Mental Health Burden of the Russian-Ukrainian War 2022 (RUW-22): Anxiety and Depression Levels among Young Adults in Central Europe

Comprehensive examination of support needs and mental well-being: a mixed-method study of the Austrian general population in times of crisis

Introduction

In the recent years, the Austrian general population has faced a confluence of multiple crises. This study investigates the support wishes and mental health parameters of the Austrian general population aiming to comprehending the unmet needs and providing guidance for future psychosocial interventions and research endeavors.

Methods

1,031 participants attended the online survey and one third (n = 332) wished for further support to improve mental well-being in April 2022. A total of 280 participants accompanied their support wish with written accounts. Participants' mental health status was evaluated using the PHQ-9 (depression), GAD-7 (anxiety), ISI (insomnia), PSS-10 (perceived stress), CAGE (alcohol abuse), WHO-5 (well-being), and the SCOFF (eating disorder) questionnaires. Data analysis employed a mixed-methods approach.

Results

The preeminent support wish identified was the need for professional mental support (29.3%), followed by communication (21.6%), other professional support except mental and medical support (13.9%). In line with these findings, participants expressing a support wish experienced increased mental health distress across all assessed parameters.

Conclusion

The findings indicate the presence of a vulnerable population within the Austrian general population, which may benefit from targeted support interventions. Consequently, this study contributes to the identification of unmet support needs among the Austrian populace during times of crisis, facilitating the development and enhancement of precisely tailored intervention strategies.

Anxiety and watching the war in Ukraine

On 24 February 2022, Russia attacked Ukraine. Millions of people tuned into social media to watch the war. Media exposure to disasters and large-scale violence can precipitate anxiety resulting in intrusive thoughts. This research investigates factors related to anxiety while watching the war. Since the war began during the ongoing coronavirus pandemic, threat from COVID-19 is seen as a predictor of anxiety when watching the war. A theoretical model is put forward where the outcome was anxiety when watching the war, and predictors were self-reported interference of watching the war with one's studies or work, gender, worry about the war, self-efficacy and coronavirus threat. Data were collected online with independent samples of university students from two European countries close to Ukraine, Germany (n = 348) and Finland (n = 228), who filled out an anonymous questionnaire. Path analysis was used to analyse the data. Findings showed that the model was an acceptable fit to the data in each sample, and standardised regression coefficients indicated that anxiety, when watching the war, increased with interference, war worry and coronavirus threat, and decreased with self-efficacy. Women reported more anxiety when watching the war than men. Implications of the results are discussed.

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.

Trajectories of relationship and sexual satisfaction over 2 years in the Covid-19 pandemic: A latent class analysis

OBJECTIVE

Previous research on the impact of the Covid-19 pandemic on romantic relationships has mainly concentrated on short-term effects and average trends of change. This study aimed to explore different trajectories of relationship and sexual satisfaction from April 2020 to March 2022.

METHOD

Including a cross-national sample of 2859 individuals, a latent class approach was applied to identify subgroups of sexual and relationship satisfaction trajectories. Participants' satisfaction levels, attachment style, psychological symptoms, life satisfaction, and living arrangements were taken into account.

RESULTS

Three latent classes were identified for both relationship and sexual satisfaction: (1) a group with high satisfaction levels but a slightly declining trajectory, (2) a group with low satisfaction levels but an ascending trajectory, and (3) a fluctuating group. Living apart, having children, psychological symptoms, low life satisfaction, and avoidant attachment characterized the two groups with low or fluctuating trajectories.

CONCLUSIONS

The findings suggest that there were different trajectories of relationship and sexual satisfaction during the pandemic, which can be predicted by individual dispositions. Even 2 years after the pandemic, its effects had not disappeared.

For whom the bell tolls. A spatial analysis of the renewable energy transition determinants in Europe in light of the Russia-Ukraine war

The ongoing invasion of Russia of Ukraine and energy crises have sparked concern about economic and geopolitical stability all over the world. In Europe, the war has destabilized and endangered the energy cooperation and transition between European countries within and outside of the EU. This emergency has shown once more the importance of energy resilience policies to offset the vulnerability of energy systems and energy insecurity at the national and regional levels. Consilience has been reached on the necessity of enhancing EU energy security as an adaptation strategy. This work contributes to the existing scholarship on renewable energy transition and citizens' perception, focusing on European Union member states. Key characteristics of the renewable energy transition in the EU prior to the energy crisis and the war in Ukraine are examined. To this end, we analyze selected economic, environmental, social, policy and political variables on energy sorting from the Eurobarometer studying European citizens' perceptions. The exercise makes use of spatially-clustered regression to explore spatial heterogeneity and to elicit determinant information on specific regional groups. We learn that southern Europeans attribute less importance to energy infrastructure to facilitate the renewable energy transition and repute the EU solidity not a requirement for energy security access. Conversely, northern European citizens tend not to associate the responsibility of the EU in guiding competitiveness and policy toward green energy sources transformation. Robustness tests confirm our hypothesis. Regardless of regional differences, the EU energy and ecological transition will thrive with industrial and political cohesion. This process will pass through increased trust in institutions and dedicated energy policy action which will smooth the risks and disruptions coming from current and future shocks.

