Suicidality, depression, and anxiety among Hong Kong veterinarians: a quantitative pilot study

doi:10.21203/rs.3.rs-1951267/v3

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Research Article

Suicidality, depression, and anxiety among Hong Kong veterinarians: a quantitative pilot study

https://doi.org/10.21203/rs.3.rs-1951267/v3

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Objective

The suicidality and poor mental health conditions of the veterinary profession have drawn increasing attention; however, little is known about the mental health status of veterinarians in Hong Kong. This study aimed to examine the prevalence of suicidality and symptoms of depression and anxiety among Hong Kong veterinarians.

Methods

All veterinarians were registered and practising in Hong Kong at the time of recruitment to the e-survey study between 1 January 2022 and 31 March 2022. Participants’ suicidality, depressive symptoms, and anxiety symptoms were assessed using validated scales.

Results

Data from 56 participants were included in the analysis. Among them, 22.0% self-reported as at risk of suicide, 19.6% had current suicidal ideation, 29.4% had depressive symptoms, 29.4% and anxiety symptoms, and 23.5% were comorbid with depression and anxiety. Our findings were comparable to or higher than those reported in Anglophone and European countries.

Conclusion

Contextual factors affecting the mental health of veterinarians practising in Hong Kong are worth further investigation. It is important to enhance mental health awareness by improving the profession’s mental health literacy as a suicide prevention strategy.

Mental health

veterinary

suicide

depression

anxiety

The suicidality and poor mental health of veterinary professionals have drawn increasing attention. Studies suggested veterinarians there had high levels of depression (ranging from 6% to 28%) ^1-5 and anxiety (ranging between 4% and 33%) ^1-4, the suicide rate of veterinarians in the U.S. was higher than of the general U.S. population ⁶. Previous studies suggested the complexity of veterinarians’ roles, including their long working hours, heavy caseloads, engagement in euthanasia ^{1 7 8}, the balancing of human clients’ expectations and medical interests ⁹, poor workplace culture ¹⁰ and isolated working conditions are significant contributors to veterinarians’ poor mental health status. Studies also advised the profession’s easier access to pentobarbital ¹¹, a drug commonly used for euthanasia of animals, to be a significant factor in their suicidal behaviour. However, little is known about the prevalence of mental health status of Hong Kong veterinarians.

Contextual factors in Hong Kong can affect the mental health situation of veterinarians. Being one of the most urbanised cities in the world, a study indicated Hong Kong’s high rental costs, competitive business environment, and clients’ unrealistic expectations are major stressors affecting the profession ¹². Unlikely many other countries, investing in veterinary clinics in Hong Kong are not restricted to licensed veterinarians, the relatively low market entry barrier possibly amplified rivalry among clinics clustered in proximity ¹³. While Hong Kong pet owners were mostly satisfied with their veterinarians (64.7%), those who were dissatisfied might not revisit the clinic (33.2%) or might file a complaint (8.2%) to the clinic or official channels ¹².

The duration of some complaints lodged to the Hong Kong Veterinary Surgeon Board, an independent statutory authority and the official channel that investigate veterinary-related complaints, could take up to 7 years to resolve ¹⁴ and were stressful for both the pet owners and the veterinarians ¹³. In comparison, it was reported that complaints in the U.K. and the U.S. would be scheduled within 15 months and resolved within 4 years ^{15 16}. Clients’ cyberbullying and negative comments were found an emerging phenomenon upon that appeals as a convenient channel expressing weighted opinions upon their unmet expectations, and are affecting the mental health of veterinarians in Hong Kong ^{13 17} and around the globe ^{18 19}.

This quantitative study examines the prevalence of suicidality, depression, and anxiety among veterinarians in Hong Kong. We hypothesised that (i) Hong Kong veterinarians have a similar prevalence of poor mental health as veterinarians in other countries, and (ii) the mental health of Hong Kong veterinarians is similar to that of medical professionals since they share similar situational and cultural influences.

