Impact of the Russian Invasion on Mental Health of Adolescents in Ukraine

Psychometric properties of the revised Ukrainian version of the Continuous Traumatic Stress Response scale (CTSR) in the context of the Russo-Ukrainian war

Background: The Continuous Traumatic Stress Response scale (CTSR) was designed to measure symptoms associated with multiple ongoing security threats in the context of Israeli-Palestinian conflict. Since 2014, Ukraine has faced armed invasion and war, with nationwide insecurity since February 2022.Objective: This study aimed to adapt the CTSR scale into Ukrainian and evaluate its psychometric properties within a Ukrainian sample during the ongoing war.Method: The Ukrainian adaptation of the CTSR followed the procedure used in creating the original instrument (Goral, A., Feder-Bubis, P., Lahad, M., Galea, S., O'Rourke, N., & Aharonson-Daniel, L. (2021). Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats. PLoS One, 16(5), e0251724). To identify a unique context-specific factor structure relevant to the Ukrainian experience, the initial 25 items were tested in a sample of 584 Ukrainians using exploratory and confirmatory factor analyses. Subsequently, the established scale structure was assessed for homogeneity, and convergent validity using measures of depression (PHQ-9), anxiety (GAD-7), perceived stress (PSS-4), resilience (BRS), and PTSD symptoms (PCL-5).Results: A three-factor, 9-item solution, representing the constructs of exhaustion, alienation, and helplessness, demonstrated the most acceptable fit among all the alternative CTSR models, including the original: χ2 = 72.84, df = 24, p < .001, χ2/ (df) = 3.04, CFI = 0.94, TLI = 0.91, SRMR = 0.05, RMSEA = 0.08. Cronbach's α for internal consistency ranged from 0.68 to 0.84 for total score, and subscales. Significant positive correlations ranging from 0.41 to 0.67 with symptom severity of depression, anxiety, perceived stress, and PTSD established the convergent validity of the Ukrainian CTSR, indicating that it measures related yet distinctive psychological phenomena of reactions to continuous traumatic stress.Conclusions: The revised Ukrainian version of the CTSR scale is a reliable and valid measure of continuous traumatic stress response, accurately reflecting its manifestation in the Ukrainian context. These findings are crucial for guiding clinical interventions and research in prolonged war environments, where understanding the nuances of ongoing trauma is essential.

Prevalence of war-related posttraumatic stress disorder in adolescents: a systematic review and meta-analysis

Background: Posttraumatic stress disorder is common in civilians who are currently experiencing, or who have experienced, war. Most previous studies have focused on adult populations and, despite the recognised detrimental effect of war trauma on adolescent mental health, there remains a paucity of evidence on the prevalence of war-related PTSD in adolescents.Objective: This pre-registered (https://osf.io/dqg2z) systematic review and meta-analysis aims to understand the prevalence of PTSD, as well as both risk and protective factors for developing PTSD, in adolescents aged 10-24 years from across the world who are experiencing, or have experienced, war-related traumatic events, described in papers published in a 10 year period (2013-2023). We also examine how the choice of PTSD diagnostic assessment tool influences prevalence rates.Method: Medline (PubMed), PsycINFO (EBSCOhost), and PTSDpubs (ProQuest) were searched, which resulted in 21 papers eligible for inclusion. Data was searched, extracted and synthesised using the software tool Covidence.Results: The age range of adolescents in the included papers was 11-19 years. The average prevalence of PTSD was 29.4% (95% CI [18.7%, 43.0%]), although prevalence rates across studies were highly inconsistent (I2 = 99.4%). Prevalence rates were significantly higher in studies conducted longer after war exposure, and the PTSD diagnostic assessment tool used influenced prevalence.Conclusions: There is high prevalence of PTSD in adolescents during and after war. The prevalence of war-related PTSD increases with time in the post-war period, highlighting the need for access to psychological services following war. This study underscores the importance of defining age ranges and using validated and culturally sensitive assessment tools when interpreting prevalence rates of PTSD in adolescents.

Adolescents during wartime: Vulnerability-based profiles

Adolescents in war zones face the dual burden of normative developmental challenges and stressors from their proximity to active conflict, raising critical questions about their vulnerability during wartime. The aim of the current study was to identify distinct vulnerability profiles among Israeli adolescents (ages 11-18) during Israel's ongoing Swords of Iron War. Drawing on Hobfoll's conservation of resources theory, we assessed protective factors (positive affect, resilience, and perceived social support) and one risk factor (war-related adjustment disorder symptoms). Differences in profiles were also examined in relation to demographic variables and war impact variables (house damage, displacement, and injury). In this quantitative, cross-sectional study, we utilized self-report questionnaires from 305 Jewish Israeli adolescents (ages 11-18). LatentGold was employed to conduct a three-step latent profile analysis. Wald tests were used to explore differences between the various adolescent profiles in terms of protective and risk factors, as well as to assess associations with distal variables. Three distinct vulnerability profiles were identified: low, moderate, and high. Adolescents in the low-vulnerability group were younger, lived farther from conflict borders, experienced fewer war-related adjustment disorder symptoms, and reported higher levels of positive affect, resilience, and perceived social support. Among these factors, perceived social support emerged as the most sensitive variable differentiating profiles. These findings highlight the importance of internal and external resources in mitigating vulnerability and fostering resilience among adolescents in conflict-affected regions. The categorization into vulnerability levels enables faster identification of at-risk adolescents and more efficient resource allocation. Given the critical role of social support, clinicians should prioritize interventions that enhance such support to promote adolescents' well-being during wartime.

Conflict exposure and mental health: a survey of adolescent girls and young women in Myanmar post the 2021 coup d'état

BACKGROUND

Following the 2021 military coup in Myanmar, adolescent girls and young women have faced a multitude of threats to their health and wellbeing. Beyond direct exposure to armed combat, injuries and loss of life, they are also experiencing displacement, family separation, and restricted access to education and healthcare. These challenges are further compounded by military-imposed restrictions on humanitarian aid and access to the country. This study sought to address a critical gap in understanding how exposure to conflict in Myanmar is impacting adolescent girls' mental health.

METHODS

We conducted a survey, co-developed with peer-researchers, with 750 girls and young women aged 10 to 21 years from disproportionately disadvantaged communities across Myanmar. The survey included questions on participants' demographics, their exposure to conflict-related stressors and their self-reported depressive symptoms.

RESULTS

Participants reported widespread exposure to traumatic conflict-related stressors and high levels of depressive symptoms. There was a significant positive association between the number of different conflict-related stressors experienced by the study participants and the number of depressive symptoms reported. Additionally, participants who were living away from their parents reported significantly higher levels of depressive symptoms, emphasising the psychological implications of family separation during conflict.

CONCLUSIONS

Our results highlight the urgent need for tailored interventions for adolescents, particularly girls and young women, who are exposed to armed conflict. In contexts of protracted instability and uncertainty, such as in Myanmar, interventions should explore ways to foster a sense of social safety, especially among adolescent girls who are displaced or living away from their families. Strengthening social safety systems may help to reduce the adverse mental health impacts of conflict-related stressors.

The adaptation of psychological first aid for children released from war captivity (PFA-CC): A qualitative evaluation

BACKGROUND

The abduction of children during armed conflict is a pervasive problem on a global scale. However, interventions aimed at alleviating acute distress in children released from war captivity remain rare.

OBJECTIVE

We conducted a qualitative evaluation of PFA-CC-a Psychological First Aid Intervention (PFA) tailored to children and adolescents (aged 2.5-18 years) in Israel, administered immediately following their release from war captivity. The goal was to assess its feasibility, fidelity, and practitioner experiences.

METHODS

We employed an ethnographic approach to evaluation. Data collection methods included 250 h of participant observation and in-depth interviews with a subset of practitioners (n = 37)-social workers, psychologists, psychiatrists, nurses, and pediatricians-who delivered the intervention.