Exploring the Prevalence and Predictors of Anxiety among Lithuanian Adolescents during Times of Crisis: A Cross-Sectional Study

Recent events in Europe, like the COVID-19 pandemic and the 2022 Russo-Ukrainian War (RUW), might have sparked anxiety among adolescents. This study aimed to compare anxiety levels in Lithuanian adolescents post-COVID-19 peak (Study 1, October 2021) and during the onset of the RUW (Study 2, April-June 2022). Data from 459 participants in Study 1 and 6637 in Study 2, aged 11-17, were collected through HBSC pilot and national surveys in Lithuania. Self-reported questionnaires assessed anxiety, social media use, stress, loneliness, self-efficacy, and peer support factors. Analysis was conducted using multivariable logistic regressions. Notably, anxiety prevalence in Lithuanian adolescents showed no significant difference between Study 1 and Study 2, stabilizing around 24%. In 2021, stress (OR = 5.89, 95% CI 3.11-11.17), problematic social media use (OR = 4.58, 95% CI 1.89-10.58), and female gender (OR = 2.87, 95% CI 1.58-5.22) significantly predicted anxiety. By 2022, stress (OR = 3.68, 95% CI 3.14-4.30), loneliness (OR = 2.85, 95% CI 2.43-3.35), and lower self-efficacy (OR = 1.40, 95% CI 1.20-1.60) emerged as important predictors. This study enhances our understanding of adolescent anxiety during crises, emphasizing the urgency of addressing multiple factors to manage and support vulnerable youth.

Generation climate crisis, COVID-19, and Russia-Ukraine-War: global crises and mental health in adolescents

Climate change, COVID-19, and the Russia-Ukraine War are some of the great challenges of our time. These global crises affect young people in a particularly vulnerable phase of their lives. The current study aimed to assess the impact of these crises on mental health (depression, anxiety, and health-related quality of life) in secondary school students in Germany. Furthermore, we assessed known predictors of mental health, such as socio-economic factors, individual life stressors, and resilience factors (self-efficacy, expressive flexibility) as covariates. In our sample of 3998 pupils, pandemic- and climate-related distress were linked to greater depression and anxiety and reduced health-related quality of life. War-related distress was associated with greater anxiety. Critically, these associations remained significant after controlling for all covariates, supporting the incremental predictive value of the crises measures. The study reveals a significant impact of the crises on the mental health of the current generation of adolescents. As such it suggests that mental health policies should include interventions that help youth to cope with the stress caused by the crises.

Trauma-related and risk factors associated with perceived exacerbation in psychological distress due to the Russo-Ukrainian war

This study examined trauma-related and other potential risk factors associated with perceived exacerbation in psychological distress among Israelis due to the Russo-Ukrainian War. Specifically, we assessed how vulnerability factors such as previous traumatic exposure, having relatives and friends affected by the war, media exposure, having a Holocaust familial background, lower levels of resilience, and probable posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) are associated with perceived exacerbation in psychological distress. A random sample of 845 Israeli Jews aged 18-75 who reported exposure to at least one traumatic event participated in the study. Univariate logistic regression showed that Holocaust familial background, previous exposure to trauma, media exposure to the Russo-Ukrainian War, and probable diagnosis of PTSD or CPTSD are the main factors associated with perceived exacerbation in psychological distress. These results suggest that various traumatic factors associate with perceived higher psychological vulnerability to international conflicts, even when there is no direct personal threat. Practitioners should be aware of these factors among individuals exposed to trauma.

Sense of danger, sense of country's mastery, and sense of personal mastery as concomitants of psychological distress and subjective well-being in a sample of Poles following Russia's invasion of Ukraine: Prospective analyses

This study investigated psychological toll of the ongoing war in neighboring Ukraine in a sample of adult Poles (N = 1245). Data were collected online in early February and August 2022. Prospective analyses that accounted for psychological health status assessed before the Russian invasion showed that higher levels of sense of danger due to the war predicted higher levels of psychological distress and lower levels of affect balance close to 6 months after Russia attacked Ukraine. Sense of country's mastery (i.e. beliefs that government, its major institutions, and citizens would effectively cope with various emergencies and crises) served as a protective factor. Likewise, Poles who had confidence in their personal mastery (e.g., beliefs in ability to exercise control over life challenges) exhibited less distress and more subjective well-being. These findings emerged after controlling for sociodemographic factors, the presence of stressful experiences associated with the COVID-19 pandemic, and other life events. Wars dramatically reverberate beyond the borders of the countries involved. People's own sense of mastery and their trust in the resilience of their governmental and public institutions are critical in times of coping with existential security threats and wars.