Study sample and procedure

All Hong Kong veterinarians who were practising in Hong Kong at the time of recruitment were eligible and invited to take part in the study. They were invited by an e-invitation through (i) the Hong Kong Veterinary Association, (ii) The City University of Hong Kong’s College of Veterinary Medicine and Life Sciences; (iii) the research team’s personal network; (iv) and referrals from research participants. We invited interested potential participants to click an online link or scan a QR code between 1 January 2022 and 31 March 2022. They were guided to a self-administered e-survey ²⁰ and were provided an information sheet and asked to check a box marking their consent before the screening questions. After the e-screening confirmed their eligibility, participants were guided to the main e-survey. The e-survey was in English. The study protocol was approved by the Human Research Ethics Committee at the University of Hong Kong (Reference number: EA200192).

Measures

Suicidality

The Suicidal Behaviours Questionnaire-Revised (SBQ-R) ²¹ consists of four items that assess aspects of suicide-related thoughts and behaviours, including lifetime suicidal ideation or attempt, the frequency of suicidal ideation over the last 12 months, the threat of suicide attempts, and the likelihood of future suicidal behaviours. The SBQ-R total score ranged from 3 to 18, which determines the risks of suicide. The Cronbach α for the four items scale was α = .85, which indicated good internal reliability of the scale. Item number 9 of the Patient Health Questionnaire-9 (PHQ-9) ²² measured the current risk of participants’ suicidal ideation in the past 2 weeks.

Depressive symptoms

The PHQ-9 ²² is a 9-item scale used for clinical diagnoses of major depressive disorder ²³. Each item is assessed on a scale from 0 (not at all) to 3 (nearly every day), adding up to 0–27, whereby higher PHQ-9 scores indicate greater depressive symptoms. The symptom severity can be categorised as none to minimal (0–4 points), mild (5–9 points), moderate (10–14 points), moderately-severe (15–19 points), and severe (20–27 points). PHQ-9 is a reliable scale with 88% sensitivity and the specificity. The Cronbach α was .86, indicating excellent internal reliability of the scale ²².

Anxiety symptoms

The General Anxiety Distress-7 (GAD-7) ²⁴ is a 7-item scale and a clinical diagnostic tool for generalised anxiety disorder ²³. Each item is scored from 0 (not at all) to 3 (nearly every day), with 21 as the highest possible score. The severity of anxiety symptoms can be categorised into none to minimal (0–4 points), mild (5–9 points), moderate (10–14 points), and severe (15–21 points). GAD-7 is a reliable and validated anxiety survey with a sensitivity of 89% and specificity of 82% ²⁵, and the Cronbach α was .92, indicating excellent internal reliability of the scale.

Statistical Analysis

The prevalence of suicidality, depression, and anxiety were calculated by determining the proportion of respondents with SBQ-R scores > 7, PHQ-9 scores > 9, and GAD-7 scores > 9. The ninth item of the PHQ-9 measured respondents’ current suicidal ideation. Correlation assessed the strength and direction of linear relationship of between hours of work per week and SBQ-R, PHQ-9, and GAD-7 scores. Missing values involving scores calculation were excluded listwise. Statistical analyses were conducted using SPSS for Windows v. 28 ²⁶. All significance tests were two-tailed, and findings with a p-value of .05 were considered statistically significant.

Sixty-five respondents took part in the e-survey. The response rate accounted for 6.6% of registered veterinarians in Hong Kong ²⁷. Those who had completed less than 15.0% of the questionnaire (n = 9) were excluded from the analysis. Hence, data from 56 participants, with a 90.7% data completion rate (see Supplementary table 1), were included in the analysis. Table 1 provides an overview of respondents’ background information. The average hours of work per week were 46.6 ± 8.8 for respondents who worked full time (n=43) and 27.8 ± 11.1 for those who worked non-full time (n=13). Pearson’s correlation identified a weak-positive relationship between average hours of work per week with GAD-7 scores (r =.28, p<0.05), and moderate-positive relationship between SBQ-R with PHQ-9 (r =.46, p<0.01) and with GAD-7 (r =.37) and a strong positive relationship between PHQ-9 and GAD-7 (r =. 82, p<0.01).

