Age-related differences in the mental health burden among Ukrainians during war and forced migration.

Age-related differences in the mental health burden among Ukrainians during war and forced migration

Introduction

Our study focuses on the effects of the stressors of modern conditions of martial law and forced displacement on the state and mental health of Ukrainians adult. The aim of our study is to analyze the state of mental health and wellbeing of Ukrainians during war and forced migration compared, namely to determine the level of the most common mental health problems - depression, anxiety and post-traumatic stress disorder (PTSD), as well as resources for overcoming the consequences of stressful influences.

Method

We developed a conceptual model of the components of mental health and wellbeing, which became the basis for the development of an online questionnaire on the LimeSurvey platform, with using the PTSD Checklist for DSM-5 (PCL-5), the Life Events Checklist for DSM-5 (LEC-5), the Refugee Post-Migration Stress Scale (RPMS), the Brief Symptom Inventory Derogatis (BSI-18), block of open-ended socio-demographic issues, and SPSS Statistics 21.0.

Results

The sample comprised 306 Ukrainian participants. Participants were grouped by age: under 26 years and 26 years or older; and place of residence: 1) “lives in another country;” 2) “lives in Ukraine, moved;” 3) “lives in Ukraine, did not move.” Differences in symptom scores were observed between subgroups, with the smallest subgroup interpreted cautiously. Among Ukrainian people affected by armed conflicts and migrants, the most common mental disorders (CMDs), such as depression, anxiety disorders and post-traumatic stress disorder, constitute a significant proportion of serious illnesses worldwide. The results obtained in our study confirm this trend also among Ukrainians, who are currently experiencing all the difficulties of wartime.

Discussion

The findings provide a descriptive comparison of psychological symptoms and perceived coping resources across different age and residential groups of Ukrainians adult in the condition of war. Resource-oriented to mental health assessment and intervention for war-affected populations is important, contributing to understanding adaptive functioning in the context of protracted armed conflict and may nevertheless inform future research and support planning for war-affected populations.

1Introduction

The war in Ukraine in recent years has triggered many stressors that have a powerful impact on the wellbeing and mental health of Ukrainians, both those who have remained in Ukraine and those who have been forced to migrate in search of safe haven. Unfortunately, living in Ukraine during the war and seeking safe haven and resettlement have a powerful impact not only on the wellbeing of people, but also on their mental health. And this is natural, as prolonged life in stressful conditions can usually have both immediate and long-term consequences. It has been proven that populations affected by war often experience extreme and chronic stress.

Various consequences of the war, such as the death of a loved one, displacement of family, damage to property or other valuable assets, lack of psychological preparedness for a man-made disaster, lack of social support, negative coping skills, and others, can negatively affect the mental health of the Ukrainian population (1). Thus, according to research, war-affected people are at high risk of mental health complications, including post-traumatic stress disorder (PTSD), anxiety and depression (2, 3). A study by Peek (4) found that children, adolescents and women experience various behavioral, psychological and emotional problems and instability after any type of disaster. Emotional instability, stress reactions, anxiety, trauma and other psychological symptoms are often observed after disasters and other traumatic experiences (5). In a systematic review of the mental health of war refugees, Bogic et al. (6) found that psychological disorders such as post-traumatic stress disorder, depression and unspecified anxiety disorders were generally very common among war refugees, even after years of resettlement.

According to the results of the meta-analysis (5) was estimated that the prevalence of mental disorders (depression, anxiety, post-traumatic stress disorder) was 22.1% at any point in time in the conflict-affected populations assessed. They estimated that approximately one in five people in post-conflict settings has depression, anxiety disorder, post- traumatic stress disorder According to a study conducted among Ukrainian refugees in the Czech Republic: 51% of Ukrainian refugees have depressive conditions, but only 14% admit it by self-assessment; 23% of Ukrainian refugees have high and very high levels of anxiety (7).

Adolescents and young adults are considered by the (8, 50, 56) to be at high risk of mental disorders, including depression, anxiety and conduct disorders. Ukrainian youth are, of course, the most affected by the full-scale invasion, as they are directly responding to the ongoing crisis, while the psychological impact of the war on the populations of neighboring countries, especially in Central Europe, cannot be ignored. A study by nine reported high levels of anxiety, anger, perceived threat and compassion for the Ukrainian people in some NATO countries, i.e., Germany, Poland, the United States (US) and the United Kingdom (UK) (9, 55).

There is evidence that psychological stress, especially prolonged stress, leads to significant changes in behavioral risk factors (BRFs). Armed conflicts contribute to the spread of unhealthy behaviors such as excessive alcohol consumption, smoking, poor eating habits, lack of physical activity and sleep disturbances. These behaviors, in turn, contribute to the development of various diseases and the deterioration of public health. It is clear that young people are one of the most vulnerable groups of the population, along with children and adolescents, who are severely limited by the capabilities of the adults responsible for them. Mental health professionals are increasingly aware of the need to better understand and research the mental health needs of the population in order to be able to respond to them adequately.

It is precisely because of the urgency of mental health problems of the population affected by war and forced migration that we have seen numerous attempts over the past two decades to study, describe and structure the peculiarities of mental health manifestations in the current period.

1.1Analysis of recent research and publications

Aspects of mental health and psychosocial support for forced migrants have been studied in many works. First of all, it is important to note that there is epidemiological evidence that the population during war in their country, as well as refugees and asylum seekers during and after displacement, are disproportionately exposed to extreme stressors compared to other population groups, including significant losses and potentially traumatic events such as torture and war (6). Compared to the general population, refugees have been found to experience significantly higher levels of psychological distress, higher levels of social stress in various domains (economic, demographic, social and cultural, environmental events), as well as higher rates of several mental disorders, including post-traumatic stress disorder (PTSD), depression and anxiety (10). Compared to the general population, psychosis is also more common among people who have experienced trauma and displacement (57, 67).

