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

Mental health of university students twenty months after the beginning of the full-scale Russian-Ukrainian war

BACKGROUND

Russia's full-scale military invasion of Ukraine on February 24, 2022 led to an increase of anxiety and depressive states, psychosomatic manifestations, and a tendency to abuse alcohol and psychoactive substances in the population. The aim of this paper is to examine the mental health burden among university students twenty months after war and to identify risk and protective factors for mental health problems.

METHODS

A cross-sectional study was conducted among Ukrainian students in October 2023 (n = 1398). The online survey included sociodemographic data collection, evaluation of psychological well-being and measured depression, anxiety, PTSD symptoms and insomnia. Normality of included variables was verified by Kolmogorov-Smirnov test. An independent-samples t-test, Mann-Whitney U-test, χ2 test and analysis of variance were used to compare the data. Differences in PHQ-9 and GAD-7 levels based on sociodemographic characteristics were analyzed using ANOVA. Correlation between variables was calculated with Pearson correlation, adjusted with Benjamini-Hochberg procedure. To develop the predictive model the XGBoost algorithm was employed, additionally, the SHAP algorithm was utilized.

RESULTS

Symptoms of PTSD, as well as moderate and severe symptoms of anxiety, depression, and insomnia, were reported by 48.1%, 34.1%, 33.6%, and 19.3% of students, respectively. The severity of these symptoms varied based on factors such as sex, age, prior trauma experiences, and living conditions. Additionally, the type of relocation (within Ukraine or abroad) significantly influenced mental health outcomes. A majority of participants (68.5%) reported the experience of war-related traumatic events. Factors linked to higher depression symptom scores included lower initial well-being, greater social media use, female gender, exposure to multiple traumatic events, experiences of assault or sexual violence, the loss of a loved one, pre-existing and ongoing mental health treatment during the war, and the use of psychotropic medications.

CONCLUSIONS

Ukrainian university students face a significant mental health burden due to the ongoing war, with high rates of reported PTSD, anxiety, depression, and insomnia symptoms. These findings highlight the importance of tailored mental health interventions through different stakeholders that take into account individual needs, past experiences, burdens and social media usage.

An educational approach to develop intercultural nursing care for refugees from Ukraine: A qualitative study

AIM

To describe how nurses and nursing students in Poland and the United States perceive the practice of intercultural care of refugees from Ukraine.

BACKGROUND

Millions of Ukrainian citizens sought safety in other countries when Russia invaded Ukraine in February 2022.

INTRODUCTION

Nurses in Poland and the United States are positioned to provide nursing care for refugees from Ukraine yet lack intercultural knowledge, skills, and attitudes to meet refugee needs.

METHODS

This education-focused qualitative description study was conducted in Spring 2023. Eighteen MSN and BSN students from one university in Poland and one university in the United States completed an international virtual exchange course that concentrated on the health and well-being of refugees from Ukraine. Students' reflection papers generated the data for this study. Content analysis was used to systematically structure the data, and themes were inductively derived for an initial understanding of intercultural care for refugees. The COREQ guidelines were followed for reporting study findings.

RESULTS

Major themes were troubled communication, overlooked trauma-informed care, and compromised vaccine status. Language differences, a gap in nursing knowledge, and cultural variations impeded intercultural care.

DISCUSSION

To address intercultural care for refugees from Ukraine, macro- and microlevel factors should be considered. Healthcare facilities need certified interpreters or adequate language-access technology for nurses. Nursing programs might evaluate content on trauma-informed care and cultural competency to meet the needs of war-affected refugees. Leaders from Ukrainian refugee communities could partner with nurses to deliver culturally relevant information to increase vaccine uptake.

IMPLICATIONS

Nurses should advocate for inclusion of the WHO competency standards of care for refugees in healthcare policies with emphasis on communication and evidence-informed practice. Placing Ukrainian community leaders on health councils could bridge the gap between refugees and mainstream society.

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.

War Anxiety: A Review

PURPOSE OF REVIEW

This review critically evaluates literature on war-induced anxiety, highlighting findings from 2021 to 2024, especially during the Russia-Ukraine war.