FINDINGS

Practitioners described techniques they employed for establishing safety, promoting calmness and fostering self-efficacy in the post-captivity context. Particular emphasis was placed on assisting families in delivering difficult news, respecting children's autonomy and free choice, following children's pace in processing trauma, re-establishing daily routines, and preparing for reintegration. Two important adaptations to the classical PFA model-the use of a transitional hospital setting and the adoption of a family-centred approach-were consistently identified as intervention strengths.

CONCLUSIONS

Our study suggests that PFA-CC is a feasible and appropriate early intervention for children released from war captivity. Key implications for early intervention include: (1) adoption of a dialectical approach that balances children's autonomy with boundaries; (2) creation of a dedicated, enclosed, and 'sterile' space to foster safety; (3) implementation of a family-centered approach amid acute family disruption and displacement.

Growing Up in the Pandemic: Examining Associations Between Reproductive Development and Depressive Symptoms in Pre- and Pandemic Girls

In 2020, youth experienced transformative change, as schools shut down and adolescents' social and school lives moved fully online due to the COVID-19 pandemic. Amid this upheaval, adolescents also experienced the normative changes of the pubertal transition, a well-known time of rapid physical and psychosocial change that coincides with increases in depressive symptoms for youth. The present analysis draws on a sample of N = 596 female youth recruited continuously from 2014 to 2023 to explore how an altered social landscape may change the experience of puberty. Multiple linear regression was utilized to examine cohort differences in the associations between pubertal status and timing with depressive symptoms, as well as associations between months since menarche and age at menarche with depressive symptoms. We found that previously established associations between pubertal status and timing with depressive symptoms were not replicated in the pandemic cohort; however, months since menarche was significantly associated with depressive symptoms in both pre- and pandemic cohorts. Our findings stress the importance of considering broader socio-historical context in studying adolescent development. They also highlight the value of considering the continuous reproductive development that occurs after menarche and extends the critical period for the development of internalizing symptoms in adolescence.

Hope and Distress: A Cross-Country Study Amid the Russian-Ukrainian War

Conflict deeply affects human experiences, frequently testing individual resilience to its breaking point and leaving enduring psychological and societal wounds. The current conflict in Ukraine, initiated by Russia's invasion in 2022, illustrates this phenomenon by altering regional relationships and triggering a major humanitarian crisis marked by extensive displacement, loss of life, and emotional turmoil. This study explores the factors influencing hope and distress in Ukraine alongside six nearby European countries during the ongoing conflict. A cross-sectional survey collected data primarily via internet panel samples from the Czech Republic, Georgia, Lithuania, Poland, Romania, Slovakia, and Ukraine in the second year since the war's initiation. The current study utilised validated instruments, collecting data on levels of hope, distress, individual resilience, community resilience, societal resilience, morale, sense of danger, perceived security threats, and demographic characteristics. Hope and distress levels differ across countries, with Ukraine exhibiting the highest levels of both (3.74 ± 1.02 and 2.89 ± 0.87, respectively). Overall, average scores of hope were higher than average distress levels. Across the regression models for the seven countries, hope showed strong associations with individual (between β = 0.089 and β = 0.327) and societal resilience (between β = 0.206 and β = 0.514), while morale (between β = -0.104 and β = -0.479) and individual resilience (between β = -0.077 and β = -0.335) displayed a protective relationship against distress (all β values were significant, p < 0.01). Monitoring hope and distress is crucial during the Russian-Ukrainian war and other adversities, as these factors give insight into the current and future psychological states of affected populations. The results offer valuable information that can guide the development of tailored strategies to enhance hope and buffer distress in war-impacted countries, as well as those experiencing its broader effects. Fostering individual and societal resilience, alongside enhancing morale, may strengthen hope and mitigate distress amid adversity. Developing targeted interventions that address each population's unique needs, as well as their sociocultural and geopolitical contexts can enhance efficacy.

Bullying victimization among adolescents during the early phase of war in Ukraine - A comparative cross-sectional study in 2016-2017

BACKGROUND

War profoundly impacts adolescent development and may increase the likelihood of aggressive responses when such behavior is perceived as acceptable and accessible. War may, hence, exacerbate a form of interpersonal violence already prevalent among children and adolescents.

METHODS

We conducted a comparative cross-sectional study 2 years after the Russian invasion of Eastern Ukraine in 2014 by comparing the prevalence of bullying victimization among adolescents aged 11-17 years (N = 2766) in two administrative regions with different levels of wartime traumatic stressor exposure.

RESULTS

Female adolescents in the war-affected region were bullied more often compared to those in the non-affected region [65.3% vs. 56.3%, adjusted Odds Ratio (aOR) = 1.5, 95% CI 1.2-1.9]. For both boys and girls, symptoms of psychopathology were associated with bullying victimization often [girls: depression (aOR = 2.9, 95% CI 2.4-3.4); boys: depression (aOR = 3.3, 95% CI 2.6-4.1) and PTSD (aOR = 1.7, 95% CI 1.4-2.02)]. In the war-affected region, a dose-response relationship between bullying victimization often and war-event exposure was observed in both sexes [girls: 1-3 war-events (aOR = 1.4, 95% CI 0.7-2.6), 4-6 (aOR = 2.4, 95% CI 1.3-4.5) and ≥7 (aOR = 5.5, 95% CI 2.7-11.1); boys: 1-3 (aOR = 1.4, 95% CI 0.7-2.8), 4-6 (aOR = 3.2, 95% CI 1.7-6.3), and ≥7 (aOR = 6.8, 95% CI 3.1-14.8)].

CONCLUSIONS

War exposure was associated with bullying victimization, with girls being bullied more often than boys. Bullying victimization was linked to cumulative traumatic stressor exposure in the war-affected region for both sexes.

Depression and academic performance among youths in armed conflict areas in North Wollo, Ethiopia: Structural equation modeling

BACKGROUND

Adolescents living in war-affected areas are more likely to suffer from depression than adolescents living outside war-affected areas. However, there is limited evidence from Northern Ethiopia that was affected by armed conflicts. This study was conducted to assess the magnitude of depression and to identify inter-related factors with depression and academic performance in armed conflict-affected areas of North Wollo Zone, Ethiopia.

METHODS

A school-based cross-sectional study was conducted among high school students in North Wollo Zone, Ethiopia. A multistage sampling method was used, and the study participants were selected using simple random sampling. The Structural Equation Model was used to verify the hypothesized relationship between various internal and external or mediating factors. The effect size was provided using standardized beta coefficients, 95% CI, and statistical significance defined as a p-value <.05.

RESULTS

Out of 3,400 study participants, 48.1% (95% CI [46.5%, 49.8%]) endorsed depressive symptoms. Being female (β = .05, 95% CI [0.011, 0.087]), far from family because of education (β = .10, 95% CI [0.060, 0.134]), anxiety (β = .95, 95% CI [0.893, 1.011]), and alcohol use (β = .14, 95% CI [0.108, 0.180]) had a significant and positive association with a total direct effect on depression. Conversely, academic performance (β = -.04, 95% CI [-0.061, -0.011]) had a significant and negative association with a total direct effect on depression.

CONCLUSION

This study found a much higher magnitude of depression among students in conflict-affected areas compared to non-affected areas. High school students, particularly girls in conflict-affected areas, need social support and special protection. Additional efforts are needed to ensure safety and security in high schools and establish student support systems such as student counseling and guidance services.

Mental Health of Residents of Ukraine Exposed to the Russia-Ukraine Conflict

Importance

Quantifying the association between the ongoing Russia-Ukraine war and Ukrainians' mental health is crucial for guiding reconstruction and rebuilding efforts in the postwar period.

Objective

To examine the association between war exposure and civilians' mental health in both the short and medium term and the potential channels through which these associations occur.

Design, Setting, and Participants

This cohort study used data from 7 nationally representative surveys conducted by the Kyiv International Institute of Sociology between December 4, 2015, and July 18, 2022. Six surveys were conducted before the war and one during the ongoing conflict in July 2022. Each survey included approximately 2000 respondents aged 18 to 95 years in 110 localities.