COVID-19 or threat of a nuclear war in Europe? A cross-sectional study of anxiety levels in adults living in Portugal

Background

Since 2019, Europe has experienced ongoing stressors with the emergence of the COVID-19 pandemic and the Russian-Ukrainian War, which have had social, financial, physical, and psychological impacts. Studies suggest that anxiety, fear, post-traumatic stress disorder, depression, and other psychological disorders are common in such situations, and there is a need for more research on the impact of the war on mental health in Portugal. The main goal of the present study was to assess the impact of the fear of COVID-19 and anxiety related to nuclear war on the general anxiety levels of adult individuals living in Portugal.

Methods

A cross-sectional study was conducted from May to July 2022 using an online questionnaire built on the Google Forms platform. Portuguese-speaking male and female individuals aged 18 years or older, who provided informed consent and agreed to participate, were included. The outcome variable was defined using the Portuguese version of the GAD-7 scale, while the main predictors were the FCV-19S and the NWA Scale in Portuguese. Linear and logistic regression models were used to test associations between predictors and outcome variable.

Results

The study included 1,182 participants, with a mean age of 46.5 (±11.7) years, mostly women (80.6%). The global mean GAD-7 score was 5.8 (±4.5) points, and 17.9% of the participants scored above the 10-point cutoff. Higher scores were found in both the FCV-19S and the NWA scale among participants with anxiety, as measured by both a 10-point cutoff (p < 0.001), and GAD-7 scale mean scores (p < 0.001). The study showed that fear of COVID-19 [OR of 1.133 (95%CI: 1.097-1.170)] and, at a lesser extent, nuclear war anxiety [OR of 1.020 (95%CI, 1.009-1.031)] contribute to anxiety in the general population. This is also true for those with a personal history of anxiety, revealed by multiple regression.

Discussion

This study contributes to the research on COVID-19's impact on anxiety and provides the first comprehensive assessment of nuclear war anxiety in Portugal. Results highlight the need for long-term care for anxiety, as prevalence is expected to increase due to the pandemic and war, even in non-conflict areas like Portugal.

Perinatal experiences of Ukrainian women at the beginning of the war

OBJECTIVE

Pregnancy and childbirth are related to the experience of distress at their core. However, this distress is significantly increased under war conditions. The study aims to examine the perinatal experience of women during the war in Ukraine.

METHODS

12 Ukrainian women who were pregnant and lived in Kyiv or the suburbs of Kyiv from February to May 2022 took part in the study. In-depth interviews were conducted online in the form of semi-structured interviews, and the thematic analysis technique was used.

RESULTS

The perinatal experiences of women during the war in Ukraine were divided into 2 basic groups: negative perinatal experiences and positive perinatal experiences during the war. The negative perinatal experiences were grouped into three main themes: 1) negative emotions experienced in association with war, 2) dissatisfaction with medical support during the war, 3) suffering associated with separation from a husband and relatives. The positive perinatal experiences include 6 main themes: 1) the joy of returning or/and staying home, 2) satisfaction with medical support during the war, 3) coping with stress during the war, 4) family relationships and support during the war, 5) positive attitudes towards the child (or unborn child), 6) patriotic sentiments.

CONCLUSION

The study revealed negative and positive aspects of the perinatal experience of Ukrainian women during the war. Providing access to medical advice, facilitating uncertainty reduction, and communication between women and their families contribute to positive perinatal experiences of pregnant women and new mothers during the war.

Psychological distress among healthcare students in Poland from COVID-19 to war on Ukraine: a cross-sectional exploratory study

Objectives

Healthcare students went through a rough time in March 2022 due to extreme changes in the educational system (moving from online to stationary learning) and Ukrainian-Russian war circumstances. Our study aims to update knowledge about psychological distress and its impact on healthcare students in Poland after two years of the COVID-19 pandemic, followed by intense and political instability in Europe.

Methods

We conducted a cross-sectional study on healthcare students from Poznan University of Medical Sciences, Poland, from March to April 2022. The questionnaire included subjective retrospective 5-point Likert-scales ratings of anxiety, stress, and depression and self-reported information on various psychological distress predictors.

