A qualitative study exploring the perceived effects of veterinarians' mental health on provision of care.

Introduction: Veterinary medicine is a rewarding, yet demanding profession with a myriad of occupational stressors that can impact the mental health of veterinarians. Stress, mental health outcomes, and associated risk factors amongst veterinarians have been well-researched. Much less research has investigated how high stress and/or poor mental health can impact veterinarians' provision of care. Methods: One-on-one research interviews were conducted with 25 veterinarians at a Canadian veterinary conference in July 2016 and verbatim transcripts were produced from the audio recordings. The research team collaboratively analyzed the interviews using thematic analysis. Results: Five themes described the perceived impacts of high stress and/or poor mental health: perceived negative impacts on interactions with (1) co-workers and (2) clients; (3) reduced concentration; (4) difficulty in decision making; and (5) reduced quality of care. Discussion: These results highlight the perceived impacts of self-reported high stress and/or poor mental health on veterinary team dynamics, the potential to impact case outcomes, and possibly endanger patient safety. Interventions to help mitigate the impacts of high stress and poor mental health are discussed.

Laparoscopic adrenalectomy for resection of unilateral noninvasive adrenal masses in dogs is associated with excellent outcomes in experienced centers.

OBJECTIVE: To report the short- and long-term outcomes of laparoscopic adrenalectomy (LA) for resection of unilateral adrenal masses and to document risk factors for conversion and peri- and postoperative morbidity. ANIMALS: 255 client-owned dogs. METHODS: Dogs were included if LA was attempted for resection of a unilateral adrenal mass. Medical records were evaluated and relevant data were reported, including complications, conversion, perioperative death, and long-term outcomes. Signalment, clinicopathological data, and surgical experience were factors statistically evaluated for possible associations with capsular penetration during surgery, conversion, surgical time, duration of hospital stay, death prior to discharge, mass recurrence, and survival time. RESULTS: 155 dogs had left-sided tumors, and 100 had right-sided tumors. Conversion to an open approach was performed in 9.4% of cases. Capsular penetration (19.2%) and major hemorrhage (5.4%) were the most prevalent intraoperative complications. Of the dogs operated on, 94.9% were discharged from the hospital. Lesion side, portion of the gland affected, and surgeon experience influenced surgical time. Conversion rate increased with increasing body condition score and lesion size. Risk of death prior to discharge increased with increasing lesion size. Risk of conversion and death prior to discharge were lower when performed by more experienced surgeons. Capsular penetration during LA increased the risk of tumor recurrence. CLINICAL RELEVANCE: LA for resection of unilateral adrenal masses is associated with excellent outcomes in experienced centers. Surgeons with greater experience with LA have lower surgical times, conversion rates, and risk of death prior to discharge.

"Farmers Aren't into the Emotions and Things, Right?": A Qualitative Exploration of Motivations and Barriers for Mental Health Help-Seeking among Canadian Farmers.

Working in agriculture has been associated with an increased prevalence of psychological distress and mental health concerns. Farmers are also less likely than non-farmers to seek-help for their mental health. Previous research examining help-seeking among farmers has focused predominantly on male farmers, and has not included many of the Canadian agricultural commodity groups or provinces. The goal of this study was to explore perceptions of farmer help-seeking for mental health amongst farmers and people who work with farmers. The study objectives were to characterize the motivations and barriers to help-seeking behaviours. Semi-structured interviews were conducted with 75 farmers and individuals who work with farmers in Ontario, Canada, between 2017 and 2018. Interviews were conducted in person, and by telephone when needed. Topics of discussion included farming stresses and their impacts; personal well-being; agricultural crises and mental health help-seeking; use of mental health supports; motivators and barriers to help-seeking; and perceived ideals for mental health supports. Thematic analysis was conducted collaboratively by three authors using inductive and deductive coding. Our analysis resulted in five themes around help-seeking motivations and barriers: 1) Accessibility of mental health supports and services; 2) Stigma around mental health in the agricultural community; 3) Anonymity and/or lack of anonymity in seeking support; 4) Farm credibility; and 5) Recommendations for implementing mental health services for the agricultural community. This study provides insights around how farming culture and the accessibility and delivery of services may influence help-seeking for mental health, and proposes strategies to break down barriers to help-seeking in this population.

Mental Health and Substance Use of Farmers in Canada during COVID-19.

