Our study is the first approach to investigate the association of psychosocial stress, demoralization and the consumption of psychotropic substances in the veterinary profession. Due to the limited knowledge in this field we conducted a cross-sectional study using self-administered questionnaires. We obtained a high response rate of about 53% and we could find no differences between the responders and the non-responders in sex or age. Nevertheless there might be some bias due to the selection of non-responders.
Self-reported data on the consumption of alcohol, tobacco and medical drugs may be biased in the direction of what is socially desirable. For this reason, questions and instruments like the CAGE test were used which had already been proven in other studies on substance use.
To our knowledge the Demoralization Scale was used for the first time to examine the association of disturbances in the psychological state and the use of psychotropic substances.
We developed a job-specific score for psychosocial stress, which has not been formally validated. This may limit the generalizability of our results.
As changes with time cannot be considered in a cross-sectional study, the OR can provide evidence for factors influencing the results, but only restricted conclusions about the causality of these correlations are possible. It would therefore be desirable to confirm these findings by additional research.
Psychosocial stress and demoralization
Time pressure due to a heavy workload, difficulties in balancing one's professional and personal life, dealing with difficult customers and insufficient free time were regarded as causes of psychosocial stress. Veterinarians working in practices were exposed to an increased risk. More than two-thirds of the veterinarians in Germany are working in a practice [14]. During their typical work-life, veterinarians in practices deal with on-call duties and/or emergency veterinary service at the weekends. On the other hand most of the veterinarians are self-employed as the practice owner and they have to acquire their customers to compete with other practices. In addition, veterinarians in large animal practices have to deal with client home visits to treat the animals and with customers (e.g. farmers, rancher) under high economic pressure.
The probability of psychosocial stress increased with the number of hours worked per week. Veterinarians work a mean of 47.9 h per week, which is much higher than the mean figure of 39.9 h per week for fully employed persons in Germany [30].
Other studies have come to similar results. As mentioned above Trimpop et al. [6] conducted a study on accidents and stress in German veterinary practices. 778 veterinarians participated in the study and it was shown that the mean number of hours worked per week was 51.5 h and that there was a correlation between the high number of working hours and stress. Gardner and Hini [4] performed a study on work-related stress in veterinarians in New Zealand, in which 927 veterinarians took part (response 48.6%). They concluded that veterinarians suffer stress because of the number of working hours, the expectations of their customers and from unexpected events. In a longitudinal Australian study reported by Heath [5], 124 veterinarians with 10 working years after completing university were asked about their attitudes to their profession. More than two thirds reported that they suffered considerable stress from work and that they had difficulty in combining their professional and personal lives.
About 6% of veterinarians reached high values of demoralization. In other words, they often suffer from symptoms of demoralization. Demoralized veterinarians report that they are often dissatisfied with themselves. According to Gardner und Hini [4], the expectation of themselves was a factor which caused stress in veterinarians.
Risk factors for demoralization include moderate and, especially, intense psychosocial stress. This is in accordance with the hypothesis that psychosocial stress can trigger disturbances in the psychological state. Demoralized veterinarians often work ≤ 20 h per week. On the other hand, a working time of ≥ 60 h per week has a protective effect with respect to demoralization, after correction for psychosocial stress. It should therefore be assumed that there must be a complex interrelationship between working hours and demoralization which could not be clearly mapped because of the cross-sectional design. For example, demoralization may be caused by the lack of professional demands, if lack of work leads to low working hours. Otherwise, it could be assumed that demoralized people are not able to work more and that they therefore reduced their working schedule or do not remain in the profession. Other studies have not covered the relationship between stress, working hours and demoralization.
Tobacco consumption
19.4% of veterinarians are smokers. The 2003 Telephone Health Survey, based on a randomly generated sample of 8318 persons in the resident German-speaking population (response rate 59.2%) measured the much higher prevalence of 32.5% for smokers [31].
Veterinarians belong to the upper social class and the 1998 National Health Survey found that there are fewer smokers in the social upper class (27.6%) than in the social lower class (36.8%) or middle class (32.9%). The 1988 National Health Survey was performed using a written questionnaire and a medical investigation on 7124 subjects; their social class was recorded using the Winkler and Stolzenberg multidimensional index [32].
The 1995 microcensus found the lowest prevalence of smoking in professional groups (teachers and doctors) who were comparable to veterinarians with respect to their educational standard. The microcensus is an official representational statistic; 0.5% of the resident population (95359 persons) were interviewed in 1995 on questions including their smoking habits [33].