Risk of suicide, suicidal ideation, and behaviours

The SBQ-R mean score among the participants was 5.8 ± 3.4 and indicated 22.0% (n = 11) were as at risk of suicide (SBQ-R score > 7). It was found that 50.0% (n = 25) of the participants never had suicidal ideation in their lifetime, 34% (n = 17) had suicidal ideation, 14.0% (n = 7) had plans for suicide, and 2.0% (n = 1) had attempted suicide. Regarding past-year suicidality, 66.0% (n = 33) of the participants had never thought of killing themselves, 16.0% (n = 8) had thought of it once, 8.0% (n = 4) considered it twice, 4.0% (n = 2) had thought of killing themselves 3 to 4 times, and 6.0% (n = 3) had conceived it more than four times in the past year. Item 9 of the PHQ-9 asked if participants have thoughts they would be better off dead or of hurting themselves in the past 2 weeks, identified 19.6% (n = 10) had current suicidal ideation.

Out of all participants who have conceived killing themselves at some stage of their lives (50%, n=25), 32.0% (n = 16) told no one that they might attempt suicide, 8.0% (n = 4) disclosed it once but did not want to die, 8.0% (n = 4) disclosed more than once but did not want to die, and 2.0% (n = 1) had disclosed it more than once and really wanted to die. In terms of likelihood of future suicide attempts, 44% (n = 22) and 22% (n = 11) of the respondents claimed they would never attempt suicide or there was no chance that it would happen in the future, 18% (n = 9) indicated that it would be rather unlikely, 14% (n = 7) stated it was likely, and 2% (n = 1) reported that it was very likely.

Depression and anxiety: symptom severity and prevalence

The prevalence of depression (PHQ-9 > 9) in the overall sample was 29.4% (n = 15) among our participants. While our study identified none of our respondents had severe depressive symptoms, 7.8% (n = 4) indicated evidence of moderately-severe depressive symptoms. and 21.6% (n = 11) had moderate depressive symptoms. Most respondents had minimal (41.2%, n = 21) or mild symptoms (29.4%, n = 15) of depression. The overall PHQ-9 mean score ranged between insert figure here, with an average score of 6.8 ± 5.3 out of a possible 27 points.

The prevalence of anxiety (GAD-7 > 9) among participants was 29.4% (n = 15). We found 19.6% (n = 10) and 9.8% (n = 4) were identified to have moderate and severe anxiety symptoms, respectively. Almost half of the respondents had minimal anxiety symptoms (47.1%, n = 24) and 23.5% (n=12) had mild symptoms. The GAD-7 mean score was 6.3 ± 5.4 out of a possible 21 points for anxiety.

Out of the 15 respondents with anxiety or depression, 12 were classified comorbid with both conditions, representing 23.5% of respondents (see Supplementary table 2). Chi-square test of independence showed significant relationships between current suicidal ideation and depression (χ2 = 5.61, df = 1, p = .18), anxiety (χ2 = 5.61, df = 1, p = .18), and comorbidity (χ2 = 9.20, df = 1, p = .00). Significant relationship between participants who were at risk of suicide and anxiety (χ2 = 4.05, df = 1, p =. 04) were also confirmed by Chi-square.

This first-of-its-kind quantitative study explored the prevalence of mental health of veterinarians in Hong Kong. Our participants have a lower risk of suicide than estimates in existing literature (Australia at 29.4% ⁷ 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 explained the relatively generous remuneration package in Hong Kong played a protective factor in preventing suicidal behaviour.