This is supported by research (58), on stress resulting from both adverse or traumatic experiences prior to migration and difficulties following migration (58). There is evidence that post-traumatic stress disorder (PTSD) and other mental disorders affect at least one in three refugees (10, 48, 53). In a meta-analysis, the prevalence of post-traumatic stress disorder (PTSD) among refugees and asylum seekers was 31.46% (11). A recent study using the ICD-11 found that 36.1% of Syrian refugees and asylum seekers reported complex PTSD (59).

A number of studies have investigated the most common mental health disorders, such as anxiety disorders, acute stress recognitive disorders, personality changes, or post-traumatic stress disorder of the population during war or forced migration (60, 61). Much attention is paid to the study of distress, both before displacement and after moving to a new place (country) of residence (6, 7, 10–14, 62).

These findings are consistent with other studies that have found that anxiety and depression These findings are consistent with other studies that have found that anxiety and depression among people are common responses in people from countries experiencing crisis and war (7, 15–17) High levels of depression and anxiety have been reported among people affected by the war in Ukraine (18), particularly if respondents believe that the crisis will last a long time (19). Increased levels of depression and a tendency toward addictive behaviors (such as alcohol and drug abuse) have been reported among Ukrainian university students (17).

In recent years, many authors have naturally focused on the study of mental health problems associated with the full-scale Russian war in Ukraine, which has become one of the largest humanitarian emergencies since World War II, as statistics show that in the first 6 months of the war (2022) alone, more than 6.7 million Ukrainian refugees fled their country (20). The United Nations Children's Fund estimates that 0.5 million children became refugees in the first week of the conflict alone, 1 and the number has been growing rapidly since then.

Armed conflicts are generally perceived as public health emergencies, man-made disasters that require a significant level of international cooperation in the field of health, including mental health (21, 22).

Interestingly, the scientific-based reported prevalence of psychiatric disorders in children, adolescents, and young adults varies considerably. The prevalence of posttraumatic stress disorder (PTSD), anxiety, and depression ranges from 7.6 to 68.9%, 23.7 to 94.9%, and 4.1 to 41.2%, respectively. These significant variations may be explained by culturally mediated factors, methodological issues, and the use of different psychiatric assessment instruments.

Studies have also shown that children from low socioeconomic status families including a large number of children of forced migrants reported higher levels of distress, and that experiencing more of traumatic events increased the risk of developing PTSD. Strong social support, high levels of parental education, and positive coping strategies have been shown to be protective factors that decrease the risk of developing of PTSD and other psychological symptoms (23, 47).

Interesting results regarding the mental health problems of young people in conditions of crisis and stress in Lebanon were obtained in a systematic review of studies on this issue (24). Namely, a connection was found between the manifestations of anxiety, depression and stress, with physical pain, in young people living in crisis conditions of political and economic instability of the country.

According to the statistics data, in the world 10%−20% of people aged 18–29 have mental health problems that are associated with the feeling of physical pain. The article also compares the results of studies on this problem in Lebanon with similar studies in WEIRD countries. The data show a two-way relationship between mental health and physical pain, and that university students suffer the most from this (36.1% of studies), and 81% of studies reported a higher prevalence of pain among women. As already noted, prolonged psychological stress, one type of which is post-migration stress, leads to hormonal dysregulation, including elevated cortisol levels, which can disrupt cardiovascular and metabolic processes (25, 26), and also increase unhealthy behaviors and bad habits.

These trends are reinforced by behavioral risk factors among Ukrainians during the war, which are exacerbated by existing stressors. According to the study results, military conflicts and the stress associated with them often lead to lifestyle changes and an increase in behavioral risk factors, such as eating behavior problems, tobacco and alcohol abuse, gambling addiction, etc., problems that are also relevant for adolescents and young people (27).

In particular, according to the study, 34.7% of the subjects who constantly experienced the stress of being in war conditions reported eating problems, while 22.4% experienced weight gain and 36.2% experienced weight loss. In addition, 13.3% and 16.8% reported an increase in smoking and alcohol consumption, respectively. Sleep disturbances were reported by 72.4% of respondents, while 55.6% reported a decrease in physical activity. These are behavioral risk factors that are directly related to a decrease in quality of life of being in war conditions, social maladjustment, and traumatic experiences.

Acculturation stress, caused by separation from family due to forced migration, disruption of social ties, social isolation, changing gender roles, unemployment, loss of social status (28, 29), as well as the need to learn to navigate in a completely new community and cultural system (63), is also often the subject of research in clinical psychology in recent years. Much research is devoted to the specifics of culturally mediated mental health problems of forced migrants and refugees. The problems of mental health and psychosocial wellbeing of Syrian refugees were studied by Sijbrandij et al. (64), Eva et al. (30), the problems of Iranian refugees in the field of mental health were studied by Arnetz et al. (65), refugees - speakers of Arabic and Farsi, who are in Germany - Boettcher and Neuner (31), the problems of Ukrainian forced migrants - Fritschi et al. (32), BFS Bundesamt (68), Kovalenko et al. (33), Spitsyna (34), Długosz (35) and others.