RECENT FINDINGS

Measures and prevalence estimates of anxiety and fear are updated. Populations affected by armed conflicts include residents of conflict zones and neighboring countries, internally displaced persons, refugees, combatants, and healthcare and humanitarian aid workers. Socioeconomic factors predict anxiety incidence and individuals differ in coping strategies. Anxiety could have long-term adverse effects over the life-course and across generations. Community and online interventions may reduce anxiety. The review underscores research directions in war-related anxiety's definition and assessment, risk and protective factors, health and societal consequences, and prevention and treatment approaches. The review provides an update for mental health researchers and practitioners working with the victims of war and other crises, often compounded by additional layers of stress of social inequalities, political divisions, and ethnic and racial tensions.

Psychometric assessment of the Beck anxiety inventory and key anxiety determinants among Ukrainian female refugees in the Czech Republic

Introduction

The full-scale Russian war has caused Ukrainian female refugees to experience many stressful events which may have an adverse impact on their mental health. Understanding the prevalence and determinants associated with anxiety is essential for psychosocial support. The study aimed: to evaluate the psychometric validity of the Ukrainian version of the Beck Anxiety Inventory (BAI) among Ukrainian female refugees in the Czech Republic, to determine the prevalence of anxiety, and to identify key determinants for anxiety in this population.

Methods

Anxiety was measured by BAI, which was validated by applying confirmatory factor analysis. Linear regressions were run to understand associations between social, physical and mental health determinants and anxiety, adjusted by socio-demographics.

Results

The BAI had a high level of internal consistency. External consistency was confirmed through: structural validity via CFA, indicating that a four-factor model, including cognitive, autonomic, neuromotor, and panic factors, were the most appropriate for the Ukrainian version of BAI; and convergent validity, shown by significant correlations between the total scores of the BAI and coping strategies, perceived stress, depression as well as self-reported physical and mental health. The study revealed that more than half of the participants had moderate to concerning symptoms of anxiety. The analysis indicated that poor perceived health, ineffective coping strategies, high perceived stress, and hampered daily activities due to health issues, are significant predictors of increased anxiety. Conversely, positive or stable social relations with relatives, neighbors, and locals, and the absence of discrimination, were shown to be crucial in reducing anxiety levels.

Characterizing of dropouts in the mental health of refugees and asylum seekers (MEHIRA) study examining the effects of a stepped and collaborative care model - a multicentered rater-blinded randomized controlled trial

BACKGROUND

Dropout from healthcare interventions can negatively affect patients and healthcare providers through impaired trust in the healthcare system and ineffective use of resources. Research on this topic is still largely missing on refugees and asylum seekers. The current study aimed to characterize predictors for dropout in the Mental Health in Refugees and Asylum Seekers (MEHIRA) study, one of the largest multicentered controlled trials investigating the effectiveness and cost-effectiveness of a nationwide stepped and collaborative care model.

METHODS

Predictors were multiply imputed and selected for descriptive modelling using backward elimination. The final variable set was entered into logistic regression.

RESULTS

The overall dropout rate was 41,7%. Dropout was higher in participants in group therapy (p = 0.001; OR = 10.7), with larger satisfaction with social relationships (p = 0.017; OR = 1.87), with difficulties in maintaining personal relationships (p = 0.005; OR = 4.27), and with higher depressive symptoms (p = 0.029; OR = 1.05). Participants living in refugee accommodation (p = 0.040; OR = 0.45), with a change in social status (p = 0.008; OR = 0.67) and with conduct (p = 0.020; OR = 0.24) and emotional problems (p = 0.013; OR = 0.31) were significantly less likely to drop out of treatment.

CONCLUSION

Overall, the outcomes of this study suggest that predictors assessing social relationships, social status, and living conditions should be considered as topics of psychological treatment to increase adherence and as predictors for future research studies (including treatment type).

The Psychological Toll of War and Forced Displacement in Gaza: A Study on Anxiety, PTSD, and Depression

Background

Armed conflicts severely impact survivors psychologically, with effects tied to the trauma's intensity and widespread displacement. From October 2023 to January 2025, the Gaza Strip faced violent conflict, leading to major displacement and suffering. This study examines anxiety, PTSD, and depression among displaced adults from Gaza Strip.

