine. The lines of work–life balance are often blurred, and the stress from the workday, workweek, work month, or even work year is taken home with us. Busy, stressful days can lead to bad eating and sleeping habits, thus leaving staff feeling overtired, overworked, and underappreciated.

Chronic stress can lead to other conditions,1 such as depression, anxiety, other psychiatric disorders, musculoskeletal disorders, insomnia, cognitive impairment (inability to remember), substance abuse, employee absenteeism, and work errors. If we are not taking care of ourselves, how can we take care of others? If we are constantly putting our physical and emotional health on the back burner, how can we ensure that we will be around to care for our patients as deeply as we once did? If we cannot care for ourselves, how can we be sure we are giving 100% to our patients? If we cannot take care of each other as a community, who will?

Feelings of depression can easily be brushed aside as resulting from the nature of our work. “It’s just compassion fatigue,” or, “I know, I’m burnt out, too,” are statements that can make someone believe that it is normal to feel overwhelmed and empty. The “nature” of a job does not have to, and should not, make someone feel as if they are constantly empty, lost, saddened, angry, unhappy, overwhelmed, anxious, or afraid. We should not feel like we are burdened by the weight of the world sitting on our shoulders. We will have days when we are unhappy and sad or when it feels like nothing is going right, but chronicity is the important factor. Constantly taking work home (physically and emotionally) or being unable to enjoy life at home or outside of work because of experiences at work is a sign that the issue may be more serious. What is termed “compassion fatigue” or “burnout” can actually be depression (TABLE 1).

TABLE 1 Know the Difference: Burnout, Compassion Fatigue, or Depression4

Burnout Compassion Fatigue Depression
Definition
  • Emotional exhaustion associated with the work environment
  • Not related to trauma
  • Slower onset than compassion fatigue
  • Created by trauma of helping others in distress, leading to reduced capacity for empathy
  • Can be due to exposure on one case or a “cumulative” level of trauma
  • More rapid onset than burnout
  • A serious medical condition in which a person feels very sad, hopeless, and unimportant and often is unable to live in a normal way
  • A psychoneurotic or psychotic disorder marked especially by sadness, feelings of dejection, hopelessness, and sometimes suicidal tendencies5
Associated Feelings
  • Overloaded
  • Exhaustion
  • Tiredness
  • Lack of energy
  • Pessimism
  • Cynical attitude toward work and colleagues
  • Intrusive, negative thoughts
  • Hopelessness
  • Guilt
  • Detachment
  • Traumatic memories
  • Decreased empathy
  • Sadness
  • Emptiness
  • Irritability
  • Frustration
  • Anxiety
  • Agitation
  • Worthlessness
  • Guilt
Signs
  • Distancing oneself emotionally
  • Inability to concentrate
  • Lacking creativity
  • Avoiding stressful situations
  • Isolation
  • Decreased empathy
  • Angry outbursts
  • Loss of interest in normal activities one once enjoyed
  • Change in sleep patterns (insomnia or sleepiness)
  • Changes in appetite (increased or decreased)
  • Excessive worrying
  • Inability to sit still and/or concentrate
  • Memory loss
  • Frequent thoughts of death or suicide
Treatment
  • Usually can be treated with a change of environment
  • Does not change with time off from work, because symptoms will return
  • Requires psychotherapy/changing field or type of work to decrease exposure to trauma
  • Psychotherapy
  • Medication (antidepressants, mood stabilizers, antianxiolytics, antipsychotics)

 

Signs of depression include feelings of sadness, hopelessness, and worthlessness; low energy; inability to concentrate; irritability, anger, and hostility; loss of interest in once-loved activities; changes in appetite and sleep patterns; thoughts of harming oneself and/or others; reckless behavior (including substance abuse, promiscuity, speeding, and gambling); and feeling like a burden to others.1 Talk or plans of suicide and complete behavior changes (for instance, someone who was always a pessimist suddenly becoming a very happy optimist and vice versa) are major warning signs and should not be taken lightly or brushed aside.

