It’s a ruff job.

Veterinarians under 45 report greater rates of “serious psychological distress” than the general population, according to a new mental health and wellbeing study presented at the 2018 Veterinary Meeting & Expo Tuesday — and just 41% overall are willing to recommend the profession to friends or family. The top two concerns among vets, per the research conducted by Merck Animal Health and the American Veterinary Medical Association: high student debt and stress levels.

While about 5% of veterinarians struggle with serious psychological distress — jibing roughly with the employed general population — younger vets fare far worse than the general population and their older male counterparts, with 8.6% of those aged 18 to 34 and 9.1% of those aged 35 to 44 reporting distress. Among the nationally representative sample of more than 3,500, depression (94%), compassion fatigue and burnout (88%) and anxiety and panic attacks (83%) topped the list of conditions reported by those distressed.

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“We deal with life and death, whether that be livestock or whether that be someone’s beloved pet,” study investigator Dr. Linda Lord told Moneyish. “Those things can certainly weigh heavily on somebody.”

Sixty-seven percent of younger veterinarians identified student debt as a critically important issue, a concern in line with AVMA’s estimate that the average U.S. vet student in 2017 graduated an average of $138,067 in the hole; meanwhile, veterinarians’ average starting salary that year was around $76,000. (Veterinary medicine has the highest debt-to-income ratio of all the medical fields, according to a 2013 New England Journal of Medicine study.)

The next most pressing issues facing younger vets were stress levels (53%) and suicide rates of veterinarians (52%). About one in six American veterinarians might have contemplated suicide, according to a 2014 Centers for Disease Control study, while a 2010 paper pegged British veterinarians’ suicide rates at about four times that of the general public and double the rate of other health care professions.

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But just half of veterinarians in the Merck study suffering from serious psychological distress — measured by the Kessler Psychological Distress Scale — said they were seeking help. And less than one in five had sought mental health or wellbeing resources via state or national vet groups. There’s likely still “some perceived and probably somewhat real stigma around mental health and seeking resources,” Lord said; plus, the job’s demands can make it “difficult to get out of work and go see someone.”

Going forward, the researchers recommended, vet organizations can better advertise their wellness resources and work to alleviate student debt; employers, for their part, can educate workers on mental health issues, allow time off for doctor’s appointments, discuss and establish healthy work-life balance expectations, and launch new-employee mentoring programs. On an individual level, veterinarians can draw up stress-management plans; make time for friends, family and exercise; and enlist a financial planner. Caregiving should also be “about ourselves,” Lord said, “and not just for the animals that we care for.”