Exposure

The magnitude of war damage exposure was represented by an indicator variable set to 1 if an oblast (province) experienced severe war damage and 0 if the damage was moderate at the time of the survey. The classification of severe or moderate damage was based on the economic losses incurred.

Main Outcomes and Measures

The main outcomes were respondents' self-reported thoughts of suicide and feelings of helplessness, both represented as dummy variables.

Results

The sample included 14 140 respondents, with 3933 (27.8%) exposed to severe war damage and 10 207 (72.2%) to moderate war damage. These included 8174 female respondents (57.8%), with an overall mean (SD) age of 48.9 (16.8) years. The differences in the likelihood of reporting suicidal thoughts and feelings of helplessness between areas with severe vs moderate war damage increased by 2.2 percentage points (β estimate, 0.022 [SE, 0.006]; 95% CI, 0.009-0.036) and 4.9 percentage points (β estimate, 0.049 [SE, 0.019]; 95% CI, 0.009-0.088), respectively. Subsample analyses revealed that male respondents were more vulnerable to suicidal thoughts (β estimate, 0.030 [SE, 0.013]; 95% CI, 0.004-0.056), while female respondents were more at risk of feelings of helplessness (β estimate, 0.063 [SE, 0.024]; 95% CI, 0.013-0.113).

Conclusions and Relevance

In this survey study of war exposure, bombing was associated with increased mental health concerns among civilians, including a higher likelihood of suicidal thoughts and feelings of helplessness, which may hinder postwar recovery. These findings suggest that policymakers should prioritize creating job opportunities and ensuring a safe living environment to support citizens' recovery in the aftermath of conflict.

Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War

OBJECTIVE

More than 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, to examine the strength of the evidence base, and to inform the development of future interventions.

METHOD

Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to September 30, 2022, identifying k = 6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network.

RESULTS

The systematic search identified 6 relevant studies: 1 study evaluating digital mental health interventions for children and adolescents affected by war, and 5 studies for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents or carers/caregivers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear.

CONCLUSION

There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions.

PLAIN LANGUAGE SUMMARY

Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support for children and adolescents living in war affected regions. In this scoping review, the authors identified 1 study evaluating digital mental health interventions for children and adolescents affected by war and 5 for those affected by disasters. In addition, 35 interventions were identified through expert consultation as of possible relevance. The authors found very limited evidence for the use of digital mental health interventions for children and adolescents affected by war, and given this provide a framework to inform the development of new interventions.

DIVERSITY & INCLUSION STATEMENT

We actively worked to promote sex and gender balance in our author group.

STUDY PREREGISTRATION INFORMATION

Digital mental health interventions for children and young people affected by war: a scoping review; https://osf.io/; hrny9.

The Impact of the Ukraine Conflict on the Quality of Life of the Young Population in Romania from a Societal Security Perspective

BACKGROUND/OBJECTIVES

This study examines the perception of young Romanians (aged 18-35) regarding the Ukraine conflict's impact on Romania's national security and quality of life. It focuses on societal security dimensions, analyzing the conflict's regional and international implications, alongside sentiments toward global support for Ukraine.

METHODS

Data were collected via structured questionnaires administered to 848 participants in 2024 and 747 in 2022. Respondents' perceptions of the Ukraine conflict, its influence on national security, and the direct consequences for quality of life were evaluated using the WHOQOL-BREF instrument. Statistical analyses (descriptive, bivariate, multivariate) were employed to explore variations across socio-demographic factors.

RESULTS

The findings indicate that young Romanians appreciate international solidarity with Ukraine but remain cautious about military escalation. While the conflict heightened perceptions of personal and national insecurity, WHOQOL-BREF assessments revealed significant declines in psychological, social, and environmental quality of life indicators from 2022 to 2024. Variations were observed based on age, gender, education level, and residence, with young rural women and those with lower educational attainment experiencing the most pronounced impacts.

CONCLUSIONS

The study underscores the dual challenges of maintaining regional stability and addressing the socio-psychological fallout of conflicts. Despite resilience mechanisms tempering subjective perceptions, objective measures indicate deteriorations in the quality of life among Romania's young population. These findings emphasize the need for targeted policies to support vulnerable groups through mental health initiatives, social support systems, and equitable access to resources.

Psychological well-being and academic performance of Ukrainian medical students under the burden of war: a cross-sectional study

Introduction

The mental health of medical students is a key factor for academic performance and the delivery of high-quality medical care in the future. Globally, medical students face numerous challenges that can affect their education. Living and studying facing the war has a crucial influence on medical students' education and daily life. The study aimed to determine the psychological well-being and academic achievements of Ukrainian medical students who lived in the rear areas after the 18 months of the Russian-Ukrainian war.

Methods

The cross-sectional study was conducted at I.Ya. Horbachevsky Ternopil National Medical University. We analyzed the psychological well-being and educational achievements of medical students from the second to fifth year of Medical Faculty using the self-report scales DASS-21 and IES-R. A total of 776 students filled out the DASS-21 scale and 491 IES-R scale, respectively.

Results

Following the first 18 months of the war, 62.5, 59.6, and 58.8% of Ukrainian medical students self-reported signs of stress, anxiety, and depression, respectively. Severe and extremely severe depressive symptoms were observed in 25.6% of students, anxiety in 31.9%, and stress in 29.7%, with a higher prevalence among female students. Additionally, 44.2% of responders had significant symptoms of post-traumatic stress disorder, with the highest scores on the hyperarousal subscale (>37). Academic performance in 2023 was significantly lower compared to the pre-war period in 2019 (p < 0.001) (p = 0.000). The multiple linear regression analysis showed that academic performance was positively associated with depression (p = 0.003), hyperarousal (p < 0.001), anxiety (p = 0.03), and negatively associated with stress (p = 0.002).

Conclusion

Ukrainian medical students in rear areas are facing various challenges, with war-related stressors having a profound impact on their mental health. Our findings have shown an increasing prevalence of anxiety, stress, depression, and symptoms of post-traumatic stress disorder, all of which may negatively affect academic performance. The educational process during wartime is important for facilitating qualified medical personnel and quality healthcare. Understanding the burden of war allows for the development of wellness programs that support student mental health in conflict zones.

Development and validation of the caregiver-report version of the international depression questionnaire (IDQ-CG) and international anxiety questionnaire (IAQ-CG)

The International Depression Questionnaire (IDQ) and International Anxiety Questionnaire (IAQ) are self-report measures of ICD-11 single episode depressive disorder (DD) and generalised anxiety disorder (GAD). The present study sought to describe the development and psychometric evaluation of the caregiver-report versions of the IDQ and IAQ for children, referred to as the IDQ-CG and IAQ-CG, respectively. Participants were 639 parents living in Ukraine who provided data on themselves and one child in their household as part of "The Mental Health of Parents and Children in Ukraine Study: 2023 Follow-up" study. The latent structure of the IDQ-CG and IAQ-CG were tested using confirmatory factor analysis (CFA), composite reliability (CR) estimates were estimated, and convergent validity was assessed. Prevalence rates of probable ICD-11 DD and GAD were also estimated. CFA results indicated that the IDQ-CG and IAQ-CG were unidimensional, while the internal reliability of both scales was excellent. Convergent validity was established via associations with external measures of internalizing, externalizing, and attention problems as well as trauma exposure. Factors associated with increased IDQ-CG and IAQ-CG scores included pharmacological support for emotional or behavioural problems, delayed milestone development, being forced to move to another part of Ukraine, serious life disruption due to the war, and having experienced a bereavement. Of the total sample, 1.6% met diagnostic requirements for ICD-11 DD and 5.8% met diagnostic requirements for ICD-11 GAD. This study supports the psychometric properties of the IDQ-CG and IAQ-CG. These measures can be effectively used to identify young people in need of mental health support.