Results

The anxiety levels at the beginning of the COVID-19 pandemic were higher than in April 2022. There was no significant reduction in stress and depression. Females had higher initial anxiety levels than post-pandemic levels. Higher reported levels of anxiety, stress, and depression were significantly correlated with political instability in Eastern Europe (Spearman r_anxiety = 0.178, r_stress = 0.169, r_depression = 0.154, p ≤ 0.001, respectively). The concern about moving towards online education showed a significant association only with stress level (r_stress = 0.099, p = 0.034). We also observed a positive correlation between anxiety, stress, and depression and deteriorating sleep quality (Spearman r_anxiety,=0.325, r_stress = 0.410, r_depression = 0.440, p < 0.001), the feeling of worsening relationships with family and peers (r_anxiety = 0.325, r_stress = 0.343, r_depression = 0.379, p < 0.001), and the sense of loss of efficient time management (r_anxiety = 0.321, r_stress = 0.345, r_depression = 0.410, p < 0.001).

Conclusion

Throughout the progression of the Ukrainian war and the COVID-19 pandemic, females reported improved (lower levels) levels of anxiety. Nevertheless, the current levels of self-reported anxiety post-pandemic remain alarming, while stress and depression levels remained unchanged. Mental, psychological, and social support activities are required for healthcare students, especially those away from their families. Time management, academic performance, and coping skills in relation to the additional stressors of war and the global pandemic require further research in this group of students.

The comorbidity of somatic symptom and major depressive disorders in the times of COVID-19 lockdown in adolescence: A case-report study

Physical symptoms with normal clinical examinations have been reported without detectable structural or biochemical abnormalities in the comorbidity of somatic symptom disorder and major depressive disorder. This association can have a debilitating effect on their academic and social performance. This case report is about a 13-year-old Afghani immigrant boy with no previous psychiatric history who developed severe body pain leading to a disability during the COVID-19 lockdown and social isolation. During further evaluation, all his clinical examinations were normal, and the diagnosis of major depressive disorder and somatic symptom disorder was confirmed. Cognitive behavioral therapy includes cognitive therapy, changing lifestyle, and a motivational support method. Medical treatment with olanzapine, fluvoxamine, and gabapentin was started. During follow-up, there was improvement in the patient's mood, and the patient began to walk and communicate. It is important to suspect an association of somatic symptom disorder and major depressive disorder in patients with severe body pain and multiemotional factors. Psychiatrists should keep in mind that emotional factors can play a significant role in causing and maintaining physical symptoms.

The impact of the Russian-Ukrainian war on the mental health of Italian people after 2 years of the pandemic: risk and protective factors as moderators

Objective

This contribution aimed at investigating the moderating role of risk (e.g., the negative influence of COVID-19 on mental health) and protective (e.g., post-traumatic growth) factors on the relationship between the concern for war and stress and anxiety/depression levels among Italian people.

Methods

A questionnaire that included sociodemographic characteristics, the Perceived Stress Scale (PSS-4), the Patient Health Questionnaire (PHQ-4), the Brief Resilience Scale (BRS), the Post-Traumatic Growth Inventory (PTGI), and questions formulated ad hoc about concern for war was administered online. A sample of 755 participants (65.4% females, mean age = 32.39, SD = 12.64, range = 18-75) was recruited by convenience and snowball sampling. The researchers spread the link to the questionnaire to their acquaintances asking them to fill it out and to recruit other people.

Results

Results showed that concern for war significantly augmented the levels of stress and anxiety/depression in Italian people. Being a healthcare professional or having a chronic illness negatively moderated the effect of concern for war on stress and anxiety/depression. Instead, the negative influence of COVID-19 on mental health positively moderated the effect of concern for war on stress. Moreover, the overall positive changes after trauma and four of its five scales (i.e., Relating to Others, New Possibilities, Personal Strength, and Spiritual Change), negatively moderated the effect of concern for war on anxiety/depression.

Conclusions

In conclusion, concern about the Russian-Ukrainian war affects the mental health of the Italian population even if they are not directly involved in the conflict.

Dr. Smartphone, can you support my trauma? An informatics analysis study of App Store apps for trauma- and stressor-related disorders

Background

Psychological trauma is prevalent in developed countries, with prevalence rates and treatment needs exceeding health system capacity. As telemedicine and out-of-patient care are promoted, there has been an expansion of digital apps to compliment therapeutic stages in psychological trauma. To date there are no reviews that have compared these apps and their clinical utility. This study aims to identify the availability of trauma- and stressor-related mhealth apps, assess their functionality, and review their therapeutic abilities.

