mardi 24 février 2015

RECHERCHE USA Notes du terrain: prévalence des facteurs de risque de suicide chez les vétérinaires - États-Unis, 2014

d'après article "Suicide : un risque accru pour la profession vétérinaire"  

Les problèmes de dépression et le suicide sont une triste réalité au sein de la profession vétérinaire. Après l’Organisation mondiale de la santé (OMS) fin 2014, les Centers for Disease Control (CDC) se sont penchés sur le sujet outre-Atlantique. Les résultats ne sont pas roses.

Plus de 800 000 personnes meurent par suicide chaque année dans le monde, soit une toutes les 40 secondes. Aucune région ni tranche d’âge n’est épargnée. Toutefois, il s’agit de la deuxième cause de décès chez les jeunes de 15 à 29 dans de nombreux pays européens, selon l’Organisation mondiale de la santé. Pour son premier rapport* sur le sujet, l’OMS a appelé à agir face à ce grave problème de santé publique resté trop longtemps tabou… notamment en France.

Une récente enquête**, réalisée par les Centers for Disease Control and Prevention (CDC), s’est intéressée spécifiquement aux vétérinaires américains par rapport à ces maux si répandus que sont la dépression, la maladie mentale et le suicide. Plus de 10 000 vétérinaires ont répondu au questionnaire, dont 69 % de praticiens pour animaux de compagnie. Le tableau dressé est édifiant.
  •  6,8 % des hommes et 11 % des femmes vétérinaires présentent une maladie mentale grave et/ou des troubles psychiatriques, des sentiments de désespoir et d’inutilité depuis l’obtention de leur diplôme. Dans la population adulte américaine, ces taux sont seulement de 3,5 % chez les hommes et de 4,4 % chez les femmes.
  • 24,5 % des hommes et 36,7 % des femmes vétérinaires ont connu des épisodes dépressifs depuis leur sortie de l’école, soit environ une fois et demi la prévalence chez les adultes américains tout au long de leur vie.
  • 14,4 % des hommes et 19 % de femmes vétérinaires ont envisagé de se suicider depuis la fin de leur cursus. C’est trois fois la moyenne nationale américaine.
  • 1,1 % des hommes et 1,4 % des femmes vétérinaires ont tenté de se suicider depuis la fin de leurs études. Selon les auteurs, ces taux faibles, en dessous de la moyenne nationale, peuvent être dus à l’accès facile des vétérinaires aux euthanasiques et aux “succès” de leurs tentatives de suicide : il y a donc peu de survivants pour répondre à l’enquête…
  • Les trois principaux agents de stress identifiés par les répondants sont les exigences de la pratique vétérinaire, les responsabilités de gestion et les plaintes des clients en cas d’erreur professionnelle.

Ces résultats suggèrent que près d’un vétérinaire américain sur dix souffre de détresse psychologique grave et plus d’un sur six a envisagé le suicide depuis l’obtention de son diplôme. Des données complémentaires restent cependant nécessaires pour mieux caractériser les facteurs de risque sous-jacents du comportement suicidaire chez les vétérinaires et identifier les méthodes de prévention efficaces.

* Prévention du suicide : l’état d’urgence mondial, OMS, septembre 2014.
** Notes from the field : prevalence of risk factors for suicide among veterinarians, United States, 2015.

***

info étude citée http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6405a6.htm?s_cid=mm6405a6_w
Notes from the Field: Prevalence of Risk Factors for Suicide Among Veterinarians — United States, 2014

Please note: An erratum has been published for this article. To view the erratum, please click here.

Weekly February 13, 2015 / 64(05);131-132


Randall J. Nett, MD1,2, Tracy K. Witte3, PhD, Stacy M. Holzbauer, DVM1,4, Brigid L. Elchos, DVM5, Enzo R. Campagnolo, DVM1,6, Karl J. Musgrave, DVM7, Kris K. Carter, DVM1,8, Katie M. Kurkjian, DVM1,9, Cole Vanicek, DVM10, Daniel R. O'Leary, DVM1,7, Kerry R. Pride, DVM2, Renee H. Funk, DVM11 (Author affiliations at end of text)

Veterinarians are believed to be at increased risk for suicide compared with the general population (1). Few data on the occurrence of suicidal behavior and suicide risk factors among U.S. veterinarians are available. Veterinarians participating in two wellness summits held during September 2013 concluded that more research is needed on veterinarians and their mental health (2).

During July 1–October 20, 2014, an anonymous, Web-based questionnaire was made available through the Veterinary Information Network (VIN), an online community for veterinarians; VIN News Service; JAVMA News; and monthly e-mail messages to veterinarians in 49 states (Maine was excluded) and Puerto Rico sent through the state's veterinary medical association, agriculture or livestock department, or health department. The questionnaire asked respondents about their experiences with depression and suicidal behavior, and included standardized questions from the Kessler-6 psychological distress scale that assesses for the presence of serious mental illness (3). Respondents with nonresponses were included in the denominators when calculating prevalence estimates.