Methods

This cross-sectional study, conducted in November 2024, surveyed 952 displaced adults using the GAD-7, PCL-5, and PHQ-9 instruments and a convenience sampling method. A PTSD diagnosis required having a PCL-5 score ≥ 23 and fulfilling the DSM-5 criteria. The rates and severity of probable anxiety, PTSD, and depression were reported. Then, using SPSS, logistic regression models identified factors associated with each disorder, while multinomial regression models explored associations with the number of comorbidities.

Results

The majority were unemployed (73.7%). Over half of the participants were displaced in camps (55.6%), while 40.4% lived in shelters. Nearly a fifth (20.3%) had lost a first-degree relative, 12.7% were injured, and 4.8% were detained by the military. Moderate or higher levels of anxiety and depression were reported by 79.3% and 84.5%, respectively. The rate of symptomatic PTSD was 67.8% when defined as meeting the DSM-5 criteria for PTSD and having a PCL-5 score ≥ 23, and 88.2% based on the latter criterion alone, while subthreshold PTSD was encountered in 18.1%. Also, 63.1% suffered significant symptoms of all three comorbidities. Significant predictors of anxiety included being female and having PTSD or depression. Significant predictors of PTSD included experiencing more frequent migrations, unemployment or working in the private sector, military detention, or having anxiety or depression. Significant predictors of depression included the death of a first-degree relative, military detention, torture, and having anxiety or PTSD. Additionally, having a higher number of migrations was significantly associated with having one, two, or three disorders compared to having "no disorders," while those experiencing more forms of harm were significantly more likely to have all three disorders.

Conclusions

The study found very high rates of psychiatric disorders among IDPs in Gaza and identified several risk factors contributing to those rates. Interventions must be prioritized to support society's long-term recovery.

Resilience of Primary Health Care in Ukraine: Challenges of the Pandemic and War

This commentary examines the resilience of primary health care in Ukraine amidst the ongoing war, drawing a few reflections relevant for other fragile and conflict-affected situations. Using personal observations and various published and unpublished reports, this article outlines five reflections on the strengths, challenges, and necessary adaptations of Primary Health Care (PHC) in Ukraine. It underscores the concerted efforts of the government to maintain public financing of PHC, thereby averting system collapse. The research also highlights the role of strategic adaptations during the COVID-19 pandemic in fostering resilience during the war, including the widespread use of digital communication and skills training. The commentary emphasizes the role of managerial and financial autonomy in facilitating quick and efficient organizational response to crisis. It also recognizes emerging challenges, including better access to PHC services among the internally displaced persons, shifting patient profiles and service needs, and challenges related to reliance on local government financing. Finally, the authors advocate for a coordinated approach in humanitarian response, recovery efforts, and development programs to ensure the sustainability and effectiveness of PHC in Ukraine.

Psychosocial well-being and mental health of low- and middle-income countries' internally displaced persons and refugees during COVID-19: a systematic literature review

Background

The COVID-19 pandemic brought to light the need to address the psychosocial and mental health needs of refugees and internally displaced persons in low- and middle-income countries. COVID-19 prevention measures slowed essential services and healthcare, creating unique challenges for refugees and IDPs, including economic insecurity and societal instability. All of these factors may contribute to the reported declines in their psychosocial well-being.

Methods

To effectively define the problems of low-and middle-income countries (LMICs) in addressing the needs of these populations, we conducted a systematic literature review of literature on the mental health and psychosocial well-being of refugees and displaced persons who have migrated between LMICs in the context of COVID-19.

Findings

Our findings indicate that mental health interventions, such as digital healthcare and community-focused solutions, have the potential to address the problems faced by refugees and IDPs. Nevertheless, these community-based support networks are overextended, continuously developing to meet the needs of these vulnerable populations while considering the limited digital literacy of the subject population, internet accessibility, and overall limits in reach. We found that the efficacy of interventions varied according to the distinctive needs and challenges of various refugee and IDP populations.

Implications

The findings indicate a need for an intersectional policy approach to address the complex network of factors influencing mental health outcomes, including gender, housing, employment status, and social inequalities. Global agencies, policymakers, and local governments must prioritize the development of comprehensive mental health support systems, assuring refugees and IDPs have sustainable and equitable access.