Recommendations for Those Struggling

Many resources are available if you think you are struggling with burnout or something of a more serious nature. Your feelings about yourself, your skills, employer, and job should not be swept aside. The job description of a veterinary technician encompasses a variety of roles that can be overwhelming. We may be veterinary technicians, laboratory technicians, radiology technicians, pharmacy technicians, customer care representatives, grief counselors, and other support staff, but wearing many different hats throughout the day can be daunting to those who are overworked and feel unappreciated. Many technicians complain about the lack of pay for the number of skills we possess, but the truth is, with depression, $1000 an hour will not help fill the void of feeling empty, alone, and hopeless. BOX 1 lists some simple measures to help you take care of yourself, mentally and physically, but treatment of true depression often requires external help (TABLE 1). If you recognize the signs of depression in yourself, remember that professional assistance exists to help you, and don’t be afraid or embarrassed to seek it.

BOX 1 Self-Help Tips for Coping with Depression6

  • Reach out. There is a tendency to isolate yourself if you feel shameful and like a burden. Reaching out is not a sign of weakness. Keeping in touch with people, especially face-to-face (e.g., with friends, family, teachers, coworkers, clergy members) and engaging in activities that you used to enjoy (even though you feel you no longer enjoy them) can be helpful. Caring for a pet can get you outside and give you a sense of well-being.
  • Exercise can fight depression. Aim for 10 to 30 minutes of exercise per day, whether it’s walking your dog, doing yoga at home, swimming, walking, dancing, or even cleaningExercise can fight depression. Aim for 10 to 30 minutes of exercise per day, whether it’s walking your dog, doing yoga at home, swimming, walking, dancing, or even cleaning.
  • Push yourself. Pick up a hobby or sport that you used to enjoy. Binge-watch a TV show you used to love or a dive back into a book series you always used to read. Write down your feelings, or turn them into poetry or music. Play, or learn to play, an instrument. Go to a baseball game or a museum.
  • Get on a sleep schedule. Change the environment in which you sleep; lighten up the room during the day and darken it at night. Avoid increased stimulation (TV, computer, cellphone, etc.) for at least an hour before bedtime.
  • Get some sunlight. Take a short walk outside, enjoy your coffee on the deck, have a picnic at the park, or plant a garden that you need to water.
  • Relaxation can help relieve stress. Yoga, deep breathing, a hot bath, progressive muscle relaxation, or a massage can be beneficial.
  • Eat better. Try to avoid alcohol and caffeine. Don’t skip meals or go too long without eating. Aim for eating a snack or meal every 3 to 4 hours. Minimize sugar intake to decrease a crash in your mood and energy.

 

Recommendations for Those You Think May Be Struggling

People are often afraid to approach a coworker about depression or suicide out of fear of being embarrassed and creating an uncomfortable situation both short and long term. However, if you feel uncomfortable approaching someone whom you are worried about, just imagine how uncomfortable it is for the person who is suffering from depression.

Approaching a coworker or friend and asking how he/she is doing can make a significant difference because people suffering from depression often feel unrecognized. Keeping the number of a suicide hotline nearby is helpful in case someone confides that he/she is having those types of thoughts. If they won’t make the call themselves, you can call to seek guidance. Assuring those who are suffering that things can, and will, change and making plans for the next day so they have a reason to hang on for one more day can make a world of a difference. The first step is always the hardest, but it will make the most difference and can potentially save a life.

Recommendations for Employers

Because of the prevalence of depression and suicidal tendencies in veterinary medicine, it is recommended that employers offer anonymous support to their staff.7 A grief counselor, even to discuss work-related issues/losses, or an employee assistance program that employees can call to make personal, confidential appointments to vent about work or their personal life, can be beneficial. General awareness materials regarding depression and other mental illnesses should be made available to all staff.