Methodology

The authors conducted a systematic search using an iPhone 13 Pro in the Australian IOS App Store to extract trauma- and stressor-related apps that resulted from the search criteria. A cross-adaptation of the Mobile App Rating Scale (MARS) and the Comprehensive App Evaluation Model (CAEM) were used as a framework to produce the mTrauma App Evaluation Conceptual Model and Informatics Framework. App content descriptors were analysed based on their general characteristics, usability, therapeutic focus, clinical utility, data integration. Following an applicability in concordance with psychological trauma-informed delivery.

Results

A total of 234 apps resulting from the search strategy were screened, with 81 apps that met the inclusion criteria. The majority of apps were marketed to 4+ to 17+ years of age, categorised as 'health and fitness', with the highest target markets observed for adolescents, children, parents, clinicians, and clients. A total of 43 apps (53.1%) contained a trauma-informed specified section, and 37 (45.7%) incorporated a section useful to support trauma-related symptoms. A significant number of apps there was an absence of therapeutic utility (in 32 apps (39.5%)). Most apps were supporting post-traumatic stress disorder-informed, cognitive behavioural therapy and eye movement desensitisation and reprocessing. Provision of psychoeducation, courses, guided sessions, trainings, self-reflection/journaling, symptom management and progress tracking were highly present.

Conclusions

Trauma-informed mobile apps are available in the App Store, expanding in its target market reach and usability, with an increase of creative psychotherapies being introduced alongside conventional modalities. However, based on the app descriptors, the scarcity of evidenced-based testimonials and therapeutic applicability remains questionable for clinical validity. Although mhealth tools are marketed as trauma-related, current available apps employ a multifunctional approach to general psychological symptomatology, through to associated comorbid conditions and emphasizes on passive activity. For higher uptake on user engagement, clinical application and validity, trauma-apps require curated specification to fulfil its role as complimentary psychological treatment.

Self-regulation as a resource for coping with developmental challenges during middle childhood and adolescence: the prospective longitudinal PIERYOUTH-study

BACKGROUND

Self-regulation (SR) as the ability to regulate one's own physical state, emotions, cognitions, and behavior, is considered to play a pivotal role in the concurrent and subsequent mental and physical health of an individual. Although SR skills encompass numerous sub-facets, previous research has often focused on only one or a few of these sub-facets, and only rarely on adolescence. Therefore, little is known about the development of the sub-facets, their interplay, and their specific contributions to future developmental outcomes, particularly in adolescence. To fill these research gaps, this study aims to prospectively examine (1) the development of SR and (2) their influence on adolescent-specific developmental outcomes in a large community sample.

METHODS/DESIGN

Based on previously collected data from the Potsdam Intrapersonal Developmental Risk (PIER) study with three measurement points, the present prospective, longitudinal study aims to add a fourth measurement point (PIER_YOUTH). We aim to retain at least 1074 participants now between 16 and 23 years of the initially 1657 participants (6-11 years of age at the first measurement point in 2012/2013; 52.2% female). The study will continue to follow a multi-method (questionnaires, physiological assessments, performance-based computer tasks), multi-facet (assessing various domains of SR), and multi-rater (self-, parent-, and teacher-report) approach. In addition, a broad range of adolescent-specific developmental outcomes is considered. In doing so, we will cover the development of SR and relevant outcomes over the period of 10 years. In addition, we intend to conduct a fifth measurement point (given prolonged funding) to investigate development up to young adulthood.

DISCUSSION

With its broad and multimethodological approach, PIER_YOUTH aims to contribute to a deeper understanding of the development and role of various SR sub-facets from middle childhood to adolescence. The large sample size and low drop-out rates in the first three measurements points form a sound database for our present prospective research. Trial registration German Clinical Trials Register, registration number DRKS00030847.

Nuclear Anxiety Amid the Russian-Ukrainian War 2022 (RUW-22): Descriptive Cross-Sectional Study