Current Status and Future Directions of Artificial Intelligence in Post-Traumatic Stress Disorder: A Literature Measurement Analysis

This study aims to explore the current state of research and the applicability of artificial intelligence (AI) at various stages of post-traumatic stress disorder (PTSD), including prevention, diagnosis, treatment, patient self-management, and drug development. We conducted a bibliometric analysis using software tools such as Bibliometrix (version 4.1), VOSviewer (version 1.6.19), and CiteSpace (version 6.3.R1) on the relevant literature from the Web of Science Core Collection (WoSCC). The analysis reveals a significant increase in publications since 2017. Kerry J. Ressler has emerged as the most influential author in the field to date. The United States leads in the number of publications, producing seven times more papers than Canada, the second-ranked country, and demonstrating substantial influence. Harvard University and the Veterans Health Administration are also key institutions in this field. The Journal of Affective Disorders has the highest number of publications and impact in this area. In recent years, keywords related to functional connectivity, risk factors, and algorithm development have gained prominence. The field holds immense research potential, with AI poised to revolutionize PTSD management through early symptom detection, personalized treatment plans, and continuous patient monitoring. However, there are numerous challenges, and fully realizing AI's potential will require overcoming hurdles in algorithm design, data integration, and societal ethics. To promote more extensive and in-depth future research, it is crucial to prioritize the development of standardized protocols for AI implementation, foster interdisciplinary collaboration-especially between AI and neuroscience-and address public concerns about AI's role in healthcare to enhance its acceptance and effectiveness.

How COVID-19 pandemic and Ukrainian crisis shaped mental health services for medical students in Poland?

The mental health of medical students is a crucial concern in contemporary medical education. This manuscript reports the availability and shape of psychological support for medical students in Poland in the backdrop of the COVID-19 pandemic and the Ukrainian crisis. A survey comprising 10 questions was distributed to 22 medical schools in Poland, with a 59% response rate. The findings reveal that psychological support programs are predominantly managed by internal university units. Funding sources vary, with some universities utilizing internal budgets and others leveraging European funds or external projects. The support modalities are primarily hybrid, catering to student preferences. Limitations exist in the number of consultations, although some universities provide extended support based on student needs. Assistance is offered in multiple languages, with additional programs like stress-reduction workshops and mindfulness training being available in several universities. A notable increase in demand for psychological support post-COVID-19 was reported, with some universities establishing their programs during or after the pandemic. The commentary highlights the rising need for mental health services among medical students and underscores the importance of flexible, inclusive, and well-funded support. The effective functioning of these programs aligns with the broader objective of fostering a resilient and emotionally balanced healthcare workforce.

Coping Mechanisms and Posttraumatic Stress Exhibited by Children in Areas of Yemen's Armed Conflict in Southern Saudi Arabia

This study is an attempt to explore war-related trauma, its stressful effects, and the coping strategies of Saudi schoolchildren. The authors hypothesized that children exposed to war-related trauma will show higher levels of PTSD, and that those with higher levels of PTSD symptoms use more maladaptive coping strategies. The study describes the correlation between traumatic events and posttraumatic stress disorder (PTSD) as well as coping strategies. Five hundred twenty-seven intermediate and high school students, 12 to 18 years old, living in the conflict zone in southern Saudi Arabia completed three standardized self-reported scales: the War Zone Traumatic Events Checklist, the Child PTSD Symptom Scale, and the Children's Coping Strategies Checklist. Each participating student was randomly chosen. Analysis was based on two groups: the high-PTSD symptoms group (182 children) and the low-PTSD symptoms group (345 children). The study was conducted between September 2020 and April 2022 while the war was ongoing as part of an ongoing larger study. Children exposed to war-related traumatic events exhibited greater prevalence rates for PTSD. The children reported high levels of PTSD symptoms and applied a variety of coping strategies to manage related stress. Participants rarely reported that psychological or educational interventions had been used to manage the war-related traumatic experiences and PTSD or to improve related coping styles. The results are discussed in the context of mental health services needed for children in the conflict zone. To bridge the gap between health care services and the needs of children with PTSD, and for better understanding and interventions, health professionals are invited to develop a biopsychosocial model that identifies the risks of PTSD related to exposure to war-related traumatic events in school-aged children and, hence, provide a multidisciplinary intervention program that educates, encourages, and supports teachers and parents in following medical recommendations and goals.

Symptoms of depression and anxiety among Ukrainian children displaced to Poland following the outbreak of the Russo-Ukrainian war: Associations with coping strategies and resilience

This study sought to discern the association of resilience, coping, and contextual factors on depression and anxiety among Ukrainian children displaced to Poland following the Russo-Ukrainian war. A cross-sectional analysis was undertaken with 284 Ukrainian children, aged 11-15 years, relocated to Poland in 2022 due to the ongoing conflict. Participants were assessed using validated tools for anxiety, depression, resilience, and coping, alongside a study-specific questionnaire. Notable associations emerged between depression and variables including age (Mage = 12.04, 49% females), emotional coping, relational resilience, and significant loss, accounting for 39% of the variance (p < .001). Anxiety was intricately linked with heightened emotional coping and diminished problem-solving capabilities, accounting for notable variances (state: 32%, trait: 45%, p < .001). Resilience, particularly in relational contexts, and the experience of bereavement stood out as paramount determinants of mental health outcomes. Children's mental health in conflict zones is shaped by a convoluted interplay of individual and environmental factors. This study accentuates the pivotal role of relational resilience, bereavement, and coping mechanisms in modulating depression and anxiety amidst war-related adversities. It underscores the imperative for targeted interventions, fostering positive relationship frameworks, and enhancing adaptive coping mechanisms.

Post-traumatic stress disorder and associated factors among high school students who experienced war in Woldia town

Background

The experience of war in recent time is very common around the world, and the impact is profound on the mental health of the victims, especially among the young population. The most implicated mental health problem is post-traumatic stress disorder, which comes after an exposure to trauma as a severe and long-term result of the traumatic event. Studies in developed countries revealed this finding, but there is insufficient information in developing countries, where much of war and conflict exist and young population live including Ethiopia. Therefore, this study aims to assess the prevalence and associated factors of post-traumatic stress disorder among high school students who experienced war.

Objective

We assessed the prevalence and factors associated with post-traumatic stress disorder among high school students who experienced war.

Methods

A multi-centered school base cross-sectional study was conducted from May 23 to June 08, 2022. Data were collected from high school students in Woldia town. Bivariable and multivariable logistic regression was used to identify the independent factors associated with post-traumatic stress disorder.

Results

A total of 338 of the 410 students participated in this study (94.5% response rate). The prevalence of post-traumatic stress disorder was 39.2%. In the multivariable analysis, poor social support (AOR = 3.40, 95% CI: 1.45, 7.95), depression (AOR = 3.24, 95% CI: 1.69,6.21), high level of perceived stress (AOR = 2.98, 95% CI: 1.61, 5.50), being in war fighting situation (AOR = 2.85, 95% CI: 1.40, 5.78), and witnessing the murder of family members or friends (AOR = 3.05, 95% CI: 1.47, 6.32) were factors significantly associated with post-traumatic stress disorder at a p-value <0.05.

Conclusions and recommendations

In this study, around two in five of high school students had post-traumatic stress disorder. Independent factors of PTSD were depression, high stress levels, poor social support, witnessing the murder of family members/friends, and being in war fighting situation. We recommend that the Ministry of Education and the Ministry of Health collaborate to integrate mental health services into schools. This focuses on the early detection of students at risk of PTSD, such as those with depression, high perceived stress levels, and exposure to murder or war, and provides necessary social support to prevent PTSD.

Investigating war trauma, its effects, and associated risk factors on anxiety among high school students in Woldia town, northeast Ethiopia, 2022

Background

Anxiety symptoms are the most frequent mental health problems in the world, and it is a serious public health concern, especially among adolescents, because if left untreated, adolescent anxiety can have a number of detrimental effects, including lower academic performance, strained relationships with friends and family, substance addiction, thoughts of suicide and homicide, and trouble finding work. While this vulnerability is concerning in all situations, it is particularly critical in armed conflict areas. Ethiopia is one of the most recent war-affected countries, but to the best of our knowledge, limited studies focused on adolescents in this context. Therefore, this study assessed the experience of war trauma and its effects on anxiety symptoms among high school students in Woldia town, Ethiopia.