The results of the Polish study 2022 show that depression, anxiety disorders and post-traumatic stress disorder can be observed in 73% of respondents of Ukrainian forced migrants, 66% of respondents demonstrate psychological distress, with young respondents experiencing higher psychological distress (35). Despite the relevance and large number of studies on mental health problems in stressful and emergency situations, there has been practically no research on the most common mental health problems (CMDs) – depression, anxiety, post-traumatic stress disorder among Ukrainians, during war and forced migration.

Therefore, the purpose of our study was to describe symptoms of the most common mental health problems - depression, anxiety, post-traumatic stress disorder and subjectively perceived stress-coping resources among Ukrainians during war and forced migration, with comparisons by age group and place of residence.

2Methods

For the purposes of our study, we developed a conceptual model of mental health and wellbeing components, which became the basis for the development of an online questionnaire using the LimeSurvey platform, consisting of a series of standardized questionnaires and several blocks of open-ended socio-demographic issues, which we will name below.

The questionnaire included the PTSD Checklist for DSM-5 (PCL-5), which captures symptoms of Post Traumatic Stress Disorder and the Life Events Checklist for DSM-5 (LEC-5) (36), which is used in our study to identify the list of life events that may have been triggers in the pre-migration stressful situations experienced by our respondents. The Refugee Post-Migration Stress Scale (RPMS) (37) is used for a similar purpose, only to identify post-migration factors and as the indicator of unintended consequences of their stress. Using the Brief Symptom Inventory Derogatis (BSI-18), which is designed to assess symptoms of anxiety, depression and somatisation of our respondents (38), all questionnaires with the Ukrainian versions were validated. Statistical data processing has been carried out using computer software IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA).

3Results

The sample included Ukrainians adults, including young adults who were living either in Ukraine or were forced to migrate abroad. Participants were recruited through online channels, including personal and professional networks, social media, and non-governmental organizations, using a non-random sampling strategy (snowball method). Eligible participants were individuals who: (1) were Ukrainian citizens; (2) met the specified age criteria; (3) lived in Ukraine or were abroad following forced displacement/migration; and (4) were able to read the study information and provide electronic informed consent. In addition, incomplete questionnaires were excluded from the calculation of the overall results. Participation was voluntary and anonymous.

A total 306 participants completed the survey (see Table 1). For analysis, participants were divided into two age groups:

Table 1Characteristics of the sample by age and place of residence.

Variable Category N

Age age < 26 94

age ≥ 25 212

Place of residence Lives in another country 74

Lives in Ukraine, moved 44

Lives in Ukraine, not moved 188

Total 306

1) “age < 26;” 2) “age ≥ 25.”

And also into three groups by place of residence:

1) “lives in another country;” 2) “lives in Ukraine, and has moved to a safer location;” 3) “lives in Ukraine, has not moved.”

In addition, it can be noted that our sample consisted mainly of women, with Ukrainian citizenship, from 18 to 60 years old, the total number of N = 290, among which: 1) “lives in another country”- 75 persons; 2) “lives in Ukraine, and has moved to a safer location” - 42; 3) “lives in Ukraine, has not moved” - 173 persons. Besides, the age characteristics of the groups of women we identified are also interesting, namely: the average age of women Age M (SD) who 1) migrated to other countries - 35.3 years; 2) “lives in Ukraine, and has moved to a safer location” - 27.6 years; 3) “lives in Ukraine, has not moved” - 35.0 years.

Also, useful and interesting may be the data on education in our sample, which demonstrated a fairly high level of education among the groups of women we identified, namely: those with higher education, at least a Bachelor's degree, among those who 1) migrated to other countries - 109 people (63.0%); 2) “live in Ukraine and moved to a safer place” - 20 (46.6%); 3) “live in Ukraine, did not move” - 53 (70.7%). These data allow to more fully characterize our study sample, both as a whole and by various subgroups.

Descriptive comparisons showed symptoms of depression, anxiety, and PTSD among our participants. As we have already noted above, among people affected by armed conflicts and forced migrants, the most common mental disorders (CMDs), such as depression, anxiety disorders, and post-traumatic stress disorder, constitute a significant proportion of serious illnesses worldwide (7, 10, 69). The results obtained in our study confirm this trend also among Ukrainians, who are currently experiencing all the hardships of wartime.

The descriptive results indicated differences between subgroups. Results obtained show that Ukrainian forced migrants living in another country have a higher score on the depression scale compared to other population groups (mean 1, 41). Including the group of young migrants under 26 years of age (18–26) (mean 1, 31). This can be seen even more clearly in the diagram Figure 1, compared to the indicators of the groups of people who remained in Ukraine - both those who moved to a safer place and those who stayed at home (Figure 2).

The prevalence of depressive/anxiety symptoms among forced migrants is usually higher than among the most at-risk groups in the local population. For example, 39 note in Table 2 their study that among the refugee population, 45% of adults in the Czech Republic have symptoms of moderate depression or moderate anxiety. The mental state of forced migrants is also influenced by the circumstances that preceded their migration (pre-migration factors), whether some of their relatives remained in Ukraine, whether any of the family members suffered: whether all family members are alive, whether they ended up in the zone of direct military action or occupation, whether their property and housing were preserved, whether their work/study was preserved, etc (see Table 3).

Table 2Descriptive statistics on the depression scale for different age groups & place of residence.

Age group Place of residence M SD n

Age < 26 Lives in another country 1, 31 0, 93 16

Lives in Ukraine, moved 1, 14 0, 82 24

Lives in Ukraine, not moved 1, 23 0, 76 54

Total 1, 22 0, 80 94

Age ≥ 25 Lives in another country 1, 41 1, 15 58

Lives in Ukraine, moved 0, 73 0, 59 20

Lives in Ukraine, not moved 0, 70 0, 57 134

Total 0, 90 0, 83 212

Total Lives in another country 1, 39 1, 10 74

Lives in Ukraine, moved 0, 95 0, 75 44

Lives in Ukraine, not moved 0, 85 0, 67 188

Total 1, 00 0, 83 306

M, mean; SD, standard deviation; n = sample size. Calculated using alpha = 0.05.