It is also encouraged that the staff have fun as a team outside of work. Often, we see our coworkers when they are stressed, and it may be nice to interact in a less stressful environment, where you are unlikely to get interrupted and don’t have to deal with unruly clients and patients or ringing phones. Attend an event together, management included, outside of work, even if you are representing the hospital. Doing this may seem awkward at first, but it provides a more comfortable environment to discuss situations and feelings, promotes team-building, and helps foster trust throughout the team.

The best way to create mental health awareness and ensure that employees are taking care of themselves is to not ignore the problem. Mental health issues should be talked about and discussed openly in one-on-one conversations and as a group, and resources should be provided to all employees. This may help reduce employee turnover and treatment mistakes/oversights, increase employee compliance with company rules, and even improve client satisfaction. Making sure your staff is taken care of will increase overall happiness in the hospital. Creating an open-door policy and providing an understanding and compassionate work environment, not just for pets but also for employees, may help lessen the emotional load for some employees.

Some things to consider:

  • Breaks are important. Make sure employees are taking breaks as they need, and encourage employees to “step out” for a few minutes if they are overwhelmed. It may throw a wrench in the day, but it will help make future hours and days more productive. Make sure you are staffed appropriately to cover uninterrupted breaks, even if your state sets no legal guidelines regarding breaks and hours worked. Remind employees that breaks are important, and offer appropriate vacation time to reduce burnout.
  • Debrief. After a stressful situation goes awry—for example, a cardiopulmonary–cerebral resuscitation fails—encourage employees to take a minute to clear their heads and sort out their thoughts and feelings. Then discuss, as a team, the strengths and weaknesses of the teamwork. Acknowledge the strengths of each employee, but refrain from singling out those who need to improve. Use these situations as an opportunity to improve the quality of care your patients receive, and offer encouraging words. Building self-confidence in your employees not only benefits them personally, but also helps them perform better in future situations.
  • Encourage learning. A day-to-day routine can make employees feel bored. Offer a set time once a week or month to present a case study or discuss a disease, journal article, or new product to encourage employees to keep their brains active and keep them eager to learn and work. Being able to apply what they have learned to real-life situations will make their day interesting and boost their self-confidence, as well as increase the care your patients receive. Doing so may make employees feel like they have purpose, and it may give some employees something to look forward to.
  • Make resources easily available. Hotline business cards, magnets, and brochures can allow employees to keep matters confidential and less awkward. Offer employee assistance programs and put the information on how to get in touch with the coordinator in easily accessible areas, such as the employee break room or by the time clock.
  • Show that you appreciate your employees. Everyone in the veterinary community is at risk of developing burnout, compassion fatigue, and depression. It does not know any boundaries. A simple “thank you” at the end of the day or incentives will help employees feel appreciated and taken care of. Our job is stressful but should also be worth it. Employees need to feel they make a difference in order to know their worth.

There is no question whether depression is on the rise in veterinary medicine. The only way to combat it is by working as a team and supporting each other. Depression knows no limits, and we should all take care of ourselves and each other. The field of veterinary medicine can only be as great as the people in it.

SIDEBAR NAVTA 2016 Demographic Survey Reveals Compassion Fatigue Is 2nd Largest Factor Negatively Affecting the Veterinary Technician Profession

by Heather Prendergast, RVT, CVPM, SPHR

Compassion fatigue is not a new topic in veterinary medicine; it has been presented at conferences and in books and journals. What is difficult, however, is to admit when we are suffering from compassion fatigue. In May of last year, the National Association of Veterinary Technicians in America (NAVTA) released its 2016 Demographics Survey results. The survey was distributed to veterinary professionals and paraprofessionals nationwide; both NAVTA members and nonmembers were asked to complete the survey, and nearly 2800 responses were submitted.

Respondents were asked to rank factors that would negatively affect their job as a veterinary paraprofessional in the next 5 years. Fifty-four percent of respondents felt low salary and benefits were a factor, 41% felt compassion fatigue was a factor, and 39% felt the economy would negatively affect their jobs. Veterinary owners and managers have the ability to positively influence compassion fatigue, salary, and benefits, whereas the economy is beyond our control.