Objective

We assessed the experience of war trauma and its effects on anxiety among high school students, as well as associated risk factors, in war-affected areas in Woldia town, northeast Ethiopia.

Methods

A cross-sectional study design was conducted from May 23 to June 08 2022. Data were collected from high school students in Woldia town. Bivariable and multivariable logistic regression analyses were used to identify independent factors associated with anxiety.

Results

A total of 624 out of 660 students participated in the study (94.5% response rate). The prevalence of anxiety among high school students in Woldia town was 39.7%. In the multivariable analysis, having depression (AOR = 9.24, 95% CI: 6.27, 13.64), witnessing the murder of family/friends (AOR = 1.93, 95% CI: 1.05, 3.57), being of female sex (AOR=1.59, 95% CI: 1.08, 2.36), and having a family history of mental illness (AOR=1.69, 95% CI: 1.00, 2.85) were factors significantly associated with anxiety.

Conclusions and recommendations

The prevalence of anxiety in this study was approximately two in five high school students. Therefore, we recommend that the Ministry of Education collaborate with the Ministry of Health to expand and implement mental health services in high schools to promote the wellbeing of students for the prevention of anxiety.

Role of Epigenetic Modification in the Intergeneration Transmission of War Trauma

War trauma has been linked to changes in the neuroendocrine and immunological systems and increases the risk of physical disorders. Traumatic events during the war may have long-term repercussions on psychological and biological parameters in future generations, implying that traumatic stress may have transgenerational consequences. This article addresses how epigenetic mechanisms, which are a key biological mechanism for dynamic adaptation to environmental stressors, may help explain the long-term and transgenerational consequences of trauma. In war survivors, epigenetic changes in genes mediating the hypothalamus-pituitary-adrenal axis, as well as the immune system, have been reported. These genetic modifications may cause long-term changes in the stress response as well as physical health risks. Also, the finding of biomarkers for diagnosing the possibility of psychiatric illnesses in people exposed to stressful conditions such as war necessitates extensive research. While epigenetic research has the potential to further our understanding of the effects of trauma, the findings must be interpreted with caution because epigenetic molecular mechanisms is only one piece of a complicated puzzle of interwoven biological and environmental components.

Neurotic Disorders in Children and Adults Under Social Stress Neurosis in Kids and Adults: Social Stress

ABSTRACT

The relevance of the research subject is to explore the neurotic disorders that arise in people affected by the Russian-Ukrainian war and who witness violence and war crimes. The purpose of the research is to reflect the specific features of the mental reaction of children and adults to military actions as an example of global social stress. Bibliographic, bibliosemantic, and statistical research methods were used in the research. Since the beginning of the full-scale invasion, the number of patients with prolonged depression and schizophrenia has increased, and neurotic disorders has become more severe and acute. Particular attention should be devoted to assistance to military personnel who have been in the combat zone for a long time and former military prisoners of war. Attention should be devoted to the psyche, emotionality, and behavior of people with labile and unformed nervous systems-children, adolescents, pregnant women, and people of retirement age.

Acute Stress Disorders Among Jordanian Adolescents After Watching Gaza News Footage on Social Media

Background

The ongoing conflict in Gaza has led to a surge in acute stress among individuals who are exposed to distressing images and videos daily via social media.

Aim

This study aimed to examine the impact of watching Gaza news footage on social media among Jordanian adolescents, and explore the experiences of watching Gaza news footage on social media from the perspective of adolescents.

Methods

An explanatory mixed methods design was conducted from 10/10/2023 until 6/11/2023, undertaken at two government high schools in Jordan. The Perceived Stress Scale was used to survey 180 Jordanian students who watched Gaza news footage on social media. Then the students who had high stress levels were interviewed.

Results

180 students participated in this study, more than half of them were male (52.2%). The quantitative findings showed that the students experienced high stress levels, with a mean score of 3.78 (SD = 1.24). 70% of students reported high levels of stress, the amount of time spent watching news footage about the Gaza attack on social media each day, and the presence of social support from family or peers are significantly linked to stress levels (p < 0.05). The qualitative findings revealed the following themes: Extreme Emotional Responses, Sources of Stressors and Impact of Stress Extreme Emotional Responses, Sources of Stressors and Impact of Stress.

Conclusion

Study findings revealed high stress levels among adolescents after watching Gaza news on social media, highlighting the need for interventions in the context of the three major themes revealed in the study.

Mental Health of Adolescents Exposed to the War in Ukraine

Importance

With exposure to traumatic events and reduced access to mental health care, adolescents of Ukraine during the Russian invasion since February 2022 are at high risk of psychiatric conditions. However, the actual mental health burden of the war has scarcely been documented.

Objective

To investigate the prevalence of a positive screen for psychiatric conditions among adolescents amidst the ongoing war in Ukraine as well as their associations with war exposure.

Design, Setting, and Participants

This cross-sectional study reports the results from the first wave of the Adolescents of Ukraine During the Russian Invasion cohort, the largest cohort study on Ukrainian adolescents' mental health during the Russian invasion since 2022. Using self-reported questionnaires, the national-level prevalence of a positive screen for various psychiatric conditions was estimated among adolescents aged 15 years or older attending secondary school in Ukraine in person or online (including those residing abroad but attending Ukrainian secondary school online) and the prevalence among Ukrainian adolescents living abroad due to the war.

Exposure

Self-reported exposure to war.

Main Outcomes and Measures

A positive screen for psychiatric conditions. The association between self-reported war exposure and a positive screen for each of the psychiatric conditions was also evaluated.

Results

A total of 8096 Ukrainian adolescents (4988 [61.6%] female) living in Ukraine or abroad were included in the analyses. Based on national-level estimates, 49.6% of the adolescents were directly exposed to war, 32.0% screened positive for moderate or severe depression, 17.9% for moderate or severe anxiety, 35.0% for clinically relevant psychological trauma, 29.5% for eating disorders, and 20.5% for medium risk or higher of substance use disorder. The burden of psychiatric symptoms was similarly large among Ukrainian adolescents living abroad. Adolescents exposed to war were more likely to screen positive for depression (prevalence ratio [PR], 1.39; 95% CI, 1.29-1.50), anxiety (PR, 1.62; 95% CI, 1.45-1.81), clinically relevant psychological trauma (PR, 1.41; 95% CI, 1.32-1.50), eating disorders (PR, 1.21; 95% CI, 1.12-1.32), and substance use disorder (PR, 1.11; 95% CI, 0.98-1.25).

Conclusions and Relevance

The findings of this study suggest that the mental health burden of Ukrainian adolescents amidst the Russian invasion of Ukraine is substantial. Mental health care efforts to alleviate the mental health burden of Ukrainian adolescents are needed.

The Nature of Combat Stress Development During Military Operations and Psychotherapy in Extreme Situations

The purpose of the research work is the theoretical and empirical analysis of the study of the nature of combat stress in military personnel and the assessment of psychotherapeutic methods of providing psychological assistance in extreme situations. The authors used the following methods to achieve this goal: method of analysis and synthesis, hermeneutic method, testing method, comparative method, and generalization method. The results of the research work have revealed the meaning of traumatic stress, psychological trauma, and combat mental trauma, and explained the concept of combat stress and the dynamics of its growth. The findings identified the factors of posttraumatic stress syndrome and its prevalence, tracked down the dynamics of psychoemotional disorders, and revealed the importance of military psychological selection and determination of combat readiness. The authors established the main tasks of a staff psychologist in working with military personnel, conducted an empirical study of the nature of combat stress in the military, observed main psychotherapeutic tools for the prevention of negative mental states in combat conditions, and investigated self-regulation techniques of emotional, physical, and mental health. The practical significance of the scientific work lies in the modern coverage of the phenomenon of combat stress and the classification of effective psychotherapeutic methods that will ensure the sustainable psychological preparation of the soldiers for extreme situations.