Nuclear anxiety, which refers to the fear of nuclear war and its consequences, is expected to increase amid the Russian-Ukrainian War of 2022 (RUW-22). This study aimed to evaluate the prevalence of nuclear anxiety and its associated variables among university students in the Czech Republic during the first weeks of RUW-22. A cross-sectional survey-based study was carried out from March-April 2022, utilizing a digital self-administered questionnaire (SAQ) to collect data from the target population. The SAQ consisted of multiple-choice items inquiring about demographic characteristics; generalized anxiety symptoms using generalized anxiety disorder-7 (GAD-7); depressive symptoms using patient health questionnaire-9 (PHQ-9); and attitudes towards civilian uses of nuclear power, and nuclear war-related anxiety. Of the 591 participating students, 67.7% were females, 68.2% were Czech nationals, and 61.8% followed the RUW-22 news at least once daily. The mean GAD-7 score of our participants was 7.86 ± 5.32 (0-21); and their mean PHQ-9 score was 8.66 ± 6.29 (0-27). Regarding the civilian uses of nuclear power, most participants agreed that nuclear power was safe (64.5%), denied being afraid that civilian use of nuclear power might deteriorate their health (79.7%), and thought that public acceptance was important for building new nuclear power plants (56.9%). About 42.1% and 45.5% of the participants reported feeling depressed at the possibility of nuclear war and agreed that the chances that there would be a nuclear war in their lifetime were very high, respectively. When asked about their preparedness measures during the previous four weeks, less than one quarter (23.9%) reported looking for recommendations for protection against nuclear accidents, and less than one-fifth (19.3%) were looking for the nearest bomb shelter. The depression about nuclear war possibility was positively and relatively strongly correlated with the level of "feeling concerned about the RUW-22" (rs = 0.401), and it was moderately correlated with GAD-7 (rs = 0.377) and PHQ-9 (rs = 0.274) scores and weakly correlated with RUW-2-related news-following frequency (rs = 0.196). Within the limitations of the present study, nuclear anxiety was common among Czech university students. Its associated factors may include but are not limited to the female gender; common psychological disorders such as generalized anxiety and depression; RUW-22-related news following-frequency; and the level of "feeling concerned".

The Effects of Art Therapy on Anxiety and Distress for Korean-Ukrainian Refugee: Quasi-Experimental Design Study

Since Russia invaded Ukraine in February 2022, there has been an urgent need to provide mental healthcare and share various practices for Ukrainian war refugees. This study urgently focuses on the need for art therapy to support the mental health of Ukrainian refugees, Koryo-saram, who are staying in the Republic of Korea due to the wartime emergency. It also examines the impact of art therapy intervention on anxiety and subjective stress. The single-session art therapy with the 54 Koryo-saram refugees aged 13-68 showed the effectiveness of the art therapy intervention. The results indicate that GAD-7 (t = 3.092, p = 0.003) and SUDs (t = 3.335, p = 0.002) were statistically significant within the intervention group. In addition, satisfaction assessments of the qualitatively analyzed participants showed that Ukrainian Koryo-saram had a positive experience of art therapy. Therefore single-session art therapy in this study demonstrated the efficacy of art therapy for the anxiety and subjective distress of Ukrainian Koryo-saram refugees. This result suggests that the intervention of art therapy as immediate mental healthcare for refugees facing war could benefit the mental health of Koryo-saram refugees.

Current Perspectives on the Challenges of Implementing Assistance Dogs in Human Mental Health Care

The prevalence of mental health disorders, driven by current global crises, is notably high. During the past decades, the popularity of dogs assisting humans with a wide spectrum of mental health disorders has significantly increased. Notwithstanding these dogs' doubtless value, research on their legal status, certification processes, training and management practices, as well as their welfare status, has been scarce. This scoping review highlights that in contrast to other assistance dogs such as guide dogs, there exists no consistent terminology to mark dogs that assist humans with impaired mental health. Legal authorities monitoring the accreditation process, training and tracking of mental health supporting dogs are broadly lacking, with only few exceptions. This review emphasizes the need to address several topics in the promotion of progress in legal and welfare issues related to assistance dogs as well as emotional support dogs for humans with a mental health disorder. The current body of knowledge was assessed in three different areas of focus: (1) the legal dimension including definitions and certification processes; (2) the dimension of performed tasks; and (3) the dog welfare dimension including aspects of the relationship with the handler and risks associated with children recipients. Considering the challenges associated with a mental health diagnosis, collaborations of dog provider organizations and health care professionals would be desirable to continuously assess the efficiency of the human-dog dyad regarding their overall compatibility, general satisfaction and mutual well-being.

Anxiety, depressive symptoms, and distress over the course of the war in Ukraine in three federal states in Germany

Introduction

The Russian invasion of Ukraine and the resulting consequences are in the center of political discussions, media, and likely individual thinking of the population in Germany. Yet, the impact of this prolonged exposure on mental health is not known hitherto.

Methods

Using the population based cohort study DigiHero from three federal states (Saxony-Anhalt, Saxony, and Bavaria), we assessed anxiety levels (GAD-7), depressive symptoms (PHQ-9), and distress (modified PDI) in the first weeks of war and 6 months later.

Results

Of those 19,432, who responded in the first weeks of war, 13,934 (71.1%) responded also 6 months later. While anxiety and emotional distress decreased during the 6 months, their average scores were still elevated, and a substantial fraction of respondents displayed clinically relevant sequelae. Persons from low-income households were especially affected, specifically by fears related to the personal financial situation. Those who reacted with a particularly strong fear in the beginning of war were more likely to have persistent clinically relevant symptoms of depression and anxiety also 6 months later.