Farmers in Canada faced higher levels of mental distress than the general public prior to the Coronavirus Disease 2019 (COVID-19) pandemic and are generally less likely than the public to seek help. However, the mental health impacts of COVID-19 on farmers in Canada remain unexplored. Our objective was to investigate mental health outcomes among farmers in Canada by gender and within the context of COVID-19. We conducted a national, online, cross-sectional survey of farmers in Canada (February-May 2021). The survey included validated scales of anxiety, depression, perceived stress, burnout (emotional exhaustion, cynicism, professional efficacy), alcohol use, resilience, and questions regarding participants' perceived changes in these outcomes during the pandemic. Data were also collected on the impact of COVID-19 specific social and economic factors on mental health, help-seeking, and sense of community belonging through the pandemic. Descriptive statistics were summarized, and Chi-square analyses and t-tests were conducted to compare survey results between genders and to data collected in our similar 2016 survey and normative population data. A total of 1167 farmers participated in the survey. Participants scored more severely across scales than scale norms and the general Canadian population during COVID-19. Scale means were consistent between the 2016 and 2021 samples. Most participants with moderate to severe scores for any outcome reported worsening symptoms since the pandemic began. Women fared significantly worse than men across measures. Over twice as many women reported seeking mental health or substance use support during the pandemic than men. Participants rated the mental health impacts of all social and economic factors related to COVID-19 examined significantly (p < 0.05) differently than the Canadian public. The pandemic has negatively impacted the mental health of farmers in Canada and in ways that differ from the general population. National level and gender-specific mental health supports are needed to help improve the mental health of farmers in Canada.

Resolution, recurrence, and chyle redistribution after thoracic duct ligation with or without pericardiectomy in dogs with naturally occurring idiopathic chylothorax.

OBJECTIVE: To document outcomes of thoracoscopic treatment of idiopathic chylothorax (IC) in dogs with and without constrictive pericardial physiology (CPP) and evaluate patterns of chyle flow redistribution after thoracic duct ligation (TDL). ANIMALS: 26 client-owned dogs. PROCEDURES: In this prospective cohort study, echocardiography and cardiac catheterization were performed to document CPP in dogs with IC. Thoracoscopic TDL with pericardiectomy was performed if CPP was present (TDL/P group). Dogs without evidence of CPP underwent thoracoscopic TDL alone (TDL group). Dogs underwent preoperative, immediate postoperative, and 3-month postoperative CT lymphangiography studies when possible. Perioperative morbidity, resolution and late recurrence rates, and long-term outcome were recorded. RESULTS: 17 dogs underwent TDL, and 9 underwent TDL/P. Twenty-five of 26 (96%) survived the perioperative period. One dog died from ventricular fibrillation during pericardiectomy. Resolution rates for TDL and TDL/P were 94% and 88%, respectively (P = .55), with 1 late recurrence occurring in the TDL group in a median follow-up of 25 months (range, 4 to 60 months). On 3-month postoperative CT lymphangiography studies, ongoing chyle flow past the ligation site was demonstrated in 5 of 17 dogs, of which 1 dog developed recurrence at 13 months postoperatively. In 15 of 17 dogs, chylous redistribution after TDL was principally by retrograde flow to the lumbar lymphatic plexus. CLINICAL RELEVANCE: In dogs without evidence of CPP, TDL alone was associated with a very good prognosis for treatment of IC. In the absence of CPP, the additional benefit of pericardiectomy in the treatment of IC is questionable.

What Impacts Perceived Stress among Canadian Farmers? A Mixed-Methods Analysis.

Globally, farmers report high levels of occupational stress. The purpose of this study was to identify and explore factors associated with perceived stress among Canadian farmers. A sequential explanatory mixed-methods design was used. An online cross-sectional national survey of Canadian farmers (n = 1132) was conducted in 2015-2016 to collect data on mental health, demographic, lifestyle, and farming characteristics; stress was measured using the Perceived Stress Scale. A multivariable linear regression model was used to investigate the factors associated with perceived stress score. Qualitative interviews (n = 75) were conducted in 2017-2018 with farmers and agricultural sector workers in Ontario, Canada, to explore the lived experience of stress. The qualitative interview data were analyzed via thematic analysis and then used to explain and provide depth to the quantitative results. Financial stress (highest category-a lot: (B = 2.30; CI: 1.59, 3.00)), woman gender (B = 0.55; CI: 0.12, 0.99), pig farming (B = 1.07; CI: 0.45, 1.69), and perceived lack of support from family (B = 1.18; CI: 0.39, 1.98) and industry (B = 1.15; CI: 0.16-2.14) were positively associated with higher perceived stress scores, as were depression and anxiety (as part of an interaction). Resilience had a small negative association with perceived stress (B = -0.04; CI: -0.06, -0.03). Results from the qualitative analysis showed that the uncertainty around financial stress increased perceived stress. Women farmers described the unique demands and challenges they face that contributed to their overall stress. Results from this study can inform the development of mental health resources and research aimed at decreasing stress among Canadian farmers.