Teaching Recovery Techniques (TRT) to Ukrainian children and adolescents to self-manage post-traumatic stress disorder (PTSD) symptoms following the Russian invasion of Ukraine in 2022 - The first 7 months

BACKGROUND

The Russian invasion of Ukraine in February 2022 prompted many to provide mental health input, especially trauma management, to Ukrainian children and adolescents (C/A) exposed to it.

METHODS

Rapid cascade training of 200 Ukrainian psychologists during 2022 to provide, in pairs, free of charge and without selection, TRT courses of 4-6, 90 min sessions online or face to face to C/A 7 to 23 years in Ukraine and those migrating abroad. CRIES-8 PTSD questionnaires were administered at the beginning and end of the courses during May-December 2022. Age, gender, their geographical war risk, and whether C/A had stayed or migrated elsewhere were collected. A CRIES-8 score of ≥17/40 defined likely PTSD.

RESULTS

3123 C/A completed an initial CRIES-8 questionnaire with matching demographics, 2737 a questionnaire at the end and 1798 both. At entry to TRT, likely PTSD was greater in females (65 %) than males (52 %, p < 0.001) declining with increasing age, particularly in males (p < 0.001). Migration had mixed effects and moving to lower war risk areas or abroad did not reduce PTSD risk. TRT benefited 68 % of C/A overall by reducing CRIES-8 from ≥17 to <17, the rate increasing the more experienced the TRT facilitators became (p < 0.0001). Online and face to face outcomes were the same.

LIMITATIONS

The chaos of war prevented capture of all potential C/A questionnaires and long-term repeat testing not yet undertaken.

CONCLUSIONS

Even in the chaos of war, effective mental health input can be rapidly and cheaply (c.50 USD/child) provided and should be encouraged.

Impact of war-associated factors on spread of sexually transmitted infections: a systemic review

Introduction

Statistical data indicate a link between war and the spread of sexually transmitted infections (STIs), then it is necessary to carefully analyze the factors that directly affect the identified pattern in order to overcome this problem. Therefore, the purpose of the study was to systematically analyze the factors that influence the spread of STIs during war.

Methods

The study included all original research articles and meta-analyses on the impact of war on the spread of sexually transmitted infections that met the following eligibility criteria: (1) articles published exclusively in English; (2) articles published in the period 2013-2023; (3) studies with quantitative, qualitative or mixed design. The search for relevant literature was conducted using four databases: PubMed, Embase, Web of Science, and Ebsco.

Results

The articles selected for our systematic review had different research designs and were mainly published as original studies (n = 8) and literature reviews (n = 6). As a result of the evaluation of the selected articles for the systematic review, the authors identified migration, a decrease in access to health care, difficult access to contraception, sexual violence as the most frequent factors directly affecting the spread of STIs during the war.

Conclusion

This systematic review systematizes data on the impact of hostilities on the spread of STIs and outlines the main factors that contribute to the dissemination of pathogens far beyond the territory at the epicenter of the conflict.Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023479808, CRD42023479808.

The prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics in wartime-An observational cross-sectional study six months after outbreak

Russia's invasion of Ukraine is the largest European land offensive since World War II. Individuals affected by conflicts such as war are at an increased risk of mental disorders, which result from frequent exposure to traumatic events and the breakdown of supportive social networks. The aim of the study was to assess the prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics six months after the Russian invasion of Ukraine. A cross-sectional study was conducted using validated questionnaires: The Life Events Checklist, PTSD Checklist for DSM-5, The International Trauma Questionnaire (ICD-11), The Generalized Anxiety Disorder-7, The Patient Health Questionnaire-9, The World Health Organization Disability Assessment Schedule 2.0. The study showed that 61.1 % of participants indicated combat or exposure to a war zone as the most bothersome event in their experience. Physicians and paramedics did not differ in the prevalence of PTSD according to the DSM-5 diagnostic rule and of depression (criteria met by 14.5 % and 9 % of participants, respectively). However, more physicians than paramedics met the criteria of PTSD according to the ICD-11 diagnostic rule (5.1 % vs. 1.2 %) and of anxiety (16.5 % vs. 10.0 %). The risk factors for the mental health problems included personal combat experience, total trauma exposure, parenthood, and economic situation. Despite the differences found in the prevalence of PTSD depending on the criteria used, the severity of mental problems and disability in this group is significant. It is advisable to monitor the mental state and need for help among Ukrainian civilian medical personnel.

Parental conscription and cumulative adverse experiences in war-affected children and adolescents and their impact on mental health: a comment following Russia's invasion of Ukraine in 2022

BACKGROUND

With Russia's invasion of the Ukraine on February 2022, Ukrainian children and adolescents have been exposed to several stressful life events. In addition to the confrontation with war, flight and parent-child separation due to flight and forced displacement, the majority underwent another challenge at the initial phase of the war: the fatherly separation due to conscription.

MAIN BODY

In the literature, the negative effects of exposure to war and flight/refuge, parent-child separation due to flight or forced displacement and parental deployment are well established. In the context of self-experienced war, the effects of parent-child separation caused by compulsory military service have not yet been sufficiently taken into account. However, the findings of the literature on the impact of these events on the mental health of children and adolescents show that they are at high risk for developing numerous psychological and behavioral problems.

CONCLUSION

As children's and adolescents' mental health might be severely affected by war and its consequences, interventional programs that address the special needs of those children and adolescents are crucial.

How Is the Fear of War Impacting Italian Young Adults' Mental Health? The Mediating Role of Future Anxiety and Intolerance of Uncertainty

The Russian-Ukrainian conflict is affecting mental health even in communities that are not directly involved in the war; added to this is the escalating conflict in the Middle East and its dangerous spread, which brings the war back to the center of the contemporary social and economic horizon. The present study aims to explore the psychological impact of war in a sample of 310 Italian young adults (18-30 years; M = 22.0; SD = 2.6) while exploring the relationship between Fear of War and psychological distress and evaluating the mediating effects of Future Anxiety and Intolerance of Uncertainty in this relation. Findings highlighted how Fear of War positively and significantly affects Stress, Anxiety, and Depression, and, at the same time, how it fuels both Future Anxiety and Intolerance of Uncertainty. These constructs, in addition to positively affecting the mental health outcomes considered, mediate the relationship between Fear of War and youth psychological distress with a significant indirect effect observed in all three mediation models performed. Finally, significantly higher levels of psychological distress, Fear of War, and Future Anxiety are reported in women than in men. The findings are discussed with reference to the recent literature on the psychological impact of war and on contemporary youth psychological distress, indicating the importance of educational policies and targeted interventions aimed at supporting this target in coping with multiple contemporary collective stressors.

The role of school functioning, physical activity, BMI, sex and age in building resilience among Ukrainian refugee children in Poland

The study aims to examine the relationship between school functioning, physical activity (PA), sex, Body Mass Index (BMI), age, and resilience in Ukrainian children who migrated to Poland due to the war. A cross-sectional study was conducted in 2022, focusing on 248 children aged 10-15 years. The findings suggest that school environment, including enjoyment of school and strong support from teachers, plays a significant role in building resilience in children. PA enhanced the resilience of girls, whereas a higher BMI negatively impacted it. A child-friendly school environment that encourages PA and provides social support could be a promising approach for the mental health of Ukrainian refugee children.

Uncertainty Breeds Anxiety and Depression: The Impact of the Russian Invasion in Ukraine on a Swedish Clinical Population Receiving Internet-Based Psychotherapy

Background

Recent global crises, such as the COVID-19 pandemic and the 2022 Russian invasion of Ukraine, have contributed to a rise in the global prevalence of anxiety and depressive disorders. This study examines the indirect impact of the Ukraine war on emotional disorders within a Swedish clinical population.

Method

The sample comprised participants (n = 1,222) actively engaged in an internet-based psychotherapeutic intervention (cognitive-behavioral, psychodynamic, and waitlist) when the war broke out. The Patient Health Questionnaire-9 scale and the Generalized Anxiety Disorder-7 scale were used to measure depression and anxiety.