Discussion

The Russian invasion of Ukraine is accompanied by continuing impairment of mental health in the German population. Fears surrounding the personal financial situation are a strong determinant.

Response of Polish Psychiatric Patients to the Russian Invasion of Ukraine in February 2022-Predictive Role of Risk Perception and Temperamental Traits

This study examined the impact of the Russian invasion of Ukraine in February 2022 on Polish patients with depression and schizophrenia. It has been hypothesized that possible changes in symptoms may be predicted by the subjective risk perception related with the Russo-Ukraine War (RUW) as well as by temperamental traits. The study was conducted with 80 patients with schizophrenia or depression. A questionnaire measuring sociodemographic characteristics, perception of risk, temperamental characteristics, and symptoms of depression and schizophrenia were used as research tools. Symptom intensity was compared with the average symptom intensity calculated on the basis of archival symptom measurements from the three consecutive months preceding the outbreak of the RUW. Predictors of change in symptoms were also analyzed, taking into account sociodemographic variables, the level of risk perception, and temperamental traits. The results indicate the specific patterns of reactions to war danger for patients with different types of psychiatric diagnosis. Depressed patients reacted with an increase in seven symptoms related to unworthiness and/or guilt, lack of interest, and/or pleasure and pessimism. The response of schizophrenic patients was related only with an increase in positive symptoms. This study highlights the need to provide more support to psychiatric patients in acute emergencies.

The Opinions of Poles about the Need to Provide Humanitarian Aid to Refugees from the Area Covered by the Russian-Ukrainian War

The armed conflict in Ukraine has caused a lot of emotions around the world. Many countries have been involved in helping brutally attacked people, especially mothers and children. The versatile involvement of large powers is monitored and noticeable by the media. Active help from Poland is a very visible sign of human solidarity with the suffering Ukrainian nation. Open hearts, houses and institutions and humanitarian and medical aid are elements of Polish kindness and empathy. The aim of the research was to collect Poles' opinions about the need to provide humanitarian aid to Ukrainians from the territories of the Russian-Ukrainian war. Capturing feelings of Poles towards Ukrainians during the war is an interesting issue that shows subjective opinions about the existential situation perceived in the space of mutual personal interactions. The results showing opinions on help were collected from a group of 1012 people throughout Poland with the help of an authorial questionnaire. The obtained data shows a positive attitude of Poles to Ukrainians. The most willing to help are people over 49 years old, more often with a good and very good financial situation. Respondents believe that general assistance from other countries and the European Parliament is not sufficient. Military support is accepted the most by the oldest participants of research, and less by the age group up to 30 years who support medical help more. More concerned about the ongoing conflict are respondents under the age of 30 and the least wealthy, including, more often, women. The richest respondents are least afraid of the effects of the ongoing Russian-Ukrainian conflict. The conducted research confirms the openness of Polish society to refugees and brings opinions about existential solidarity with the suffering Ukrainian nation.

Anxiety Assessment in Polish Students during the Russian-Ukrainian War

Anxiety is described as a feeling of fear that appears in stressful or threatening situations. A terrorist attack is one such situation. The aim of this study was to assess anxiety levels among students using the STAI questionnaire. The study group consisted of 510 participants. Statistical analysis was performed using Statistica software. Anxiety levels, correlations between STAI scores, and individual variables were assessed. Logit models were performed for the study variables. Higher levels of anxiety were found in females compared to males (p = 0.0000). The highest level of anxiety overall was found in year 1 students, the lowest in year 5 students (p = 0.0005). The highest level of anxiety overall was found in pharmacy students, the lowest in midwifery students. We concluded that there was a relatively strong relationship between anxiety and gender. Gender and fear of an armed attack on Poland had a significant impact on anxiety.

Current War in Ukraine: Lessons from the Impact of War on Combatants' Mental Health during the Last Decade

Ukrainian Military Hospital retrospective analysis during a decade of conflicts (3995 records) unveils specific mental health ICD-10-CM distribution per rank and the long-lasting impact of active conflict or trench warfare. Most hospitalizations in all years of observation were among soldiers. Anxiety-related disorders have been present since 'peacetime', mainly among professional soldiers and high ranks, pointing to the need for rank-tailored psychological training in skills to reduce the anxiety burden. High frequency of psychoactive substance use emerged with acute conflicts and in nonprofessional soldiers during wartime. This dictates the need to strengthen the selection of military personnel, considering the tendency to addiction. Military operations multiply the hospitalizations in psychiatric hospitals. The data warn about a 'need for free beds effect', which is worse for soldiers. This is relevant to estimating and planning the need for hospital resources for the current situation where the general population has been recruited for defense. In the current war, tightening the rules of sobriety in units and up to a ban on the sale of alcoholic beverages in areas where hostilities are taking place is recommended. The specific impact on nonprofessional soldiers is relevant to the current war, with the general population of Ukraine recruited for defense and combat.