We hypothesised that Hong Kong veterinarians have a similar prevalence of poor mental health as veterinarians in other countries. This study confirmed the prevalence of depression among Hong Kong veterinarians (29.4%) is comparable to or higher than those of Germany (28.8%) ⁵, Australia (19.8%) ³, Canada (8.9–9.0%) ^{2 4} and the U.K. (5.8%) ¹, while anxiety of Hong Kong veterinarians (29.4%) is comparable to those in the U.K. (26.3%) ¹ and Canada (23.6–29.0%) ^{2 4} but higher than those in Australia ³. We found comorbidity of depression and anxiety were common among Hong Kong veterinarians (23.5%), which is higher than those in Australia (4.5%) and Canada (7.1–7.2%) ^{2 4}. The prevalent of past 12 months suicidal ideation of Hong Kong veterinarians (19.6%) is similar to those in Germany (19.2%) ⁵.

Despite common sources of stress, such as workplace demand and client expectations, are shared among the profession, contextual factors in Hong Kong suggested some unique stressors that were uncommon 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 ^{12 13}. We consider Hong Kong’s geographic convenience contributed to clients’ price shopping and vet-hopping behaviours, thus heightening veterinarians’ psychological tension. Moreover, they city’s lack of business regulatory requirements for the profession challenges veterinarian-employees and, possibly, the welfare of animals ¹³. Besides the limited legal liability for medical misconduct on non-veterinarian investors ¹³, 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 a fair-minded profit model of the veterinary enterprises ¹³. Our previous qualitative study found that veterinarians’ experience of workplace leadership and workplace harmony were some factors affecting their mental health ¹³. The main barriers to accessing mental health services was due to their lack of work-life balance, resulted from their late finishing and unpredictable work schedule.

Our second hypothesis tested whether the mental health of Hong Kong veterinarians is similar to that of medical professionals. A similar study surveyed 393 Hong Kong physicians found 16.0% were depressed, and 15.3% had suicidal ideation in the past 2 weeks ²⁸. Depression and anxiety were prevalent among 35.8% and 37.3% of Hong Kong nurses ²⁹, respectively. In contrast, the depression, anxiety, and past-year suicidal ideation among the general population were 10.7%, 4.2%, and 1.2%, respectively ^{30 31}. Based on our findings, veterinarians were more prone to depression (29.4%) and past 2 weeks suicidal ideation (19.6%) than other medical professionals in Hong Kong. We believe the healthcare profession’s continuous engagement to keeping up with healthcare development contributed to additional stress than those of the general population. While we know little 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, stigma to the fitness-to-practice, and barriers to professional advancement ^{32 33}.

We speculate the veterinarian-client-patient dynamic are additional challenges facing the veterinary profession, compared to physicians, and contributed to their poorer mental health. While veterinarians are trained to manage the health of their animal patients who cannot speak, they are anticipated to meeting expectations of their human clients (usually the animals’ caretakers) who have a significant role in medical decision-making on behalf of the animals ³⁴. 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 ³⁵ and emphasised client-handling, clear communication, and good relationship with colleagues are important elements to maintain good mental health ¹³. Although the Internet enabled convenient access of information on subjects like animal welfare and caretaking of companion animals, research indicated that health misinformation is prevalent on social media ³⁶ 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.

Limitation

There are a few limitations to this research. First, our study only has 56 valid respondents. Despite our study represented 6.6% of all Hong Kong veterinarians, which has a similar response rate to local mental health studies of the healthcare profession ²⁹, the small size of the profession restricted the generalizability of our findings. Second, systematic missing values in gender disable sub-group analysis that address the gender paradox of suicide and depression ³⁷. Third, our research cannot dismiss possible influence of COVID-19 on veterinarians’ mental well-being as data were collected during the pandemic.

Suicide and mental health disorders are a global concern affecting the general public and high risks professions like veterinarians. Although the low response rate raised questions about Hong Kong veterinarians’ willingness to explore and enhance their mental health, our findings suggested their mental ill-health of Hong Kong was comparable to or more prevalent than those reported in Anglophone and European countries and is in need for more attention and efforts to improve the worrying situation. Future research can examine the profession’s coping strategies for their stress, including the tendency to seek professional help and the usage of mental health resources.