Table 3Descriptive statistics by the anxiety scale for different age groups &place of residence.

Age group Place of residence M SD n

Age < 26 Lives in another country 1, 31 0, 88 16

Lives in Ukraine, moved 0, 91 0, 83 24

Lives in Ukraine, not moved 1, 13 0, 73 54

Total 1, 11 0, 79 94

Age ≥ 25 Lives in another country 1, 21 0, 97 58

Lives in Ukraine, moved 0, 90 0, 67 20

Lives in Ukraine, not moved 0, 92 0, 74 134

Total 1, 00 0, 81 212

Total Lives in another country 1, 23 0, 94 74

Lives in Ukraine, moved 0, 91 0, 75 44

Lives in Ukraine, not moved 0, 98 0, 74 188

Total 1, 03 0, 80 306

M, mean; SD, standard deviation; n = sample size. Calculated using alpha = 0.05.

We studied these data using the Refugee Post-Migration Stress Scale (RPSM) and a block of open-ended questions from the questionnaire, the results of the analysis of which will be available in subsequent publications.

Symptoms of depression and anxiety are closely related in populations that experience systemic chronic and catastrophic stressors such as war or man-made disasters, as well as in forced migrants (Czech Republic study). Only a minimal number of people have anxiety symptoms without suffering from depressive symptoms. Therefore, the results we obtained with the BSI anxiety scale are very similar to the results with the depression scale.

As we can see from the table, the indicators of the level of anxiety in the youth sample of forced migrants are higher than in all other groups of our Ukrainian respondents - 1.31, compared to 0.9 in the group of young Ukrainians who remained in Ukraine and moved to a safer place. At the same time, it should be noted that anxiety scores were also high in all age groups of Ukrainians who migrated abroad (mean = 1.23).

Overall, according to the results obtained, in the present sample, most participants did not meet the study threshold for elevated PTSD symptoms, whereas approximately 30% showed substantially elevated symptom scores according to the study estimates. These screening results should not be interpreted as clinical diagnoses. Interestingly that young adult Ukrainians demonstrate a significantly lower level of PTSD symptoms than older Ukrainians (see Figure 3). It is in such a situation that preventive and supportive measures in communities can have a good effect in reducing the impact of numerous stressors on young Ukrainians.

It will also be useful to consider the following block of information received regarding resources for overcoming difficult life situations that participants reported using or considering useful for coping with difficult life situations.

In addition to symptoms of mental illness, we also investigated the extent to which young adults, both those who remained in Ukraine and forced migrants, are aware of their available resources to overcome the impact of stressors. A separate block of our online questionnaire with LimeSurvey was dedicated to this aspect. Living under the influence of chronic stressors puts increased demands on young people's resilience and available resources. Therefore, an important issue that we wanted to clarify in our study is the question about resources that respondents prefer to use to overcome difficult life situations. To study the preferred available resources, we suggested the following answer options:
Your personal qualities and abilities (1)

Your beliefs and convictions (1)

Your communication and relationships with others

Your work and professional activities

Sports and physical activity

Cultural activities, creativity, art

Support from family members, friends and others (1)

Support from mental health professionals

Something else (what exactly?)

The full picture of the priorities in the resources used can be seen in Figure 4. We received interesting results about the priorities of our young respondents: in the first place, three resources were preferred, namely: reliance on your beliefs and convictions, personal qualities & abilities and social support - from family members, friends and others. The second place was shared by resources communication and relationships with others and professional activities (job).

4Discussions

The findings provide a descriptive comparison of psychological symptoms of the most common mental health problems - depression, anxiety, and PTSD and subjectively perceived stress-coping resources among Ukrainians during war and forced migration, with comparisons by age group and place of residence. Resource-oriented to mental health assessment and intervention for war-affected populations is important, contributing to understanding adaptive functioning in the context of protracted armed conflict.

This quantitative cross-sectional study provides a description of depression, anxiety, and PTSD symptoms among Ukrainian participants living in different residence contexts. Differences in levels of symptom manifestation were observed across age and residence subgroups, including a descriptive pattern of higher depression and anxiety scores among participants living abroad.

In whole, our study shows a deterioration in mental health among young Ukrainians, both forced migrants and those who stayed in Ukraine, in terms of symptoms of depression, anxiety and post-traumatic stress disorder (PTSD), which is consistent with the findings of many studies. For example, this is also consistent with the results of a Czech study (39), which found that 23% of refugees suffer from moderate anxiety symptoms, compared to 7% of Czechs. Again, anxiety is more prevalent among women, who make up over 70% of refugees in the Czech Republic. Symptoms of anxiety measured by the GAD-7 questionnaire used in their study include, among others, nervousness, worry, restlessness or irritability.

According to the accumulating evidence of worse mental health in consequence of russian war in Ukraine 2022 (40, 41, 66), Ukrainians unequivocally reported worse levels of all mental health indices compared to bordering and distal countries. Although the rate of Ukrainians screened positive for CPTSD has largely ranged across studies (40–42), in this study, it was higher for Ukrainians and bordering countries than the distal countries. Ukrainians also had the lowest resilience levels, though at comparable levels to similar studies (17).