Prevalence of depression, anxiety and post-traumatic stress in war- and conflict-afflicted areas: A meta-analysis

BACKGROUND

With the rise of fragility, conflict and violence (FCV), understanding the prevalence and risk factors associated with mental disorders is beneficial to direct aid to vulnerable groups. To better understand mental disorders depending on the population and the timeframe, we performed a systematic review to investigate the aggregate prevalence of depression, anxiety and post-traumatic stress symptoms among both civilian and military population exposed to war.

METHODS

We used MEDLINE (PubMed), Web of Science, PsycINFO, and Embase to identify studies published from inception or 1-Jan, 1945 (whichever earlier), to 31-May, 2022, to reporting on the prevalence of depression, anxiety and post-traumatic stress symptoms using structured clinical interviews and validated questionnaires as well as variables known to be associated with prevalence to perform meta-regression. We then used random-effects bivariate meta-analysis models to estimate the aggregate prevalence rate.

RESULTS

The aggregate prevalence of depression, anxiety and post-traumatic stress during times of conflict or war were 28.9, 30.7, and 23.5%, respectively. Our results indicate a significant difference in the levels of depression and anxiety, but not post-traumatic stress, between the civilian group and the military group respectively (depression 34.7 vs 21.1%, p < 0.001; anxiety 38.6 vs 16.2%, p < 0.001; post-traumatic stress: 25.7 vs 21.3%, p = 0.256). The aggregate prevalence of depression during the wars was 38.7% (95% CI: 30.0-48.3, I ² = 98.1%), while the aggregate prevalence of depression post-wars was 29.1% (95% CI: 24.7-33.9, I ² = 99.2%). The aggregate prevalence of anxiety during the wars was 43.4% (95% CI: 27.5-60.7, I ² = 98.6%), while the aggregate prevalence of anxiety post-wars was 30.3% (95% CI: 24.5-36.9, I ² = 99.2%). The subgroup analysis showed significant difference in prevalence of depression, and anxiety between the civilians and military group (p < 0.001).

CONCLUSION

The aggregate prevalence of depression, anxiety and post-traumatic stress in populations experiencing FCV are 28.9, 30.7, and 23.5%, respectively. There is a significant difference in prevalence of depression and anxiety between civilians and the military personnels. Our results show that there is a significant difference in the prevalence of depression and anxiety among individuals in areas affected by FCV during the wars compared to after the wars. Overall, these results highlight that mental health in times of conflict is a public health issue that cannot be ignored, and that appropriate aid made available to at risk populations can reduce the prevalence of psychiatric symptoms during time of FCV.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=337486, Identifier 337486.

Impact of the COVID-19 pandemic and the Russia-Ukraine war on stress and anxiety in students: A systematic review

BACKGROUND

The outbreak of the COVID-19 pandemic at the end of 2019 and the Russian-Ukrainian war in February 2022 created restrictions and uncertainties that affected the general population's mental health. One of the affected groups was students. This systematic review summarizes the current literature on the prevalence, outcomes, and interventions for stress and anxiety among university, college, graduate, or postsecondary populations.

METHODS

A systematic literature search was performed on PubMed, Web of Science, Scopus, Embase, Cochrane Library, CINAHL, PsychInfo, and ProQuest, following PRISMA guidelines. Specific inclusion and exclusion criteria were applied, and screening was performed to identify the definitive studies.

RESULTS

The prevalence of anxiety was relatively high, ranging from 88.9 to 13.63%, and the prevalence of stress ranged from 56 to 28.14%. The predictors of stress and anxiety included young age, gender being female, STEM course, loneliness, low academic level in school, urban lockdown, confinement, having a preexisting disease, having relatives or friends infected with COVID-19, and proximity to a COVID-19 zone. The predictors of stress included gender being female, living with family, living in a household with many people, being confined rather than having the freedom to relocate, proximity to confirmed cases of COVID-19, lack of access to materials on COVID-19, preexisting mental disorders, and lack of knowledge on the preventable nature of COVID-19. The sources of anxiety among the university students identified in the study included academics, postponement of graduation, cancelation or disruption of planned events, inability to achieve goals, and finances. In addition, the students used trauma-focused, forward-focused, task-oriented, emotion-oriented, and avoidance-oriented coping strategies.

CONCLUSION

The included studies showed that stress and anxiety increased during the pandemic and the war, with gender and uncertainty playing a critical role. The studies provide insights into the widespread use of problem-focused and task-focused coping strategies despite their impact on increasing stress and anxiety.