A low-cost digital first aid tool to reduce psychological distress in refugees: A multi-country randomized controlled trial of self-help online in the first months after the invasion of Ukraine

Armed conflicts increase distress levels among affected populations, particularly impacting refugees who often face barriers to accessing psychological support. We evaluate an online version of a previously tested in-person and endorsed for online adaptation by the WHO Self-Help Plus (SH+) program among Ukrainian refugees dispersed across 17 countries, internally displaced and not displaced Ukrainians. This is the first randomized controlled trial to test an online psychological intervention simultaneously on refugees, internally displaced, and non-displaced conflict-affected populations. This study is an online two-arm, individually randomized controlled trial among participants above 18 years old in Ukraine or EU countries who were randomly assigned to receive either the Self-Help Online (SHO) intervention and passive informational resource or the passive informational resource alone. We recruited 652 participants starting the program on July 7th, 2022. The analysis focused on 292 participants who completed the final survey one week after the end of the program. Results indicated significant distress reduction among refugees (β -2.16, 95% CI -4.17 to -0.16; p = 0.03; d -0.47) but not among internally displaced in Ukraine (β 0.56, 95% CI -1.1 to 2.99; p = 0.17; d 0.2) or non-displaced participants in Ukraine (β 0.2, 95% CI -0.95 to 1.35; p = 0.73; d 0.08). The effect size in stress reduction for refugees was comparable to other similar interventions but with lower average costs. The average cost per participant was €11, with €46.16 for each benefiting (refugee) participant, suggesting cost-effectiveness for scale-up. These findings suggest that Self-Help Online is an effective psychological intervention for reducing stress among geographically dispersed refugees at a low cost. We also find that the online delivery format of psychological interventions is feasible for internally displaced and non-displaced conflict-affected populations.

Trauma and mental health problems among Iraqi IDPs following the 2014 ISIS Invasion: a systematic review

This study aimed to examine the mental health issues and trauma faced by Iraqi IDPs post-2014. Adhering to PRISMA guidelines, we conducted a literature search in PubMed, Scopus, and Google Scholar, identifying 208 articles. After excluding 190 articles for duplication and ineligibility, we ultimately included 18 studies. The Joanna Briggs Institute critical evaluation checklist was used for quality assessment. Studies involved 5,764 participants from diverse ethno-religious groups including Arabs, Kurds, Christians, and Yazidis. Participants were mostly female (55.5%), male (38.4%), and the smallest and largest study samples were 29 and 1,256, respectively. Ages ranged from 12.18 to 43.34 years. The results revealed a high prevalence of PTSD at 61.9%, with depression and anxiety rates at 49% and 51%, respectively, and suicidal behaviours at 67.5%. Among IDP subgroups, PTSD and suicidal behaviours were particularly high among Yazidi-enslaved girls and women, at 90.6% and 67.55% respectively. Major trauma exposures included forced displacement, encounters with combat and violence, enslavement, and witnessing the death or abuse of relatives. Critical contributing factors to mental health problems were gender (being female), economic instability, prolonged displacement, exposure to combat, experiences of rape and torture, and limited access to services. The mental health support of this vulnerable population is critical.

Social and emotional well-being intervention to reduce stress, anxiety, and depression among Ukrainian refugees resettled in Massachusetts

BACKGROUND

Mental health problems are high among refugees due to their traumatic experiences of fleeing war and witnessing disasters and deaths due to violence and conflict. Refugees are exposed to various socio-cultural stressors during their migration journey before, during, and after arriving at the host country, which may increase their risk of mental health problems. Strength-based interventions may be beneficial to address their socio-cultural and psychological stressors by strengthening individual's strengths to address their problems.

AIMS

This study evaluated the effect of a Social and Emotional Wellbeing intervention on mental health (stress, anxiety, and depression) and emotional health outcomes (coping, self-efficacy, social support, and conflict resolution) among Ukrainian refugees in Massachusetts.

METHODS

We implemented intervention (once-weekly/5-week) among 31 Ukrainian refugees with pre-and post-assessment of mental and emotional health outcomes (2022-2023). The intervention consisted 5-module: managing stress and mind-body exercise, strengthening communication and social networking, problem-solving, and creating a healthy family environment. Validated scales were used to measure mental and emotional health outcomes, such as the Hopkins-Symptom-Checklist-25 for anxiety and depression and the Cohen-Perceived-Stress scale for stress. Paired t-test was used for data analysis.