Importantly, recent peer-reviewed studies has confirmed the association of low resilience with high levels of mental health symptoms in a variety of traumatic/stressful contexts (43, 51, 54). There are also other explanations, such as the cumulative and/or overlapping impact of other factors on mental health (e.g. COVID-19) (66). According to the Conservation of Resources (COR) theory (49), the consequences of military events are intertwined with resource losses, which again and again activate stress reactions (49, 52). That is why, in the context of extreme resource loss in consequence of the war, when researchers note the insurmountable stress and depletion of Ukrainians' resources that results from this (44, 45), we believe it is very important to study the “treasure trove” of conscious resources available for use by Ukrainians right now.

In addition to studying the general level of symptoms of depression, anxiety, PTSD, somatization, etc., our conceptual model included the study of personality problems in the social context, including pre- and post-traumatic factors of migrants' psychological trauma. This allows us to take into account not only the short-term effects of stressors, but also the long-term effects of certain events (stimuli) on a person's life when conceptualizing personal outcomes. The results of our study are in line with those of our Swiss and Ukrainian colleagues. Thus, according to the results of a resent studys in 2023 (32, 68), the situation of Ukrainian refugees in Switzerland is characterized by a really high level of exposure to stress factors, which can still be stabilized in a certain sense with the help of primary support services. It is important to understand that for such a large and diverse group of people as refugees and migrants, there is an increased risk of mental health problems under certain conditions. Some of the most common stressors for this group of internally displaced people in Ukraine include difficulties finding work, financial difficulties, lack of a sense of belonging to the host community, family conflicts, low mood, alcohol abuse, fear of the future, loneliness and feelings of loss - all of which can, and often do, increase the risk of mental health problems. A recent study shows that mental disorders among internally displaced persons are significantly associated with cumulative traumatic experiences, more recent displacement, and poor economic status (46).

Our results indicate deterioration in the mental health of Ukrainians, which is consistent with other studies. In addressing the psychological health of youth, it is important to focus on early systematic identification of problems. The advantage is that, unlike interventions for adults, interventions can be carried out in an educational environment, for example, at a university or college. Interventions should be aimed primarily at ensuring the social conditions of young people's lives and integration into the community, or, if necessary, directing them to professional help.

5Limitations and future research

This study has several limitations. First, sample characteristics varied significantly across subgroups, regarding both place of residence and age, - due to the chosen data collection method. It is evident that the relatively small size and unequal numbers of certain subgroups may, unfortunately, reduce the statistical power of comparisons and make the results more sensitive to potential deviations from the assumptions underlying parametric methods. Consequently, results pertaining to the smallest subgroups should be regarded primarily as preliminary descriptive trends that require confirmation in larger and more balanced samples. This applies particularly to the subgroup of participants under the age of 26 residing abroad (comprising only 16 individuals), consequently, the data obtained for this group can be interpreted only as preliminary. Second, the study relied on self-report scales rather than clinical diagnoses, which is acceptable for psychological and psychosocial research, but also has interpretative limitations in the psychiatric field. Third, it should also be noted that the cross-sectional study design limits the assessment of changes in mental health over time and does not support causal relationships. In addition, access to some sociodemographic and migration variables collected via LimeSurvey was technically limited at the time of analysis; therefore, their potential impact could not be fully explored. These limitations should be taken into account when interpreting the study results.

We hope that most of these limitations can be overcome in future studies, which would benefit from the following. First, it is advisable to use a longitudinal study design to assess changes in mental health over time and distinguish between the effects of war, displacement, and adaptation. Second, future work could include more detailed studies of the effects of socio-economic status, prior mental health status, access to services, etc. Third, it would be desirable to combine online and offline recruitment and implement procedures to check for uniqueness of responses. Finally, resource orientation in mental health assessment and intervention for war-affected people should become an important basis for future research and planning of psychosocial support for Ukrainians.

6Conclusions

The findings provide a descriptive comparison of psychological symptoms and perceived coping resources across different age and residential groups of Ukrainians adult in the condition of war. Our study showed that Ukrainians, both those who forced migrated abroad and those who have stayed in Ukraine, have higher rates of manifestation of the most common mental health problems (CMDs), including depression, anxiety disorders and post-traumatic stress disorder. These scores are higher for young Ukrainians who have migrated on depression and anxiety scales. It is also important that, given the context of protracted armed conflict, loss and depletion, resource-oriented in mental health assessment and intervention for war-affected people is important, contributing to understanding adaptive functioning in these conditions and may be a good basis for future research and planning psychosocial support for Ukrainians.

References

1.Bryant RA Schnurr PP Pedlar D . Addressing the mental health needs of civilian combatants in Ukraine . Lancet Psychiatr. (2022 ) 9 :346 –7 . doi: 10.1016/S2215-0366(22)00097-9 35305300

2.Riad A Drobov A Krobot M Antalová N Alkasaby MA Perina A . Mental Health Burden of the Russian– Ukrainian War 2022 (RUW-22): anxiety and depression levels among young adults in central Europe . Int J Environ Res Public Health. (2022 ) 19 :8418 . doi: 10.3390/ijerph19148418 35886269 PMC9318466

3.Morina N Stam K Pollet TV Priebe S . Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions . A systematic review and meta-analysis of epidemiological studies J Affect Disord. (2018 ) 239 :328 –38 . doi: 10.1016/j.jad.2018.07.027 30031252

4.Peek L . Children and disasters: understanding vulnerability, developing capacities, and promoting resilience . Child Youth Environ. (2008 ) 18 :1 –29 . doi: 10.1353/cye.2008.0052

5.Makwana N . Disaster and its impact on mental health: a narrative review . J Fam Med Prim Care. (2019 ) 8 :3090 . doi: 10.4103/jfmpc.jfmpc_893_19 31742125 PMC6857396

6.Bogic M Njoku A Priebe S . Long-term mental health of war-refugees: a systematic literature review . BMC Int Health Human Rights. (2015 ) 15 :29 . doi: 10.1186/s12914-015-0064-9 26510473 PMC4624599

7.Charlson F van Ommeren M Flaxman A Cornett J Whiteford H Saxena S . New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis . Lancet . (2019 ) 394 :240 –8 . doi: 10.1016/S0140-6736(19)30934-1 31200992 PMC6657025

8.WHO. Mental Health: Strengthening Our Response (2022 ). Available online at: https://www.who.int/news-room/fact-sheets/ detail/mental-health-strengthening-our-response. (Accessed June 17, 2022).