Our team believe prevention is always better than treatment. We recognised that practicing veterinarians may be too busy to seek professional help ¹³, we have recently piloted an animal-assisted mental health educational programme with veterinary medical students in Hong Kong. The programme aimed to prepare future veterinarians from possible stressors and challenging ahead, assisted by trained therapy dogs as evidence suggested animal-assisted education effectively engages mental health conversations ³⁸ and reduces anxiety ³⁹. We also believe that because veterinarians have more love and care for animals than others, therefore in the presence of animals, students are expected of better socio-emotional engagement and adherence to memory ⁴⁰, thus encourages the learning of mental health literacy and sustainability when compared to non-animal-assisted programs. Improving veterinary professionalism, restoring veterinarian-client trust, and encouraging mental health assessments are crucial to the betterment of the veterinarians’ mental health is beneficial to the welfare of animals, and “Not One More Vet” to suicide is necessitated.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Competing interests

The authors report no relevant financial or non-financial interest to disclose.

Authors contribution

The authors alone are responsible for the content and writing of the paper. Chan,CKY. conceptualised the original idea, analysed and interpreted the data, and drafted the main manuscript. Wong, PWC. supervised the study design, analysis, and critically revised the manuscript. All authors agreed with the main focus and ideas of the main manuscript, reviewed the results and approved the final version of the manuscript.

Ethics approval

Research ethics approval was obtained by the Human Research Ethics Committee of the University of Hong Kong (Reference number: EA200192).

Consent to participate

Informed consent was obtained from all participants included in the study.

Acknowledgements

The research team would like to thank the Hong Kong Veterinary Association and The City University of Hong Kong’s College of Veterinary Medicine and Life Sciences Department, who helped disseminated the research invitation.

SBQ-R: Suicidal Behaviours Questionnaire-Revised

PHQ-9: Patient Health Questionnaire-9

GAD-7: General Anxiety Distress-7

1. Bartram DJ, Yadegarfar G, Baldwin DS. A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession. Social psychiatry and psychiatric epidemiology 2009;44(12):1075-85.

2. Best CO, Perret JL, Hewson J, et al. A survey of veterinarian mental health and resilience in Ontario, Canada. The Canadian veterinary journal = La revue veterinaire canadienne 2020;61(2):166-72.

3. Hatch PH, Winefield HR, Christie BA, et al. Workplace stress, mental health, and burnout of veterinarians in Australia. Australian veterinary journal 2011;89(11):460-8. doi: 10.1111/j.1751-0813.2011.00833.x [published Online First: 2011/10/20]

4. Perret JL, Best CO, Coe JB, et al. Prevalence of mental health outcomes among Canadian veterinarians. J Am Vet Med Assoc 2020;256(3):365-75.

5. Schwerdtfeger KA, Bahramsoltani M, Spangenberg L, et al. Depression, suicidal ideation and suicide risk in German veterinarians compared with the general German population. Veterinary Record 2020;186(15):e2-e2. doi: 10.1136/vr.105430

6. Tomasi SE, Fecther-Leggett ED, Edwards NT, et al. Suicide among Veterinarians in the United States from 1979 through 2015. J Am Vet Med Assoc 2019;254(1):104-12.

7. Tran L, Crane MF, Phillips JK. The distinct role of performing euthanasia on depression and suicide in veterinarians. Journal of Occupational Health Psychology 2014;19(2):123-32. doi: 10.1037/a0035837

8. Platt B, Hawton K, Simkin S, et al. Suicidal behaviour and psychosocial problems in veterinary surgeons: a systematic review. Social psychiatry and psychiatric epidemiology 2012;47(2):223-40. doi: 10.1007/s00127-010-0328-6

9. Janke N, Coe JB, Bernardo TM, et al. Pet owners’ and veterinarians’ perceptions of information exchange and clinical decision-making in companion animal practice. PLOS ONE 2021;16(2):e0245632. doi: 10.1371/journal.pone.0245632

