This first-of-its-kind quantitative study explored the prevalence of mental health of veterinarians in Hong Kong. Although it is limited by its small sample size and the unique influence of COVID-19, it was found that veterinarians in Hong Kong have a lower risk of suicide than estimates in existing literature (Australia at 29.4% (11) and Germany at 32.1%) (5). While our study did not investigate the reasons behind the relatively low risk of suicide, some veterinarians who participated in our previous qualitative study (submitted) explained that the relatively generous remuneration package in Hong Kong compared to other countries seems to play as a protective factor in preventing suicidal behaviour.
In terms of their mental well-being, the prevalence of depression among veterinarians in Hong Kong is comparable to or higher than existing data reported in Germany (28.8%) (5), Australia (19.8%) (3), Canada (8.9–9.0%) (2, 4) and the United Kingdom (U.K.) (5.8%) (1). The prevalence of anxiety among Hong Kong veterinarians is comparable to those in the U.K. (26.3%) (1) and Canada (23.6–29.0%) (2, 4) but is higher than those in Australia (3). We also found that comorbidity of depression and anxiety are common among Hong Kong veterinarians and higher than those in Australia (4.5%) and Canada (7.1–7.2%) (1, 2, 4). They also have a similar current suicidal ideation rate as veterinarians in Germany (19.2%).
Although the veterinarian profession shares similar stressors such as workplace demand and client expectations, Hong Kong veterinarians face contextual factors that veterinarians do not share in Anglophone and European countries. As Hong Kong is one of the world’s most populous and urbanised cities, veterinarians were most stressed about sustaining the business under extremely high rental costs and intense competition (17). We consider the geographic convenience contributed to clients’ price shopping and vet-hopping behaviours, thus heightening veterinarians’ psychological tension. We also believe Hong Kong’s lack of business regulatory requirements for the profession challenges veterinarian-employees and, possibly, the welfare of animals. In addition to the limited legal liability for medical misconduct on non-veterinarian investors (21), businessmen-owned veterinary clinics are believed less familiarised with the specificity of ethics in veterinary medicine, such as the appropriate length of medical consultation and the appropriate profit model of the veterinary enterprises. Our previous qualitative study found that years of experience, seniority, clinic management and leadership, workplace demand and support, local language proficiency, and incidents of complaints or cyberbullying were some factors affecting the mental health of veterinarians practising in Hong Kong (submitted). The aftermath of being cyberbullied, such as dealing with a damaged reputation and potentially losing clients, meriting further investigation.
In Hong Kong, previous studies found common mental disorders were more prevalent among health medical practitioners than in the general population. Among physicians who participated in a similar study surveyed in a study, 16.0% were depressed, and 15.3% had current suicidal ideation (Ng et al., 2021). Depression and anxiety were prevalent among 35.8% and 37.3% of Hong Kong nurses (Cheung & Yip, 2015), respectively. In contrast, the depression, anxiety, and past-year suicidal ideation among the general popular were 10.7%, 4.2%, and 1.2%, respectively (Centre for Health Protection; Lam et al., 2015). Our study found that Hong Kong veterinarians were more prone to depression but had less current suicidal ideation than other medical professionals. A common trait shared among healthcare professionals is their continuous engagement with healthcare development. On one hand, gaining knowledge and being able to apply new skills can be rewarding (33), however the encounter of emergent clinical events and dealing with dissatisfied patients or their family members can negatively affect their psychological and physical well-being (34, 35). While little is known about veterinarians’ willingness to access mental health services; a study indicated the low priority to physician mental health is embedded in the culture of medicine where help-seeking is considered “punitive”, due to reasons like discrimination in medical licensing, fitness-to-practice, and professional advancement (36, 37).
We speculate that veterinarians’ poorer mental health, compared to physicians, could be explained by the additional challenges of the veterinarian-client-patient dynamic. While veterinarians are trained to manage the health of their animal patients who cannot speak, they are anticipated to meet the expectations of their human clients (usually the animals’ caretakers) who have a significant role in medical decision-making on behalf of the animals (38). However, the traditional curriculum of medical schools often focuses its training on biomedical and clinical skills, where medical professionalism such as communication techniques, customers’ (or clients’) experience, workplace relations, and emotional well-being were neglected (39, 40) and emphasised client-handling, clear communication, and good relationship with colleagues are important elements to maintain good mental health (submitted). Furthermore, although the Internet enabled easy access of information on subjects like animal welfare and caretaking of companion animals, research indicated that health misinformation is prevalent on social media (41) restricted animal caretakers’ aptitude to look after their pets. Discontented experiences and deepening distrust between clients and veterinarians can negatively affect the quality of veterinary medical service, their mental well-being, and, ultimately, the welfare of animals.