9.Moshagen M Hilbig BE . Citizens' Psychological Reactions following the Russian invasion of the Ukraine: a cross-national study . PsyArXiv. (2022 ) 1 :20 . doi: 10.31234/osf.io/teh8y

10.Turrini G Purgato M Acarturk C Anttila M Au T Ballette F . Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis . Epidemiol Psychiatr Sci. (2019 ) 28 :376 –88 . doi: 10.1017/S2045796019000027 30739625 PMC6669989

11.Blackmore R Boyle JA Fazel M Ranasinha S Gray KM Fitzgerald G . The prevalence of mental illness in refugees and asylum seekers: a systematic review and meta-analysis . PLoS Med . (2020 ) 17 :e1003337 . doi: 10.1371/journal.pmed.1003337 32956381 PMC7505461

12.Carta MG Moro MF Bass J . War traumas in the Mediterranean area . Int J Soc Psychiatr. (2015 ) 61 :33 –8 . doi: 10.1177/0020764014535754 24869846

13.Sangalang C Becerra D Mitchell M Lechuga-Peña S Lopez K Kim I . Trauma, post-migration stress, and mental health: a comparative analysis of ref- ugees and immigrants in the United States . J Immigrant Minority Health. (2019 ) 21 :909 –19 . doi: 10.1007/s10903-018-0826-2 30244330

14.Wu S Renzaho AMN Hall BJ Shi L Ling L Chen W . Time-varying associations of pre-migration and post-migration stressors in refugees' mental health during resettlement: a longitudinal study in Australia . Lancet Psychiatr. (2021 ) 8 :36 –47 . doi: 10.1016/S2215-0366(20)30422-3 33156999

15.Bareeqa SB Ahmed SI Samar SS Yasin W Zehra S Monese GM . Prevalence of depression, anxiety and stress in China during COVID-19 pandemic: a systematic review with meta-analysis . Int J Psychiatry Med . (2021 ) 56 :210 –27 . doi: 10.1177/0091217420978005 33243029

16.Marie M Saad Adeen S Battat M . Anxiety disorders and PTSD in Palestine: a literature review . BMC Psychiatry. (2020 ) 20 :509 –18 . doi: 10.1186/s12888-020-02911-7 33066736 PMC7566157

17.Kurapov A Pavlenko V Drozdov A . Toward an understanding of the Russian-Ukrainian war impact on university students and personnel . J Loss Trauma. (2022 ) 28 :167 –74 . doi: 10.1080/15325024.2022.2084838

18.Chaaya C Thambi VD Sabuncu Ö Abedi R Osman AOA Uwishema O . Ukraine–Russia crisis and its impacts on the mental health of Ukrainian young people during the COVID-19 pandemic . Ann Med Surg. (2022 ) 79 :104033 . doi: 10.1016/j.amsu.2022.104033 35765517 PMC9221679

19.Shuster A O'Brien M Luo Y Berner A Perl O Heflin M . Emotional adaptation during a crisis: decline in anxiety and depression after the initial weeks of COVID-19 in the United States . Transl Psychiatry. (2021 ) 11 :1 –7 . doi: 10.1038/s41398-021-01552-y 34417441 PMC8377451

20.UNHCR. Ukraine Situation (2022 ). Available online at: https://www.unhcr.org/publications/remarks-mr-antonio-guterres-united-nations-high-commissioner-refugees-european-union (Accessed May 28, 2022).

21.WHO. Adolescent Mental Health (2022 ). Available online at: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health (Accessed May 28, 2022).

22.Martin ML . Child participation in disaster risk reduction: the case of flood-affected children in Bangladesh . Third World Q. (2011 ) 31 :1357 –75 . doi: 10.1080/01436597.2010.541086 21506299

23.Osokina O Silwal S Bohdanova T Hodes M Sourander A Skokauskas N . Impact of the Russian invasion on mental health of Ad- olescents in Ukraine . J Am Acad Child Adolesc Psychiatr . (2023 ) 62 :335 –43 . doi: 10.1016/j.jaac.2022.07.845 36441074

24.Tandon T Rouhana Y Rahme E Zalaket N Martin-Soelch C . Youth mental health in crisis: understanding the relationship between mental health and physical pain in Lebanon's youth—A scoping review . Int J Public Health . (2025 ) 70:1608156. doi: 10.3389/ijph.2025.1608156 40313789 PMC12043447

25.WHO. Preventing Violent Conflict-The Search for Political Will, Strategies and Effective Tools (2022 ). Available online at: https://iris.who.int/server/api/core/bitstreams/324896d0-3227-4446-bb16-d4d42743738f/content (Accessed March 10, 2022).

26.Mourani SC Ghreichi MC . Mental health reforms in lebanon during the multifaceted crisis . Arab Reform Initiative. (2021 ) 13 :87 .