High Psychosocial Work Demands, Decreased Well-Being, and Perceived Well-Being Needs Within Veterinary Academia During the COVID-19 Pandemic.

Higher psychosocial work demands in veterinary and academic professions are associated with decreased occupational, physical, and mental well-being. COVID-19 introduced far-reaching challenges that may have increased the psychosocial work demands for these populations, thereby impacting individual- and institutional-level well-being. Our objective was to investigate the psychosocial work demands, health and well-being, and perceived needs of faculty, staff, residents and interns at the Ontario Veterinary College, in Ontario, Canada, during COVID-19. A total of 157 respondents completed a questionnaire between November 2020 and January 2021, that included the Third Version of the Copenhagen Psychosocial Questionnaire (COPSOQ-III) and open-text questions on perceived needs for well-being. Results showed that COPSOQ-III dimensions of quantitative demands, recognition, sense of community, burnout, stress, and depressive symptoms, were significantly worse in our study population than the Canadian norm. Quantitative and emotional demands, health and well-being (including depressive symptoms, stress, cognitive stress, somatic stress, and burnout), and work-life conflict were also reported to have worsened since the COVID-19 restrictions for most respondents. Females and caregivers had higher odds of experiencing increased work demands, and decreased health and well-being, compared to males and non-caregivers. However, male caregivers experienced worsened supervisor relations, compared to female caregivers. Social capital also worsened for clinical and part-time employees, compared to full-time and non-clinical employees. Respondents identified increased workload support, community-building, recognition of employees' capacities and personal needs, flexible work schedules, and consistent communication, as strategies to increase well-being during COVID-19 and generally. Overall, our findings suggest that COVID-19 has increased occupational demands, work-life conflicts, and decreased well-being in veterinary academia. Institutional-level interventions are discussed and recommended to aid individual and institutional well-being.

Tailored Mental Health Literacy Training Improves Mental Health Knowledge and Confidence among Canadian Farmers.

This study evaluated the impact of "In the Know" mental health literacy training for Canadian agriculture. We hypothesized that "In the Know" would significantly increase participants' knowledge around mental health, confidence in recognizing mental health struggles, confidence in speaking about mental health with others, and confidence in helping someone who may be struggling with mental health. "In the Know" was a 4-h, in-person program delivered by a mental health professional who also had experience in agriculture. Six sessions were offered in Ontario, Canada in 2018. Participants were farmers and/or worked primarily with farmers. A pre-training paper questionnaire was administered, followed by a post-training questionnaire at the end of the session and 3 and 6 month post-training questionnaires via email. Wilcoxon signed-rank tests were performed to compare participants' self-reported knowledge and confidence across four timepoints. "In the Know" significantly improved participants' self-reported mental health knowledge and confidence in recognizing mental health struggles, speaking to others, and helping others who are struggling immediately following training and often at 3 and 6 months post-training. This is the first study among farming populations to measure program impact with 3- and 6-month follow-ups. Given the reported associations between mental health literacy and increased help-seeking, disseminating "In the Know" more broadly across farming communities may help to increase mental health literacy and thus increase help-seeking among farmers.

A Systematic Review and Meta-Analysis of Depression among Farming Populations Worldwide.

A systematic review and meta-analysis were conducted to determine the overall prevalence of depression among farming populations globally, and explore any heterogeneity present. Eligible studies were primary research articles published in English, which involved the collection of data for the purpose of determining the prevalence of depression among a farming population. Four relevant databases were searched in January 2019. Potential for bias was assessed using a modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. From 7662 records, 72 articles were deemed relevant and had data extracted. Of these, 45 utilized the Center for Epidemiologic Studies-Depression Revised scale (CES-D/DR) to quantify depression, 42 of which were conducted in the United States (U.S.). As a result, meta-analyses were restricted to this geographic location. Substantial heterogeneity was seen in the initial whole-group analysis (I2 = 97%), and while sub-group exploration suggested a significantly higher prevalence of depression among migrant farm workers (26%, 95% CI = 21-31%) than in studies examining a non-migrant farming population (12%, 95% CI = 8-17%), substantial heterogeneity remained (I2 = 96%), indicating that the majority of between study variation was due to factors other than sampling error. Additionally, the majority of studies (81%) in migrant farm worker populations were published since 2010, while only 21% of studies in non-migrant farming populations were published in this timeframe. It is possible with recent efforts to de-stigmatize mental illness, participants in more recent studies may be more likely to self-report depressive symptoms. Hence, while it appears that migrant farmworker populations may have an elevated prevalence of depression, it is also apparent that little research in the U.S. has been done to evaluate depression among non-migrant farming populations in recent years. Perhaps a reporting bias may account for some of the difference between the two populations. A research gap also appears to exist in estimating the prevalence of depression among farming populations outside of the US. Assessment for bias at the study level revealed challenges in reporting of key study design elements, as well as potential for selection bias in the majority of studies.

