Professional help-seeking behavior for mental health problems among veterinarians in Norway: a national cross-sectional study (the NORVET study) | BMC Public Health

To taste

The sample included all veterinarians in Norway with a valid license as of May 2020 (not= 4256), according to the Norwegian Food Safety Authority. Veterinarians were excluded for the following reasons: no residential address in Norway (not= 527), unknown address (not= 196), working abroad (not= 62), or deceased (not= 7). This resulted in an eligible sample of 3464 veterinarians.


A 12-page questionnaire, information sheet and prepaid envelope were distributed by mail in November 2020. The information sheet included contact details for a psychiatrist from the research group and the support network of colleagues from the Norwegian Veterinary Association. Reminders were sent in January and February 2021. Five sports store gift cards were placed in a raffle to increase the response rate. An external company managed both the data collection and the awarding of prizes. Respondents returned their questionnaires in a sealed envelope, and the identity of the respondents was not known to the researchers. The complete questionnaire can be found elsewhere [22].

Instruments – dependent variable

Our primary dependent variable was mental health problems requiring treatment and help-seeking for such problems, first used by physicians [26] and later a slightly modified version was validated in the same craft [15, 27]. Veterinarians were asked the following questions, consistent with previous studies [15, 27]: ‘If you had mental health problems in the past year, did you seek/receive help for this?’ The question had five response options from 1 to 5, indicating a higher level of care perceived and/or received with increasing scores: 1. “Did not have a significant mental health problem”, 2. “No did not ask for help despite having needed it’, 3. ‘Yes, general practitioner consulted’, 4. ‘Yes, psychologist/psychiatrist consulted’, 5. ‘Yes, was admitted to a psychiatric hospital’. In case of multiple answers to this question, the highest level of care was retained for the analyses.

To assess the prevalence of mental health problems requiring treatment, we divided the above variables into people needing or having sought help (response option 2 to 5) and people without a significant mental health problem (response option 1 ). To assess the prevalence of help-seeking among those who felt they needed treatment (i.e. those who answered 2 to 5), we calculated a dichotomy between those who had actually sought help (answers 3 to 5 = 1) and those who had not asked for help (answer 2 = 0). This dichotomy was used as the dependent variable in the logistic regression analyses.

Severe suicidal thoughts were measured by a modified version of the fourth question of Paykel’s Suicidal Thoughts and Attempts Questionnaire [28, 29]: ‘Have you ever, in the last year, reached the point where you have seriously considered taking your own life, and even made plans on how you were going to do it?’ The answers were never, almost never, sometimes or often. Responses were dichotomized into never and any frequency in accordance with Paykel’s original work.

For those who reported having mental health problems requiring treatment, an additional question was asked: “To what extent do you think the following factors contributed to your difficulties? » ; the factors were: 1. ‘Personal problems’, 2. ‘Family problems’, 3. ‘Social problems’, 4. ‘Work problems’, 5. ‘Other problems’. Each of the factors was scored on a five-point ordinal categorical scale ranging from “not at all” (1) to “completely” (5). The responses were dichotomized into “Not at all”, “A little” and “Fairly” (0) and “Fairly” and “A lot” (1), in order to clearly identify the factors that had a significant contribution, according to the studies [22, 30].

Independent variables – individual factors

The Norwegian Research Data Center required the use of age intervals to keep the data unidentifiable. Therefore, age was reported using the following ranges: 20–25, 26–30 (…) up to 66–70 and > 70 years. In the regression analysis, we entered age as a continuous variable because age can be viewed as an ordinal and because using age categories would have generated an excessive number of effect estimates for our model. In this study, marital status was dichotomized into married/cohabiting and single/divorced/separated/widowed.

Personality trait reality weakness was measured using the nine-item reality weakness dimension of Torgersen’s Basic Character Inventory (BCI) [31]. Each item has a dichotomous (“agree”/”disagree”) response, with a total score ranging from 0 to 9. BCI-Reality weakness is a deviant trait related to perceptions and ideations at the boundary between reality and fantasy; this dimension is associated with chronic delusions, paranoid traits, and traits related to severe personality disorders [21, 32]. Examples of items on this scale are “I feel lonely most of the time” and “Sometimes I feel like I’m not myself”. This measure predicts emotional disturbances in doctors, such as severe suicidal thoughts, severe depression, and lack of help-seeking [32].