27.Kolesnikova O Vysotska O Radchenko A Zaprovalna O Emelyanova N . Prevalence of behavioral risk factors among Ukrainians during war amid existing stress factors . Academia Med. (2024 ) 1 :4 . doi: 10.20935/AcadMed7469

28.Redwood-Campbell L Thind H Howard M Koteles J Fowler N Kaczorowski J . Understanding the health of refugee women in host countries: lessons from the Kosovar re-settlement in Canada . Prehosp Disaster Med . (2008 ) 23 , 322 –7 . doi: 10.1017/S1049023X00005951 18935946

29.Yuzva L . Separated Families in Ukraine during the War (2023 ). Available online at: https://inter-lab-wojna-katastrofa.uken.krakow.pl/2022/12/28/separated-families-in-ukraine-during-the-war/- (Accessed September 2, 2026).

30.Eva H Mewes R Ramia JA Glaesmer H Hall B Shehadeh MH . Reporting cultural adaptation in psychological trials, The RECAPT criteria . Clin Psychol Eur. (2021 ) 3 :6351 . doi: 10.32872/cpe.6351 36405678 PMC9670826

31.Boettcher V Neuner F . The impact of an insecure asylum status on mental health of adult refugees in Germany . Clin Psychol Eur. (2022 ) 4 :e6587 . doi: 10.32872/cpe.6587 36397747 PMC9667345

32.Fritschi T von Bergen M Müller F Lehmann O Pfiffner R Kaufmann C . Finanzflüsse und Finanzierungsmodelle im Bereich Wohnangebote für Menschen mit Be-hinderung . Bern: BFH (2022 ).

33.Kovalenko AB Hryshchuk EY Sharapa SV . The relationship between social identity and socio-psychological adaptation in Ukrainian migrants . Ukrainian Psychol J. (2024 ) 1 :63 –97 . doi: 10.17721/upj.2024.1(21).4

34.Spitsyna L . The problematic field of psychological research on mental health and psychosocial support of forced migrants . Ukrainian Psychol J . (2024 ) 2 :132 –49 . doi: 10.17721/upj.2024.2(22).8

35.Długosz P . War trauma and strategies for coping with stress among Ukrainian refugees staying in Poland . J Migrat Health. (2023 ) 8 :100196 . doi: 10.1016/j.jmh.2023.100196 37637859 PMC10450964

36.Weathers FW Litz BT Keane TM Palmieri PA Marx BP Schnurr PP . The PTSD Checklist for DSM-5 (PCL-5) – LEC-5 and Extended Criterion A. National Center for PTSD (2013 ). Available online at: https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp (Accessed May 15, 2026).

37.Malm A Tinghög P Narusyte J Saboonchi F . The refugee post-migration stress scale (RPMS) – development and validation among refugees from Syria recently resettled in Sweden . Confl Health. (2020 ) 14 :2 . doi: 10.1186/s13031-019-0246-5 31921332 PMC6945710

38.Sereda Y Dembitskyi S . BMC Psychiatry validity assessment of the symptom checklist SCL-90-R and shortened versions for the general population in Ukraine . BMC Psychiatr. (2016 ) 16 :300 . doi: 10.1186/s12888-016-1014-3 27561313 PMC5000449

39.Kavanová M Prokop D Škvrnák M Levinský M Guerrero Z Winkler P . Voice of Ukrainians: mental health/ research among refugees . PAQ Res. (2022 ) 12 :21 .

40.Hyland P Shevlin M Martsenkovskyi D Ben-Ezra M Brewin CR . Testing predictions from the memory and identity theory of ICD-11 complex posttraumatic stress disorder: measurement development and initial findings . J Anxiety Disord. (2024 ) 105 :102898 . doi: 10.1016/j.janxdis.2024.102898 38991292

41.Karatzias T Shevlin M Ben-Ezra M McElroy E Redican E Vang ML . War exposure, posttraumatic stress disorder, and complex posttraumatic stressdisorder among parents living in Ukraine during the Russian war . Acta Psychiatr Scand. (2023 ) 147 :276 –85 . doi: 10.1111/acps.13529 36625445

42.Lotzin A Morozova-Larina O Krupelnytska L . War-related stressors and ICD-11 (complex) post-traumatic stress disorders in Ukrainian students living in Kyiv during the Russian-Ukrainian war . Psychiatry Res. (2023 ) 33330 :115561 . doi: 10.1016/j.psychres.2023.115561 37956590

43.Munk AL Schmidt NM Alexander N Henkel K Hennig J . Covid-19—Beyond virology: potentials for maintaining mental health during lockdown . PLoS ONE. (2020 ) 15 :e0236688 . doi: 10.1371/journal.pone.0236688 32750072 PMC7402475

44.Palace M Zamazii O Terbeck S Bokszczanin A Berezovski T Gurbisz D . Mapping the factors behind ongoing war stress in Ukraine-based young civilian adults . Appl Psychol. (2023 ) 16 :868 –85 . doi: 10.1111/aphw.12493 37727930

45.Palii V Velykodna M Pereira M McElvaney R Bernard S Klymchuk V . The experience of launching a psychological hotline across 21 countries to support Ukrainians in wartime . Ment Health Soc Inclusion . (2023 ) 28 :321 –25 . doi: 10.1108/MHSI-04-2023-0040

46.World Bank. Mental Health among Displaced People and Refugees: Making the Case for Action at the World Bank Group . Washington, DC: World Bank. (2017 ). Available online at: ersatz.html (Accessed Nov 14, 2017).