Farmer Burnout in Canada.

While farmers in several countries worldwide are reported to be at higher risk for poor mental health outcomes like chronic stress, depression, and anxiety, there is a paucity of research on burnout in farmers. This cross-sectional study used an online survey administered between September 2015 and February 2016 to investigate burnout (as measured by the Maslach Burnout Inventory-General Survey (MBI-GS)) amongst farmers in Canada. The specific objectives were to measure the three components of burnout (exhaustion, cynicism, and professional efficacy), and to explore potential associated risk factors, as well as to determine the prevalence of the different burnout profiles (engaged, ineffective, overextended, disengaged, and burnout). MBI-GS results were obtained from 1075 farmers. Approximately 70% of the study sample identified as male and 30% as female, and participants were from a variety of farming commodities. Scores for exhaustion, cynicism, and professional efficacy were all higher than international norms. While 43% of participants were classified as engaged, 44% were classified in the ineffective, overextended, or disengaged profiles (i.e., intermediate profiles on the engagement - burnout continuum), and 12% were classified in the burnout profile. Risk factor results highlighted the positive effects of farmer support from spouse/romantic partner, friends, and industry. Overall, the results from this study demonstrate cause for concern with respect to farmer burnout, suggest potential avenues for intervention, and serve as a call to action to better support farmers in Canada.

Research trends in farmers' mental health: A scoping review of mental health outcomes and interventions among farming populations worldwide.

BACKGROUND: Mental health issues among farmers are identified population health concerns. While one systematic review focused on suicide in farming populations in the United States, there have been no scoping studies examining mental health in farming communities worldwide. The objectives of this scoping review were to: provide a descriptive analysis of the literature pertaining to mental health outcomes in farming populations; describe the international scope of the research; and highlight published mental health services and interventions that have been evaluated. METHODS: Following Arksey and O'Malley's scoping review framework, five major health and science platforms were used to identify studies examining mental health outcomes in farming populations, worldwide. Studies that met a priori inclusion criteria that were published prior to December 31, 2017 were included in this review. Data synthesis and descriptive statistics were conducted using STATA 15® software; proportions were calculated by country. RESULTS: The initial literature search yielded 9,906 records. After title and abstract screening, 676 articles were reviewed in-full. Of these, 341 met a priori inclusion criteria. Studies included were conducted between 1979 and 2017; the majority (265; 77.7%) were published between 2002-2017. The most frequently measured outcomes were stress (41.9%), suicide (33.1%), and depression (32.6%). Over 70% of studies that examined stress described using quantitative research methods, most predominantly, cross-sectional designs (42.7%). Approximately 64% of studies that measured suicide reported using a quantitative approach; the largest proportion of included suicide studies (33.6%) described using cohort designs. Approximately 84% of studies that measured depression described using quantitative approaches; sixty percent of these studies reported using a cross-sectional study design. Twenty included studies described a mental health service or intervention (5.9%). CONCLUSIONS: This scoping review provides a critical overview of the literature examining mental health outcomes in farming populations worldwide. Given the importance of farming and agriculture, this review can be used to ensure future research complements existing work, avoids unnecessary overlap, and begins to tackle the less-studied mental health outcomes amongst farmers. These results can guide researchers to identified gaps in research and services, leading to a more informed approach to future work, and ultimately, a more comprehensive understanding of mental health among farmers worldwide.

Prevalence of and risk factors for chronic bronchitis in a Canadian population: the Canadian Community Health Survey, 2007 to 2008.

BACKGROUND: Chronic bronchitis (CB) represents one of the respiratory disease phenotypes that affect the Canadian health care system significantly. Presently, almost 6.5% of total health care costs are related to respiratory diseases. OBJECTIVE: To determine the prevalence of self-reported CB and associated risk factors in the Canadian general population. METHODS: Data regarding individuals ≥12 years of age from the Canadian Community Health Survey, 2007 to 2008, were analyzed. CB was determined through self-reported health professional diagnosis. Information regarding covariates of importance, such as demographics, lifestyle variables and socioeconomic status, was obtained. A weighted logistic regression analysis was performed with appropriate technique for clustering effects. RESULTS: The prevalence of self-reported CB was 2.5%. A greater prevalence of self-reported CB associated with older age, female sex and white ethnic group was found. There were differences in the prevalence of self-reported CB among regions of Canada for household income, educational attainment and smoking status. CONCLUSION: The results suggest an association between ethnicity and the prevalence of CB. The associations between self-reported CB prevalence and household income, educational attainment and smoking status varied according to region of Canada.