The survey also asked respondents if their practice discussed compassion fatigue with the team. Seventy percent indicated yes, the effect of compassion fatigue was discussed occasionally; however, only 23% of practices offer support for those experiencing compassion fatigue. Further, 1.8% of respondents indicated they have had a coworker commit suicide because of compassion fatigue, and only 3% of those received any grief counseling from the practice.1

Compassion fatigue is not a new topic in veterinary medicine; it has been presented at conferences and in books and journals. What is difficult, however, is to admit when we are suffering from compassion fatigue.

Experts agree that the more you know about compassion fatigue, the better prepared you are to recognize and cope with its effects. Compassion is defined as “a deep awareness of the suffering of another, coupled with the wish to relieve it.”2 Fatigue is defined as “the mental weariness resulting from exertion that is associated with attending to the emotional and physical pain of others.”2 Compassion fatigue is something all of us in the veterinary profession are susceptible to, and many of us today suffer from this condition.3

What about burnout? More than 50% of technicians surveyed indicated they experienced burnout as one of their top 5 most significant problems (second only to low income), while 41% experienced compassion fatigue. Part of the difficulty of diagnosing compassion fatigue is that we tend to lump all of our negative feelings under “burnout.” When compared, they are quite different. Burnout results from the stresses within our workplace environment, whereas compassion fatigue results from the stresses within ourselves regarding the relationships we form with our patients and clients. You may be burned out because you are working long hours in a facility that has run out of space and has faulty equipment, but you are compassion fatigued because a favorite patient just died or a client erupted angrily when you presented a treatment plan.3

Minimizing compassion fatigue, otherwise known as “the cost of caring,” begins with taking care of ourselves. Developing a self-care plan is not as hard as it looks, yet it also is not as easy as it sounds. We simply cannot change years, perhaps a lifetime, of giving care to others first when we wake up tomorrow morning. We need tools to make these changes, as well as an understanding of what we hope to gain.

Review the signs of compassion fatigue and burnout in Melanie Codi’s article, and identify self-help tips to enable success in the future.

As veterinary professionals and paraprofessionals, we must start with ourselves and encourage discussion among our team. Whole Team Wellness is an initiative being explored by many organizations, including the American Veterinary Medical Association. To better serve the professionals of the veterinary team, tools and support networks encompassing compassion fatigue should be implemented in practices immediately.

NAVTA would like to recognize Merial for its sponsorship of the NAVTA 2016 Demographic Survey.

Heather Prendergast, RVT, CVPM, SPHR, is Editor in Chief of the NAVTA Journal and co-chair of the National Credential Task Force.

References

  1. National Association of Veterinary Technicians in America. NAVTA 2016 demographic survey results. navta.net/?page=Demographic_Survey. Accessed September 2016.
  2. Figley CR, Roop RG. Compassion Fatigue in the Animal-Care Community. Washington, DC: Humane Society Press; 2006.
  3. Dobbs K. Compassion fatigue exposed. NAVTA J August/September 2016.

 

 

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Show MoreReferences
  1. Depression. National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services. nimh.nih.gov/health/topics/depression/index.shtml. Accessed May 2016.
  2. Larkin M. Study: 1 in 6 veterinarians have considered suicide. JAVMA 2015;246(7):707-709.
  3. National Association of Veterinary Technicians in America. NAVTA 2016 demographic survey results. navta.net/?page=Demographic_Survey. Accessed September 2016.
  4. Scheidegger J. Burnout, compassion fatigue, depression—what’s the difference? dvm360. May 1, 2015. dvm360.com. Accessed September 2016.
  5. Depression. Def. b(2). Merriam-Webster. merriam-webster.com/dictionary/depression. Accessed September 2016.
  6. Helpguide.org; Trusted guide to mental, emotional, and social health. helpguide.org. Accessed July 2016.
  7. International Employee Assistance Professionals Association. eapassn.org. Accessed September 2016.
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