Mental distress (anxiety symptoms and depressive symptoms) over the past 14 days was measured using the SCL-5, a five-item version of the Symptom Checklist-25 [33]. This five-item version is based on a factor analysis by Tambs and Moum [34], and contains questions about how bothered by the following: 1. ‘Too much worry about things’. Each item was measured on a scale ranging from “not at all” (1) to “completely” (5). Previous studies have validated this version in medical students and doctors in Norway. [35, 36].

Attitudes toward mental illness have been studied using two items originally used in public health surveys in the United States [37]as well as in American veterinarians [8]. Veterinarians were asked to rate their level of agreement with the following statements: 1. “Treatment can help people with mental illness lead normal lives”, 2. “People are generally caring and compassionate towards people with mental illness”. The response categories were ‘strongly agree’, ‘somewhat agree’, ‘unsure/undecided’, ‘somewhat disagree’ and ‘strongly disagree’, coded from 1 to 5, respectively. The response scales for the two items were reversed, meaning that increasing values ​​on the scale indicated a more positive attitude. It was then entered as continuous variables in the regression models, with increasing values ​​on the scale indicating more positive attitudes towards both statements.

Work-related factors

The main area of ​​work reported was ‘companion animal practice’, ‘production animal practice’, ‘mixed clinical practice’, ‘equine practice’, ‘aquaculture’, ‘public administration’, ‘academic/research’, ‘ retirees” and “the others” [22]. Those who classified themselves as retired were excluded from the logistic regression analyses. In the regression analyses, ‘mixed clinical practice’ was chosen as the reference category, as it could be considered the most traditional veterinary work in Norway.

Job stress was measured using a modified version of Cooper’s Job Stress Questionnaire [26, 38]with minor adaptations to the working conditions of veterinarians [22]. Vets were asked how stressed 27 different situations/factors were, with responses reported on a five-point Likert-type rating scale ranging from no stress at all (1) to a source of stress extreme (5). Exploratory factor analysis with principal component extraction and varimax rotation, including scree plot assessment, identified three job stressors: emotional demands (Cronbach’s alpha = 0.87), work/life balance personal (Cronbach’s alpha = 0.86) and fear of complaints/criticism (Cronbach’s alpha = 0.88). The measure of work stress and the three sub-dimensions are explained in detail elsewhere. [22].

statistical analyzes

StataSE 16 was used for statistical analyses. Table analyzes and the χ2 test were used to test for gender differences. Bivariate and multivariate logistic regression models were used to estimate odds ratios (ORs) for associations between individual and work-related variables with seeking professional help. The following factors were used as independent variables: gender, age, marital status, mental distress, low reality, attitudes towards mental illness, main area of ​​work, and work stress. Initially, all independent variables were analyzed bivariate with the help-seeking dependent variable.

The help-seeking binary variable (“did not seek help” = 0, “asked for help” = 1) was used in two logistic regression analyses, one for the group of veterinarians who felt they needed treatment for mental health issues and one for vets reporting serious suicidal thoughts.

For the group of veterinarians reporting mental health problems requiring treatment, we performed a multiple logistic regression analysis with all the independent variables mentioned. For veterinarians reporting serious suicidal thoughts, independent variables in multiple logistic regression were limited to gender, age, marital status, mental distress, reality weakness, and primary area of ​​work (due to the limited N in this subgroup).

We tested the goodness of fit of the logistic regression models, and all models were found to be satisfactory. The significance level was set at 5% (p< 0.05). To investigate gender-specific effects, we entered two-way interaction terms between gender and the independent variables, with the main effect included in the model. Interaction terms were entered one at a time.

Professional help-seeking behavior for mental health problems among veterinarians in Norway: a national cross-sectional study (the NORVET study) | BMC Public Health

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