Responses were received from 10,254 currently employed veterinarians (10.3% of all employed U.S. veterinarians). The most commonly reported age category was 30–39 years (28.8%), and 31.3% were male. Thirty-four percent reported practicing veterinary medicine for <10 years, 24.6% for 10–19 years, 21.6% for 20–29 years, and 19.8% for ≥30 years. Most (68.6%) respondents practiced small animal medicine, and 37.8% were practice owners. In comparison, 44.4% of U.S. veterinarians are male, and 66.6% practice small animal medicine exclusively (4).

Approximately 6.8% (95% confidence interval [CI] = 5.9%–7.7%) of male and 10.9% (CI = 10.2%–11.6%) of female respondents were characterized as having serious psychological distress based on the Kessler-6 psychological distress scale, compared with 3.5% of male and 4.4% of female U.S. adults, respectively (5). Since graduating from veterinary school, 24.5% and 36.7% (CIs = 23.0%–26.0%, 35.6%–37.8%) of male and female respondents reported experiencing depressive episodes, respectively, 14.4% and 19.1% (CIs = 13.2%–15.7%, 18.2%–20.0%) suicidal ideation, and 1.1% and 1.4% (CIs = 0.7%–1.5%, 1.2%–1.7%) suicide attempts. In comparison, male and female U.S. adults had a lower lifetime prevalence of depressive episodes (15.1% and 22.9%, respectively) and suicidal ideation (5.1% and 7.1%) but a higher prevalence of suicide attempts (1.6% and 3.0%) (6,7).

The findings in this report are subject to at least two limitations. First, the small number of veterinarians who responded compared with the number of those potentially eligible increases the likelihood of nonresponse bias. Second, the possibility exists for social desirability bias. Both of these factors could lead to overestimation or underestimation of the actual prevalence of risk factors for suicide among U.S. veterinarians. Nevertheless, these data suggest that nearly one in 10 U.S. veterinarians might suffer from serious psychological distress and more than one in six might have experienced suicidal ideation since graduation. Additional data, particularly data from representative samples, are needed to further characterize the underlying risk factors for suicidal behavior among veterinarians and identify effective prevention methods.

Acknowledgments

Veterinarians who participated in the survey. Veterinarians and Mental Health Investigation Team. State veterinary medical associations. State agriculture and livestock departments. State health departments. National Association of State Public Health Veterinarians. Veterinary Information Network (VIN). American Veterinary Medical Association. Paul D. Pion, DVM, VIN. Mark Rishniw, PhD, University of California, Davis. Joni Scheftel, DVM, Minnesota Department of Health. Melinda Larkin, JAVMA News. Phyllis DeGioia, VIN News Service. Lori Kogan, PhD, Colorado State University. Bryan Buss, DVM, Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC.

1Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC; 2Montana Department of Public Health and Human Services; 3Department of Psychology, Auburn University; 4Minnesota Department of Health; 5Mississippi Board of Animal Health; 5Wyoming Department of Health; 7Pennyslvania Department of Health; 8Idaho Department of Health and Welfare; 9Virginia Department of Health; 10Nebraska Department of Health and Human Services; 11Emergency Preparedness and Response Office, National Institute of Occupational Safety and Health, CDC (Corresponding author: Randall J. Nett, rnett@cdc.gov, 406-444-5917)

References

  1. Bartram DJ, Baldwin DS. Veterinary surgeons and suicide: a structured review of possible influences on increased risk. Vet Rec 2010;166:388–97.
  2. Larkin M. Finding the calm amid the chaos: when it's not the patient who needs a wellness check, but the veterinarian. JAVMA News 2013;243:1368–75.
  3. Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003;60:184–9.
  4. American Veterinary Medical Association. Market research statistics: U.S. veterinarians, 2013. Available at https://www.avma.org/kb/resources/statistics/pages/market-research-statistics-us-veterinarians.aspx#categoriesExternal Web Site Icon.
  5. CDC. Mental illness surveillance among adults in the United States. MMWR 2011;60(Suppl):1–29.
  6. Kessler RC, Birnbaum H, Bromet E, et al. Age differences in major depression: results from the national comorbidity surveys replication (NCS-R). Psychol Med 2010;40:225–37.
  7. Baca-Garcia E, Perez-Rodriguez MM, Keyes KM, et al. Suicidal ideation and suicide attempts in the United States: 1991–1992 and 2001–2002. Mol Psychiatry 2010;15:250–9.

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