47.Klymchuk V Vysotska K . Decentralisation and community stakeholders' engagement for better mental health services development in the conflict-affected regions of Ukraine . J Publ Ment Health. (2022 ) 21 :288 –302 . doi: 10.1108/JPMH-06-2022-0054

48.Zouki CJ Chahine A Mhanna M Obeid S Hallit S . Rate and correlates of post-traumatic stress disorder (ptsd) following the beirut blast and the economic crisis among Lebanese University Students: a cross-sectional study . BMC Psychiatr. (2022 ) 22 :532 . doi: 10.1186/s12888-022-04180-y 35931970 PMC9356397

49.Hobfoll SE Johnson RJ Ennis N Jackson AP . Resource loss, resourcegain, and emotional outcomes among inner city women . J Pers Soc Psychol. (2003 ) 84 :632 –43 .12635922

50.WHO and United Nations High Commissioner for Refugees. MhGAP Humanitarian Intervention Guide (mhGAP-HIG): Clinical Management of Mental, Neurological and Substance use Conditions in Humanitarian Emergencies . Geneva: World Health Organization (2015 ).

51.Peterka M Peterková R Likovsky Z . Chernobyl: relationship between the number of missing newborn boys and the level of radiation in the Czech regions . Environ Health Perspect. (2007 ) 115 :1801 –6 . doi: 10.1289/ehp.10779 18087603 PMC2137097

52.Dufner M Reitz AK Zander L . Antecedents, consequences, and mechanisms: on thelongitudinal interplay between academic self-enhancement and psychological adjustment . J Personal. (2015 ) 83 :511 –22 .10.1111/jopy.12128 25181603

53.Nosè M Ballette F Bighelli I Turrini G Purgato M Tol W . Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: systematic review and meta-analysis . PLoS One. (2017 ) 12 :e0171030 . doi: 10.1371/journal.pone.0171030 28151992 PMC5289495

54.Havenaar JM Van Den Brink W . Mental health problems in the Gomel region: an analysis of risk factors in an area affected by the Chernobyl disaster . Psychol Med. (1996 ) 26 :845 –55 . doi: 10.1017/s0033291700037879 8817720

55.North Atlantic Treaty Organization (NATO). Statement by NATO Heads of State and Government on Russia's attack on Ukraine (2022 ). Available online at: https://www.nato.int/cps/en/natohq/official_texts_192489.htm?selectedLocale=en (Accessed June 30, 2022).

56.WHO. Comprehensive Mental Health Action Plan 2013–2030 (2013 ).

57.Dapunt J Kluge U Heinz A . Risk of psychosis in refugees: a literature review . Transl Psychiatry. (2017 ) 7 :e1149 . doi: 10.1038/tp.2017.119 28608852 PMC5537641

58.Porter M Haslam N . Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis . JAMA . (2005 ) 294 :602 –12 . doi: 10.1001/jama.294.5.602 16077055

59.Vallières F Ceannt R Daccache F Abou Daher R Sleiman J Gilmore B . ICD-11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire . Acta Psychiatr Scand. (2018 ) 138 :547 –57 . doi: 10.1111/acps.12973 30357808

60.Fino E Jaspal R Lopes B Wignall L Bloxsom C . The Sexual Risk Behaviors Scale (SRBS): development & validation in a university student sample in the UK . Eval Health Prof . (2021 ) 44 :152 –60 . doi: 10.1177/01632787211003950 33853360 PMC8107449

61.Ullmann E Barthel A Taché S Bornstein A Licinio J Bornstein SR . Emotional and psychological trauma in refugees arriving in Germany in 2015 . Mol Psychiatry . (2015 ) 20 :1483 –4 . doi: 10.1038/mp.2015.164 26527128

62.Kirmayer LJ Dandeneau S Marshall E Phillips MK Williamson KJ . Rethinking resilience from Indigenous perspectives . Can J Psychiatry . (2011 ) 56 :84 –91 . doi: 10.1177/070674371105600203 21333035

63.Murray R Caulier-Grice J Mulgan G . The Open Book of Social Innovation . London: The Young Foundation and NESTA (2010 ). Available online at: https://youngfoundation.org/wp-content/uploads/2012/10/The-Open-Book-of-Social-Innovationg.pdf

64.Sijbrandij M Acarturk C Bird M Bryant RA Burchert S Carswell K . Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries . Eur J Psychotraumatol . (2017 ) 8(sup2):1388102. doi: 10.1080/20008198.2017.1388102 29163867 PMC5687806

65.Arnetz JE Hamblin L Essenmacher L Upfal MJ Ager J Luborsky M . Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports . J Adv Nurs . (2015 ) 71 :338 –48 . doi: 10.1111/jan.12494 25091833 PMC5006065

66.Khan AR Altalbe A . Potential impacts of Russo-Ukraine conflict and its psychological consequences among Ukrainian adults: the post-COVID-19 era . Front Public Health . (2023 ) 11 :1280423 . doi: 10.3389/fpubh.2023.1280423 37841733 PMC10568327

67.Close C ., Kroll K, Bosqui T, Patel K, O'Reilly D, Donnelly M. The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews. Global Health. (2016 ) 12 :47 . doi: 10.1186/s12992-016-0187-3 27558472 PMC4997738

68.BFS Bundesamt . Migration and integration in Switzerland: 2022 edition . Available online at: https://www.bfs.admin.ch/bfs/en/home/statistics/population/migration-integration.html (Accessed March 18, 2025).

69.Whiteford HA Degenhardt L Rehm J Baxter AJ Ferrari AJ Erskine HE . Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010 . Lancet (2013 ) 382 :1575 –86 . doi: 10.1016/S0140-6736(13)61611-6 23993280