10. Kersebohm JC, Lorenz T, Becher A, et al. Factors related to work and life satisfaction of veterinary practitioners in Germany. Veterinary Record Open 2017;4(1):e000229. doi: 10.1136/vetreco-2017-000229

11. Platt B, Hawton K, Simkin S, et al. Systematic review of the prevalence of suicide in veterinary surgeons. Occupational medicine (Oxford, England) 2010;60(6):436-46. doi: 10.1093/occmed/kqq044

12. Mercado Solution Associates Ltd. Study on the Development of the Veterinary Profession in Hong Kong. Hong Kong, 2016:136.

13. Chan CKY, Lai JSK, Wong PWC. Intra-professional stress – demonstrating veterinarian identity in Hong Kong. Australian veterinary journal 2023;101(1-2):49-57. doi: 10.1111/avj.13214

14. VSBHK. Newsletter 2021: Veterinary Surgeons Board of Hong Kong; 2022 [Available from: https://www.vsbhk.org.hk/file/newsletter/VSB_Newsletter_2021.pdf accessed 20 Oct 2022.

15. RCVS. Information for veterinary surgeons 2022 [Available from: https://www.rcvs.org.uk/concerns/a-concern-has-been-raised-about-me/information-for-veterinary-surgeons/ accessed Feb 2022.

16. Labriola J, Garabed R, Sinclair C, et al. Insights From Veterinary Disciplinary Actions in California 2017-2019. Frontiers in veterinary science 2021;8:786265-65. doi: 10.3389/fvets.2021.786265

17. Cahalane AK. The Partnership That Might Save Your Pet’s Life Hong Kong: TEDxWanChai; 2018 [Available from: https://www.youtube.com/watch?v=mFY16H827nA accessed 5 Nov 2022.

18. Smither S. A disturbing trend: Veterinary cyberbullying. 2014 [Available from: http://www.veterinaryteambrief.com/article/disturbing-trend-veterinary-cyberbullying accessed 30 Nov 2019.

19. Volk JO, Schimmack U, Strand EB, et al. Executive summary of the Merck Animal Health Veterinarian Wellbeing Study III and Veterinary Support Staff Study. J Am Vet Med Assoc 2022:1-7. doi: 10.2460/javma.22.03.0134

20. program]. Dec 2020 version. Provo, Utah, USA, 2020.

21. Osman A, Bagge CL, Gutierrez PM, et al. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment 2001;8(4):443-54. doi: 10.1177/107319110100800409 [published Online First: 2002/01/12]

22. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x

23. American Psychiatric Association. Diagnostic and statistical manual of mental disorders : DSM-V. 5th ed: Arlington, VA 2013.

24. Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166(10):1092-7. doi: 10.1001/archinte.166.10.1092

25. Spitznagel MB, Yossef S, Porath B, et al. Development and validation of a Burden Transfer Inventory for predicting veterinarian stress related to client behavior. J Am Vet Med Assoc 2019;254(1):133-44. doi: 10.2460/javma.254.1.133

26. IBM SPSS Statistics for Windows, Version 28.0 [program]. Armonk, NY: IBM Corp, 2021.

27. VSBHK. List of Registered Veterinary Surgeons with Valid Practising Certificates: Veterinary Surgeons Board of Hong Kong; 2022 [Available from: https://www.vsbhk.org.hk/tc_chi/vsro/vsro.html accessed 2 Mar 2022.

28. Ng APP, Chin WY, Wan EYF, et al. Prevalence of depression and suicide ideation in Hong Kong doctors: a cross-sectional study. Scientific Reports 2021;11(1):19366. doi: 10.1038/s41598-021-98668-4

29. Cheung T, Yip PS. Depression, Anxiety and Symptoms of Stress among Hong Kong Nurses: A Cross-sectional Study. Int J Environ Res Public Health 2015;12(9):11072-100. doi: 10.3390/ijerph120911072

30. Centre for Health Protection. Report on Population Health Survey 2014/15. Mental Health: Department of Health, HK, 2017.

