Incidence of suicide in the veterinary profession in England and Wales

THERE have been concerns for many years that mortality due to suicide is higher in the veterinary profession than in the general population. For example, a survey of the causes of mortality in British veterinarians reported an increase in mortality from suicide (Kinlen 1983); increased mortality from suicide has also been reported in the American veterinary profession (Blair and Hayes 1980, Miller and Beaumont 1995). The high suicide rate among veterinarians has even led to the publication of an article dealing with how to cope with suicide (Anon 2000). There has been much speculation as to why the incidence of death by suicide is higher in the profession than in the general population. Occupational stress, stigmatisation of mental health disorders within the veterinary profession and a reluctance of veterinarians contemplating suicide to seek medical help, professional and social isolation, and ease of access to lethal drugs have regularly been implicated as factors leading to an increased incidence of suicide (Blair and Hayes 1980, Adkin 2000, Anon 2000, Jeyaretnam and others 2000, Tutt 2000). Despite the concerns about this high incidence, there are very few published data on the number and incidence of suicides by British veterinarians over the past three decades. The aim of this study was to collate data from the Office for National Statistics on the number and incidence of veterinarian suicides, and to compare this incidence with that in the general population and other health care professions. Data on death registrations for all deaths in England and Wales between 1979 to 2000 (with the exception of 1981, which was excluded because the data were incomplete for that particular year) of individuals whose occupation was recorded as veterinarian, where an inquest verdict of suicide (International Classification of Diseases [ICD] codes E950E959) or undetermined cause (‘open verdicts’) (ICD codes E980-E989, excluding E988·8) had been registered, were supplied by the Office for National Statistics. Open verdicts were included because there is evidence that the majority of these are suicides, although data on the number of deaths due to undetermined causes were only available from 1990 onwards (Kelly and Bunting 1998). Similar data were obtained for the death entries where the occupation was recorded as medical practitioner or dental practitioner. The proportional mortality ratio (PMR) is the observed number of suicides divided by the expected number of suicides, expressed as a percentage, and allows the incidence of suicide in a particular occupation to be compared with the general population as well as other occupations. The expected number of deaths was computed by applying the proportion of total deaths due to suicide in the general population to the total deaths in the occupational group of interest (Kelly and Bunting 1998). Consequently, a PMR of suicide of 100 means that the given occupation has the same proportion of all deaths certified as suicide as that of the general population of England and Wales, a PMR of 50 means that the given occupation has half the proportion of all deaths certified as suicide compared with the general population of England and Wales, whereas a PMR of 200 means that the given occupation has double the proportion of all deaths certified as suicide compared with the general population of England and Wales. The proportion of deaths caused by suicide relative to the number of deaths by other causes in the veterinary profession was compared with those for medical and dental practitioners by the chi-squared test with Yates’s correction. Data were considered significant at P<0·05. Table 1 shows the number of suicides and the PMR of male and female veterinarians aged 20 to 74 years, for 1979 to 1980 and 1982 to 1990, and includes data from other health care professions for comparison. Although the actual number of deaths by suicide is lower than for medical or dental practitioners, the PMR for suicide is considerably higher for the veterinary profession and is higher than other health care professions. A similar finding was observed between 1991 and 2000 for male and female veterinarians (Table 2). The most common method of suicide was self-poisoning by solid or liquid substances for both male and female veterinarians (Table 3). Although the absolute number of suicides by veterinarians is relatively small compared with other occupational groups such as farmers and medical practitioners, the PMR for suicide by veterinarians is one of the highest of all occupational groups. The finding of a high PMR in both male and female veterinarians suggests that the number of suicides relative to deaths due to other causes is much higher in the veterinary profession than in the population as a whole, and is higher than in other health care professions such as medical or dental practitioners (Tables 1, 2). Although the PMR was higher for females in both time periods, the small number of female deaths by suicide and other causes means that the higher PMR should be interpreted with caution. While the PMR is one of the most widely used methods to compare the incidence of suicide between various occupations and with the population as a whole, it should be acknowledged that the PMR is affected by the relative frequency of other causes of death. If mortality from all causes is low in a given population, a high PMR from suicide may be observed. A detailed analysis of the age, background, previous health history and type of veterinary job undertaken by the suicide victims was not possible due to the restrictions imposed by the Data Protection Act, which serves to protect an individual’s privacy. However, 10 of the 26 male veterinarian suicides that occurred between 1991 and 2000 were individuals younger than 45 years of age, which suggests that veterinarian suicides are not confined to a restricted age range. There is little evidence to suggest that the incidence of suicide in male veterinarians has increased since 1991 compared with 1979 to 1990. In contrast, the PMR from suicide is much higher for females since 1993 than in 1979 to 1990, but the small numbers of deaths by suicide and by other causes mean that the high PMR from suicide since 1993 should be interpreted with caution. However, an elevated incidence of suicide has Veterinary Record (2005) 157, 415-417