Men and demoralized individuals exhibit an increased risk of consuming ≥ 10 items of tobacco goods per day. Other studies have also concluded that men are more often smokers and that they consume more cigarettes per day than women [22, 31, 32, 34]. The other studies did not investigate any connection between demoralization and tobacco consumption.
Alcohol consumption
90.5% of the men and 84.5% of the women had consumed alcohol during the preceding 30 days. In the 2003 Epidemiological Survey on Substance Abuse, 8061 persons (response 55%) in the resident German population were asked about their consumption of illegal drugs, alcohol, tobacco and narcotics. It was found that 86.8% of the men and 79.1% of the women drank alcohol during this period [23]. According to this, veterinarians drink alcohol more often than the rest of the population.
High-risk alcohol consumption, regular binge drinking and the CAGE test
In contrast to other studies, it was striking that the female veterinarians more often reported high-risk consumption than their male colleagues (33.3% versus 30.3%). However, the 1988 National Health Survey found that women of high socioeconomic status (30%) more often practice high-risk alcohol consumption than women of intermediate (14%) or lower status (9%). The influence of socioeconomic status is apparently less marked for the male consumers (higher status: 35%, intermediate status: 29%, lower status: 32%) [25].
According to Lademann and Kolip, high alcohol consumption may be traditionally more a male role, but the recent behaviour of women of higher socioeconomic status may indicate that this level of alcohol consumption is also compatible with the female role [34].
6.9% of veterinarians engage regularly in binge drinking. These were mostly men. In the 2003 Epidemiological Survey on Substance Abuse, about twice as many persons (12.9%) regularly practiced binge drinking, including a majority of men [23].
The risk of regular binge drinking in veterinarians is markedly increased for veterinarians under intense psychosocial stress. Psychosocial factors at the workplace and problematical alcohol consumption by men was also investigated by a cross-sectional study using the data of the pilot HAPIEE Study (Health, Alcohol and Psychosocial factors In Eastern Europe). Data were analysed from 694 men from Russia, Poland and the Czech Republic. It was found that there was a association between effort-reward imbalance at work and increased alcohol consumption [9]. Most recently, a cross-sectional study by Frone [35] based on a sample of 2790 workers from the National Survey of Workplace Health and Safety (U.S.) (response rate 57%), explored the relations of 2 work stressors (work overload and job insecurity) to employee alcohol use. The results fail to support a relation between work stressors and the overall measures of alcohol use, but the results support a relation between work stressors and alcohol use during the workday and after work [35].
According to the CAGE test, the alcohol consumption of 13.0% of veterinarians is problematical. Problem drinkers – both men and women – exhibit a mean alcohol intake in excess of the threshold for high-risk alcohol consumption. In addition, demoralization is a risk factor for problematical consumption according to CAGE.
In a study on substance use by doctors during practical training, in which 431 persons (response rate 51%) provided information, the alcohol consumption of 13% was problematical according to the CAGE test. This group also more often reported that their psychological state was poor or moderate [12].
In contrast, the prevalence of problematical consumption according to CAGE in the general population is lower. Kraus et al. [24] performed a study on alcohol use and the association between onset of use and alcohol-related problems in a general population sample in Germany. In this study 7501 persons were asked about their alcohol consumption. This was based on telephone interviews between 1994 and 1996, using the CAGE test. According to the CAGE test, 8.1% of the population were problem drinkers.
A prospective British study investigated whether psychosocial factors at the workplace influence problematical alcohol consumption. 7372 civil servants (response 72%) took part at all three times of data recording. A correlation was found for men between problematical alcohol consumption according to CAGE and effort-reward imbalance at work. There was a similar trend for women, although this was not significant [8].
Regular medical drug use
About one in five veterinarians (19.8%) reported regular medical drug use, with analgesics being by far the most important group. Women more often take drugs regularly. Veterinarians in practice are more often affected than their colleagues in a non-clinical area of work. Most of the drugs are taken without medical prescription. The risk of drug consumption is increased for persons under psychosocial stress and for demoralized persons.
Other studies have reached similar conclusions. In the study with doctors in training, 19.0% reported regular use. Most of these were women. Analgesics were most often taken. For 93% of subjects, the analgesics were taken as self-medication [12].
In the 2003 Epidemiological Survey on Substance Abuse, 16.8% of persons regularly took drugs. Women reported more regular drug intake. Analgesics were more often taken than other drugs. In addition the Survey employed four questions which reflected a drug-orientated way of life. 6.8% of those questioned reported that they only felt "half human" without drugs; 9.6% thought they were unable to master the day without drugs; 7.3% could not do without sedatives or tranquilizers in some situations [29].