31. Lam LC, Wong CS, Wang MJ, et al. Prevalence, psychosocial correlates and service utilization of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey (HKMMS). Social psychiatry and psychiatric epidemiology 2015;50(9):1379-88. doi: 10.1007/s00127-015-1014-5

32. Center C, Davis M, Detre T, et al. Confronting Depression and Suicide in PhysiciansA Consensus Statement. JAMA 2003;289(23):3161-66. doi: 10.1001/jama.289.23.3161

33. Knipe D, Maughan C, Gilbert J, et al. Mental health in medical, dentistry and veterinary students: cross-sectional online survey. BJPsych open 2018;4(6):441-46. doi: 10.1192/bjo.2018.61

34. Küper AM, Merle R. Being Nice Is Not Enough-Exploring Relationship-Centered Veterinary Care With Structural Equation Modeling. A Quantitative Study on German Pet Owners' Perception. Frontiers in Veterinary Science 2019;6(56):1-16. doi: 10.3389/fvets.2019.00056

35. Gordon S, Gardner D, Weston J, et al. Fostering the Development of Professionalism in Veterinary Students: Challenges and Implications for Veterinary Professionalism Curricula. Education Sciences 2021;11(11):720. doi: 10.3390/educsci11110720

36. Suarez-Lledo V, Alvarez-Galvez J. Prevalence of Health Misinformation on Social Media: Systematic Review. J Med Internet Res 2021;23(1):e17187. doi: 10.2196/17187 [published Online First: 20210120]

37. Barrigon ML, Cegla-Schvartzman F. Sex, Gender, and Suicidal Behavior. Curr Top Behav Neurosci 2020;46:89-115. doi: 10.1007/7854_2020_165

38. Flynn E, Zoller AG, Gandenberger J, et al. Improving Engagement in Behavioral and Mental Health Services Through Animal-Assisted Interventions: A Scoping Review. Psychiatr Serv 2022;73(2):188-95. doi: 10.1176/appi.ps.202000585 [published Online First: 20210623]

39. Parbery-Clark C, Lubamba M, Tanner L, et al. Animal-Assisted Interventions for the Improvement of Mental Health Outcomes in Higher Education Students: A Systematic Review of Randomised Controlled Trials. Int J Environ Res Public Health 2021;18(20) doi: 10.3390/ijerph182010768 [published Online First: 20211014]

40. Brelsford VL, Meints K, Gee NR, et al. Animal-Assisted Interventions in the Classroom—A Systematic Review. International Journal of Environmental Research and Public Health 2017;14(7):669.

Table 1: Descriptive statistics on demographics and background.

Demographics		n (%)	Background		n (%)
Current specialty			Patient species^a
	Veterinarians	52 (92.9)		Cats and/or dogs	51 (91.1)
	Veterinary specialists	4 (7.1)		Small mammals, reptiles, and exotics	5 (8.9)
Employment status				Others	5 (8.9)
	Full-time	43 (76.8)	Primary veterinary roles^a
	Non-full-time	13 (23.2)		General Practice	50 (89.3)
Earliest qualification				Emergency Medicine	9 (16.1)
	Less than 2 years ago	0 (0.0)		Others / refused to answer	7 (12.5)
	2 < 5 years ago	4 (7.1)	Seniority
	5 < 8 years ago	9 (16.1)		Owner/ Partner	17 (30.4)
	8 < 12 years ago	15 (26.8)		(Non-owner) Key decision makers	6 (10.7)
	12 < 16 years ago	7 (12.5)		Employee	33 (58.9)
	16 < 20 years ago	7 (12.5)	Hours of sole charge per week^c
	20 < 25 years ago	6 (10.7)		Never the sole charge	10 (18.2)
	More than 25 years	8 (14.3)		Sometimes sole charge	33 (60.0)
Gender^a				Always the sole charge	12 (21.8)
	Male	7 (17.9)	Conventional working hours
	Female	30 (76.9)		Mostly between 08:00-20:00	44 (78.6)
	Others / Prefer not to say	2 (5.1)	Hours of work per week		42.2±12.3

All data are represented in respondents (%) or mean ± SD, as appropriate.