Results

Anxiety and depressive symptom severity increased following the war's onset, with an average weekly increase of 0.77-points for anxiety (p = .001, Cohen's d = 0.08) and 0.09-points for depression (p = .70, Cohen's d = 0.01); however, the increase was negligible for depression. Furthermore, higher socioeconomic status (SES) predicted declines in depression and anxiety during the study period, with a 0.69-point average weekly decrease in anxiety (p < .001, Cohen's d = 0.32) and a 1.09-point decrease in depression (p < .001, Cohen's d = 0.48) per one unit increase in SES, suggesting that SES may serve as a protective factor that buffers against psychopathological development during crises.

Conclusions

These findings have implications for mitigating the development of psychopathology during crises and interpreting treatment efficacy estimates during such events. Our findings also emphasize the potential of internet-based psychotherapy in addressing emotional disorders during crises. This study presents up-to-date information about the reaction of treatment-seeking individuals to abrupt uncertainty.

Effects of a mobile-based bioterrorism response program among clinical nurses: A quasi-experimental study

BACKGROUND

To respond to unstable international security and the outbreak of new infectious diseases, clinical nurses should be equipped with bioterrorism response competencies.

OBJECTIVES

This study developed a mobile-based bioterrorism response program for clinical nurses and examined its effectiveness on their knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies.

DESIGN

A quasi-experimental study design was used.

SETTING

General or tertiary general hospitals in South Korea were considered.

PARTICIPANTS

Participants were 45 clinical nurses (23 in the experimental group and 22 in the control).

METHODS

The mobile-based bioterrorism response program was conducted over three weeks in 10 sessions (total of 300 min). The knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies were compared between two groups using paired t-test, and Wilcoxon signed ranks test. Satisfaction with the program was measured in the experimental group.

RESULTS

Upon completion of the mobile-based bioterrorism response program, the experimental group showed significant increases in knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies.

CONCLUSIONS

The mobile-based bioterrorism response program is expected to contribute to better preparedness for bioterrorism response systems in clinical practice. In addition, this program is expected to be of valuable use in bioterrorism education for nursing students as well as other healthcare professionals involved in bioterrorism response.

Resilience processes among Ukrainian youth preparing to build resilience with peers during the Ukraine-Russia war

The war in Ukraine significantly impacts the mental health and well-being of its youth. Like other communities affected by war, Ukraine's youth are at risk of developing psychopathological symptoms, and there is a shortage of mental health and psychosocial support services to address this. Resilience-building initiatives present an alternative approach to supporting the well-being of young people by promoting protective processes to enhance the likelihood of positive development in the context of adversity. Emerging research findings suggest that young people themselves can serve as powerful facilitators of such initiatives with one another. Yet, evidence about culturally and contextually relevant protective processes is needed to guide such interventions, especially among young people experiencing the war and working to boost resilience within their communities. In this study, we identified key protective processes Ukrainian youth depend on as they adapt to the conflict while also preparing to implement a resilience-building intervention as a facilitator. Through thematic analysis of transcripts of three training sessions with Ukrainian youth (n = 15, 100% female; aged 18-22), we identified the following themes: positive thinking, sense of control, emotion awareness and regulation, close personal relationships, and community support. Findings also highlighted the cultural and contextual nuance of these protective processes, as well as individual differences in the ways they co-occurred and manifested within each youth. Results have implications for developing tailored yet flexible resilience-building interventions that can be delivered by lay people, including youth with their peers, in Ukraine and other cultures and contexts.

Traumatic events and posttraumatic stress symptoms in a treatment-seeking sample of Ukrainian children during the war

BACKGROUND

The Russian invasion of Ukraine resulted in a dramatic increase of children and adolescents being confronted with war and other traumatic experiences, which could result in an increase of trauma-related mental health disorders such as posttraumatic stress disorder (PTSD) in an entire generation. This study aims at reporting the prevalence of traumatic events, PTSD, and Complex PTSD (CPTSD) in children and adolescents seeking for mental health treatment since the Russian invasion. Additionally, the consistency of child and caregiver reported trauma, PTSD and CPTSD will be examined.

METHODS

This study is part of the "TF-CBT Ukraine" project in which Ukrainian therapists were trained in assessing their patients via the "Child and Adolescent Trauma Screen" (CATS-2) before initiating trauma-focused treatment, if indicated. Altogether N = 200 Ukrainian children and adolescents (Mage = 12.01, range 4-21; 62.0% female) were included in the study between October 2022 and August 2023. Data were analysed descriptively, via t-tests and bivariate correlations.

RESULTS

The children and adolescents reported on average four different traumatic events, most frequently war (n = 123; 68.7%), bullying threats (n = 71; 39.7%) and domestic violence (n = 68; 38.0%). Almost 70% (n = 123) of the participants fulfilled the DSM-5 PTSD criteria, 31% (n = 56) fulfilled the ICD-11 PTSD criteria and 21% (n = 38) the ICD-11 CPTSD criteria. Rates of PTSD were even higher in preschool children (95%). The comparisons of self-and caregiver reports on traumatic events and PTSD/CPTSD severity scores indicated moderate to high correlations between the patients and their caregivers (r = 0.710-0.767).

CONCLUSIONS

This study shows that Ukrainian children and adolescents starting treatment report a high number of traumatic events and trauma-related symptoms, which could have a long-lasting negative impact on their social-emotional development and quality of life. The implementation of evidence-based trauma-focused interventions for these children is therefore crucial.

Mental Health and well-being During the COVID-19 Pandemic and After the Russian Invasion of Ukraine

The study compared the mental health of university students during the COVID-19 pandemic and the Russian invasion of Ukraine. A repeated online cross-sectional study was performed twice among university students in Ukraine: in November 2020 (Pre-war sample, n = 752) and September-October 2022 (During-war sample, n = 862). The survey measured life satisfaction (SWLS), perceived stress (PSS-10), anxiety (GAD-7), and depression (PHQ-9). Stress, anxiety, and life satisfaction levels were similar during the war and pandemic, while symptoms of depression decreased during the war, compared to the pandemic. Network analysis showed that anxiety has a crucial effect on depression and stress, and stress is most closely related to life satisfaction. The association of life satisfaction with anxiety and depression disappeared in wartime, in contrast to the pandemic. The priority of prevention and intervention programs in wartime Ukraine should focus on anxiety as the most influential factor in other mental health and well-being problems. The results showed high resistance and adaptation to war conditions among university students in Ukraine.

Epidemiology of dental caries in internally displaced children during wartime in Ukraine

OBJECTIVE

Aim: To conduct a comprehensive analysis of the oral health status of this vulnerable population in order to collect objective data that will contribute to the development of effective strategies for maintaining and improving oral health in wartime conditions.

PATIENTS AND METHODS

Material and Methods: This epidemiological study was carried out within the initial 6 months of the full-scale invasion of the country. The oral health indices of 1050 internally displaced children, aged 3 to 17 years, seeking dental care at the Municipal Children Dental Clinic in Poltava, were analyzed.

RESULTS

Results: The total sample comprised 620 children aged 6-11 years (mean = 8.5, SD = 0.76), with a gender distribution of 52% boys and 48% girls. The participants were divided into three age groups: Group I (6-7 years), Group II (8-9 years), and Group III (10-11 years). The average prevalence of dental caries, as measured by the dmft + DMFT index, was 76.5%, with prevalence increasing with age. Specifically, the prevalence of dental caries based on the dmft index was lower in children of Group III (66.6%) compared to Group I (79.49%).

CONCLUSION

Conclusions: The analysis of the oral status among internally displaced children aged 6-11 years revealed higher dental caries prevalence and intensity compared to local children. Notably, children aged 6-7 years showed a high rate of caries in temporary teeth.