RESULTS

The pre versus post-intervention proportion reduced for anxiety (61.29% vs. 22.58%) and depression (58.06% vs. 22.58%). The mean scores significantly decreased from pre- to post-intervention by 6.26 points for stress, by 7.07 points for anxiety, and by 6.29 points for depression (both p's < .01). The mean scores significantly increased for coping (by 15.71), emotion-focused engagement (4.48), problem-focused engagement (4.80), social support (8.77), problem-focused coping self-efficacy (14.93), stop unpleasant emotions and thoughts (12.74), and friends networking (3.48; all p's < .01).

CONCLUSIONS

The stress, anxiety, and depression were reduced, and coping, self-efficacy, and social support networking skills were improved among Ukrainians after intervention. This program should be replicated in the larger community for a wider benefit.

The Influence of Faith on the Mental Health of Ukrainian Forced Migrants During the Russian-Ukrainian War: An Exploratory Study via Social Media

War is a significant, high-intensity stressor that forces millions of people to seek refuge in safer areas, resulting in profound physical and mental health challenges. Following the large-scale Russian invasion of Ukraine in February 2022, millions of Ukrainians became refugees in Europe. This exploratory study examines the influence of faith on the mental health of Ukrainian forced migrants during the war. The results indicate that two years after the start of the full-scale war, Ukrainian forced migrants suffer from PTSD symptoms, high levels of depression, moderate anxiety, frustration, rigidity, aggressiveness, and loneliness. This exploratory study provides insights into the role of faith in the mental health of forced migrants and underscores the importance of support services for this vulnerable population.

Resilience, avoidant coping and post-traumatic stress symptoms among female Ukrainian refugees and internally displaced people

BACKGROUND

Since the Russian full-scale invasion of Ukraine, over 10 million Ukrainians have been displaced from their homes. This has contributed to an increase in post-traumatic stress (PTS) symptoms in both refugees and internally displaced persons (IDPs). Previous research has suggested that refugees may experience higher levels of PTS due to additional stressors inherent in migration to a new country, language barriers and separation from family and social support. PTS symptoms may also be exacerbated by avoidant coping which we proposed would be more prevalent amongst refugees because of the isolating effects of migration-related stressors.

AIMS

The present study aimed to investigate the relationship between PTS symptoms, resilience and avoidant coping in refugees and IDPs. We predicted that refugees would report higher levels of PTS symptoms and use of avoidant coping strategies, and that avoidant coping would mediate the effect of resilience on PTS symptoms. We tested a moderated mediation model to examine whether this effect differed between IDPs and refugees.

METHODS

A total of 229 women (108 IDPs and 121 refugees), who were displaced after the full-scale invasion, were recruited using online platforms and volunteering centres. They completed an online questionnaire comprising measures of PTS, resilience and coping.

RESULTS

We found no significant differences in resilience, PTS symptoms or reported use of avoidance coping strategies between refugees and IDPs. As expected, avoidance coping mediated the negative association between resilience and PTS symptoms, but no group differences in this effect were observed.

CONCLUSIONS

Contrary to previous research, our findings indicate that PTS symptoms may be similarly problematic for refugees and IDPs. This may be due to increased time since the invasion as many refugees may have had time to adjust. Use of avoidant coping strategies may exacerbate PTS symptoms and our study highlights the need for mental health interventions aimed at reducing PTS symptoms in Ukrainian IDPs and refugees through fostering resilience and adaptive coping strategies.

Communicable diseases in Ukraine during the period of 2018-2023: Impact of the COVID-19 pandemic and war

BACKGROUND

By examining 2018-2023 data, this study explored the intricate impact of the Russian invasion, ongoing COVID-19 pandemic, and environmental disruptions on communicable diseases in Ukraine. This conflict exacerbates challenges in disease surveillance and healthcare, compounding stress among the population.

METHODS

Leveraging the Centers for Disease Prevention Control's surveillance system, the study employs active and passive surveillance, utilizing medical records and laboratory reports. Notification rates gauge the incidence of communicable diseases, offering insights into trends during the study period.