^aPercentage exceeded 100% due to multiple response. ^bPercentage based on valid sample (n=39). ^cPercentage based on valid sample (n=55). n – Number of respondents in the sub-group. Missing values were excluded pairwise.

Supplementary table 1: Data completion rate

Total		Veterinarians
Total		(N=56)
Mental health status
	PHQ-9 total score	51 (91.1)
	PHQ-9 suicidal ideation	51 (91.1)
	GAD-7 total score	51 (91.1)
	SBQ-R total score	50 (89.3)

Note:

PHQ-9 = Patient Health Questionnaire–9

GAD-7 = Generalised Anxiety Disorder–7

SBQ-R = Suicidal Behaviors Questionnaire-Revised

Supplementary table 2: SBQ-R results.

				Mean (SD)	Median	IQR	At risk of suicide
				Mean (SD)	Median	IQR	(SBQ-R >7)
Total respondents			N=50	5.8 (3.4)	5.0	3.0-7.0	11 (22.0)
Lifetime suicide-risk ideation
	Non-Risk / Non-Suicidal		n=25	3.6 (1.0)	3.0	3.0-5.0	0 (0.0)
	Suicide-risk ideation
		Brief passing thought	n=17	6.2 (2.0)	6.0	5.0-7.0	3 (6.0)
		Suicide plan without intent	n=5	11.2 (2.4)	11.0	10.0-13.0	5 (10.0)
		Suicide plan with intent	n=2	14.5 (3.5)	14.5	12.0-17.0	2 (4.0)
		Suicide attempt without intent	n=1	8 (NA)	NA	NA	1 (2.0)
Past 12 months suicide ideation
	Never		n=33	3.9 (1.2)	3.0	3.0-5.0	0 (0.0)
	Once		n=8	7.6 (2.1)	7.5	6.0-9.0	4 (8.0)
	Twice		n=4	7.8 (1.7)	7.5	6.5-9.0	2 (4.0)
	3-4 times		n=2	12.0 (1.4)	12.0	11.0-13.0	2 (4.0)
	5 times or more		n=3	14.3 (2.5)	14.0	13.0-15.5	3 (6.0)
Disclosure of possible suicide attempt
	No		n=41	4.6 (2.0)	4.0	3.0-6.0	4 (8.0)
	Once, without suicide intent		n=4	8.3 (2.1)	8.5	6.5-10.0	2 (4.0)
	More than once, without suicide intent		n=4	12.3 (1.5)	12.0	11.0-13.5	4 (8.0)
	More than once, with suicide intent		n=1	21 (NA)	NA	NA	1 (2.0)
Likelihood of suicide in the future
	Never / No chance		n=33	4.0 (1.3)	3.0	3.0-5.0	1 (2.0)
	Rather unlikely		n=9	7.0 (1.9)	7.0	6.0-8.0	3 (6.0)
	Unlikely		n=7	10.9 (2.6)	11.0	10.0-12.5	6 (12.0)
	Likely		n=0	NA	NA	NA	NA
	Very likely		n=1	21 (NA)	NA	NA	1 (2.0)
Suicide risks
	Not at-risk of suicide		n=39	4.3 (1.4)	4.0	3.0-5.0	39 (78.0)
	At-risk of suicide		n=11	11.1 (2.8)	11.0	9.0-12.5	11 (22.0)

^aPercentage based on valid sample. IQR – Tukey’s Hinges interquartile range. SD – standard deviation. N – Total number of respondents. n – Number of respondents in the sub-group. SBQ-R – Suicidal Behaviours Questionnaire-Revised.

No competing interests reported.

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Suicidality, depression, and anxiety among Hong Kong veterinarians: a quantitative pilot study

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