Prevalence of stress, anxiety, and symptoms of post-traumatic stress disorder among Ukrainians after the first year of Russian invasion: a nationwide cross-sectional study

Background

In February 2022 the Russian federation started a new invasion of Ukraine as an escalation of the ongoing war since 2014. After nine years of war and the COVID-19 pandemic, the mental health state of Ukrainians requires systematic monitoring and relevant action. The aim of present study was to investigate the state of mental health among Ukrainians assessing the levels of stress, anxiety, and post-traumatic stress disorder (PTSD) prevalence in not displaced persons (NDPs), internally displaced persons (IDPs), and refugees abroad.

Methods

This study was designed as an online survey arranged in the 9-12 months after the start of the new invasion of Ukraine and includes sociodemographic data collection, evaluation of stress intensity by Perceived Stress Scale (PSS-10), anxiety with General Anxiety Disorder (GAD-7), and symptoms of post-traumatic stress disorder with PTSD Check List (PCL-5).

Findings

The sample size of 3173 Ukrainians consisted of 1954 (61.6%) respondents that were not displaced persons (NDPs), 505 (15.9%) internally displaced persons within Ukraine (IDPs), and 714 (22.5%) refugees that left Ukraine. Moderate and high stress was prevalent among 68.2% (1333/1954) and 15.5% (302/1954) of NDPs, 64.4% (325/505) and 21.6% (109/505) of IDPs, and 64.7% (462/714) and 25.2% (180/714) of refugees, respectively. Moderate and severe anxiety was prevalent among 25.6% (500/1954) and 19.0% (371/1954) of NDPs, 25.7% (130/505) and 23.4% (118/505) of IDPs, and 26.2% (187/714) and 25.8% (184/714) of refugees. High levels of PTSD (33 and higher) were prevalent among 32.9% (642/1954) of NDPs, 39.4% (199/1954) of IDPs, and 47.2% (337/714) of refugees. DSM-V criteria for PTSD diagnosis was met by 50.8% (992/1954) of NDPs, 55.4% (280/505) of IDPs, and 62.2% (444/714) of refugees. Only 7.2% of the respondents reported no or mild stress, anxiety, and PTSD levels within the sample.

Interpretation

The lowest stress, anxiety, and PTSD severity was observed among NDPs, with significantly higher levels among IDPs and the highest among refugees. Being forcibly displaced from the previous living area and, especially, entering a new cultural environment significantly contributes to the mental health issues caused by war exposure and witnessing.

Funding

Ministry of Education and Science of Ukraine.

The relationship between socio-demographic factors and depression: a cross sectional study among civilian participants in hostilities in Ukraine

There is still a gap in scientific knowledge in relation to civilian participants in hostilities. This is despite the fact that there is an extensive body of literature on major depressive disorder (MDD) in individuals who have experienced armed conflict. The purpose of this article is to identify socio-demographic factors which are related to levels of depression among civilian participants in the war in Ukraine, based on a cross-sectional study that was conducted in 2019 from a convenience sample of 314 Ukrainian adults (235 males). Depression was assessed via the Beck Depression Inventory. Multiple regression analyses were conducted to identify possible predictors of depression. Significant predictors were: loss of a loved one, place of residence, age, health insurance, financial situation, and marital status (F (6, 224) = 10.515, p < 0.001, R2 = 0.21; Adjusted R2 = 0.19). They also show that symptoms of depression resulting from the loss of a loved one due to war can be reduced through participation in an educational system. Having children is associated with a risk of more severe depression. Specialists are encouraged to engage in face-to-face interviews and to maintain a supportive and safe environment for participants in hostilities, e.g., in the area of education.

The battle for mental well-being in Ukraine: mental health crisis and economic aspects of mental health services in wartime

The ongoing war in Ukraine is having profound impacts on both the local and global economy, as well as the infrastructure and overall well-being of the people. The prolonged duration of the conflict, coupled with its many related consequences such as total uncertainty, unfavorable economic conditions, and a distressing media backdrop, have a lasting impact on the mental health of the population. The ongoing war in Ukraine has exposed weaknesses in the national mental health care system and underscored the importance of mental health economics. To prevent further mental health problems, it is crucial to develop a comprehensive set of measures aimed at strengthening the capacity of the mental health care system in Ukraine. Currently, Ukraine's mental health care system suffers from a lack of financial and human resources, which hinders its ability to provide adequate support to those in need. To address this issue, joint efforts between Ukrainian mental health stakeholders and the international governmental and non-governmental organizations are needed to provide support and capacity building for mental health services in Ukraine.

The mental health impact of the ongoing Russian-Ukrainian war 6 months after the Russian invasion of Ukraine

Objective

This study aimed to investigate the impact of the ongoing war in Ukraine on the mental health of Ukrainians, focusing on war-induced trauma, disturbances in self-organization, post-traumatic stress disorder, complex post-traumatic stress disorder, anxiety, stress, and depression.

Methods

Data was collected from 703 participants 6 months after the full-scale invasion using a structured questionnaire that included sections on socio-demographic information, trauma-related issues, and mental health.

Results

The study found that levels of depression and anxiety were relatively low, while stress and resilience were relatively high among Ukrainians affected by the war. However, those who were directly exposed to military actions, physical violence, or severe human suffering had higher levels of anxiety, depression, stress, and trauma-related symptoms. The war experience varied by gender, age, and living conditions. Participants who stayed in Ukraine had significantly lower anxiety, depression, stress, and trauma-related symptoms compared to those who moved abroad. Anxiety, depression, stress, low resilience, and subjective satisfaction with living conditions were predictors of trauma-related symptoms, including PTSD and CPTSD.

Conclusion

These findings suggest that the mental health of Ukrainians affected by the war was impacted differently depending on their level of exposure to violence and their living conditions. Additionally, the study identified several predictors of trauma-related symptoms, including PTSD and CPTSD, such as anxiety, depression, stress, low resilience, and subjective satisfaction with living conditions. Future research should further explore the relationships between trauma type, sociodemographic factors, resilience, stress, anxiety, depression, and PTSD and CPTSD to better understand the mediation mechanisms underlying these relationships and to develop effective interventions to support the well-being of Ukrainians during this difficult time.

The Need for Psychiatric Treatment among Polish Users of Psychoactive Substances Is Increasing: This and Other Results from the Newest PolDrugs Survey

Background and Objectives: PolDrugs is the largest Polish naturalistic nationwide survey to present basic demographic and epidemiological data that could potentially prevent harm from illicit substances intake in drugs users. The most recent results were presented in 2021. The goal of this year's edition was to re-present the above data and compare it to the previous edition's data to identify and describe the differences. Materials and Methods: The survey included original questions about basic demographics, substance use, and psychiatric treatment. The survey was administered via the Google Forms platform and promoted via social media. The data was collected from 1117 respondents. Results: People of all ages use a variety of psychoactive substances in many situations. The three most commonly used drugs are marijuana, 3,4-methylenedioxymethamphetamine, and hallucinogenic mushrooms. The most common reason for seeking professional medical help was amphetamine use. A total of 41.7 percent of respondents were receiving psychiatric treatment. The three most common psychiatric diagnoses among the respondents were depressive disorders, anxiety disorders, and ADHD. Conclusions: Key findings include increases in the use of psilocybin and DMT, increases in the use of heated tobacco products, and a near doubling in the percentage of individuals receiving psychiatric help in the past two years. These issues are discussed in the discussion section of this paper, which also addresses the limitations to the article.

Editorial: Measuring and Buffering the Mental Health Impact of the War in Ukraine in Young People

The Russian invasion of Ukraine on February 24, 2022, has caused social, political, and financial instability worldwide. In Ukraine, the war has brought the greatest levels of violence, devastation, and disruption seen in Europe since World War II. Of course, the impact of war on the mental health of Ukrainian young people is likely substantial. Yet, more specific information about the prevalence and distribution of mental health disorders in young people is essential to document their needs, to select the best interventions, and to deliver these through international humanitarian efforts. The study by Osokina and Silwal et al.¹ presents some of the best evidence to date about the mental health impact of the war in Ukraine on young people.