RESULTS

While salmonellosis, shigellosis, and rotavirus incidence are decreasing overall, there is a surge in viral hepatitis A, chronic hepatitis B, and C. This conflict hampers hepatitis C management, as evidenced by decreased numbers of treatment centers and patient enrollment. The prevalence of cough cases will increase in 2023, emphasizing the importance of sustained vaccination. The incidence of tuberculosis will increase in 2023 despite a general decrease.

CONCLUSION

This study underscores the urgent need for sustained efforts and adequate resources, infrastructure, and international support to mitigate public health challenges in conflict-ridden Ukraine. Prioritizing vaccination programmes and enhancing healthcare accessibility in affected regions are crucial.

Prevalence of post-traumatic stress disorder and depressive symptoms among civilians residing in armed conflict-affected regions: a systematic review and meta-analysis

Background

Globally, populations afflicted by armed conflict are known to have high rates of mental health disorders.

Aims

This meta-analysis aims to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive symptoms among civilians residing in armed conflict-affected regions.

Methods

This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search employing MEDLINE(R), Embase Classic+Embase, APA PsycINFO, Ovid Healthstar, Journal@Ovid Full Text, Cochrane, PTSDpubs and CINAHL was conducted from inception until 19 March 2024 to identify relevant studies. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, and a Comprehensive Meta-Analysis was used to conduct the statistical analysis.

Results

The search yielded 38 595 articles, of which 57 were considered eligible for inclusion. The included studies comprised data from 64 596 participants. We estimated a prevalence of 23.70% (95% CI 19.50% to 28.40%) for PTSD symptoms and 25.60% (95% CI 20.70% to 31.10%) for depressive features among war-afflicted civilians. The subgroup analysis based on time since the war and the country's economic status revealed the highest prevalence for both PTSD and depressive symptoms was present during the years of war and in low/middle-income countries.

Conclusions

The results of this study provide conclusive evidence of the detrimental impacts of armed conflict on mental health outcomes. Hence, it is crucial to emphasise the significance of both physical and mental health in the aftermath of war and take appropriate humanistic measures to overcome challenges in the management of psychiatric illnesses.

PROSPERO registration number

CRD42023416096.

Exploring the complex interplay: gut microbiome, stress, and leptospirosis

Leptospirosis, a re-emerging zoonotic disease, remains a significant global health concern, especially amid floods and disasters such as the Kakhovka Dam destruction. As is known, the stress that occurs in the conditions of military conflicts among civilian and military personnel significantly affects susceptibility to infectious diseases and possibly even influences their course. This review aims to explore how the gut microbiome and stress mediators (such as catecholamines and corticosteroids) might impact the leptospirosis disease course. The review opens new horizons for research by elucidating the connections between the gut microbiome, stress, and leptospirosis.

Trauma-informed training as a means of stabilizing the negative impact of stressful and destructive factors of war on the inner world of future specialists

OBJECTIVE

Aim: To determine the conditions for the implementation of trauma-informed training as a means of stabilizing the negative impact of stressful and destructive factors of war on the inner world of future specialists.

PATIENTS AND METHODS

Materials and Methods: 1,100 students studying in the conditions of martial law took part in the experimental work.

RESULTS

Results: As a result of the negative impact of the stressful and destructive factors of the war on the inner world, the future specialists the following manifestations of the deterioration of the health were established: depression (99%), sudden change of mood (92%), worsening of well-being during sudden changes in the weather (66%), irritability (52%), aggressiveness (11%), anger (7%). It was found that future specialists wanted to postpone completing the educational task until later, as they perceived it as very difficult (79%).

CONCLUSION

Conclusions: The conditions for the implementation of trauma-informed studying were formulated as a means of stabilizing the negative impact of stressful and destructive factors of war on the inner world of future specialists. 1. During the organization of learning, teachers take into account the fact that psycho-traumas, which are caused by stressful and destructive factors of war, disturb students until they experience them. 2. Teachers take into account the traumatic experience of future specialists. 3. The teachers' actions aim to restore future professionals' sense of security, reestablish contact with other study participants, and regain control over their own lives and studies.