Discussion

This study was conducted to estimate the level of psychological distress in the Ukrainian population 18 months after Russia’s full-scale invasion. Approximately one in three adults reported problems consistent with meeting diagnostic requirements for one of seven disorders. The most common problem was GAD (15.2%), while CUD was the least common problem (1.5%). Between 8% and 12% of people screened positive for the other stress, mood, and substance misuse disorders. Comorbidity between disorders was common, and half of those meeting criteria for one disorder met criteria for at least one other disorder. Methodological differences mean it is impossible to compare current findings to prior studies from Ukraine [Reference Bromet, Gluzman, Paniotto, Webb, Tintle and Zakhozha1], but both studies found that about one-third of adults were experiencing clinically relevant mental health problems. This suggests that the overall prevalence of mental health disorders in Ukraine is not markedly different from what is seen in other Western and European nations [Reference Caspi, Houts, Ambler, Danese, Elliott and Hariri23,Reference Kessler, Angermeyer, Anthony, DE Graaf, Demyttenaere and Gasquet24]. These findings may be taken as a sign of the remarkable resilience of the Ukrainian population, given the immense challenges they have faced in recent years.

We observed the typical pattern of sex differences in disorders that has been found in Ukraine [Reference Bromet, Gluzman, Paniotto, Webb, Tintle and Zakhozha1,2], and internationally [Reference Green, Flash and Reiss25]. Women were 2–2.5 times more likely to meet diagnostic requirements for GAD and DD while men were about two times more likely to screen positive for AUD and CUD. These differences remained when controlling for all other sociodemographic variables, and in the case of CUD, the effect increased in magnitude such that men were nearly 3.5 times more likely to screen positive. Notably, we found that women were more likely than men to screen positive for any disorder, and for two or more disorders. Adjusting for all other sociodemographic variables, the effect of screening positive for two or more disorders remained significant. Among Ukrainian adults, it was previously found that men were significantly more likely than women to have a disorder, but this was likely due to the stark differences in alcohol misuse disorders [Reference Bromet, Gluzman, Paniotto, Webb, Tintle and Zakhozha1]. Current findings suggest that women differ from men not only in the type of disorders they are more likely to report, but also in their risk for disorder comorbidity.

There were some differences in disorder prevalence across geographical regions of Ukraine, with people living in the east most likely to screen positive for a disorder, and people in the west the least likely. This is perhaps not surprising given that the east of Ukraine has been under Russian attack since 2014 and continues to be on the front line of the ongoing war. Adjusting for all other sociodemographic variables, we found that people living in the east, south, and north of Ukraine were more likely to screen positive for a mental health disorder than people living in the west. These findings should be interpreted cautiously. Although we were able to recruit people living in the eastern and southern parts of Ukraine, people most severely affected by the war in these areas may not have been contactable due to the requirement for internet access. Furthermore, millions of people have left the most severely affected regions of Ukraine (east and south) since 2014 for refuge in other, safer parts of the country meaning the composition of different regions is changing rapidly over short time scales. It is difficult therefore to offer a simple explanation for why some disorders may be higher in one region than another, but we hope these findings have some value in indicating where mental health resources may be most needed.

Across our analyses, several other sociodemographic variables emerged as robust correlates of different disorders. Aligning with prior research [Reference Shevlin, Hyland, Vallières, Bisson, Makhashvili and Javakhishvili3], people who indicated that their lives were disrupted by Russia’s 2014 invasion (meaning they were forced to move, lost property, became disabled, or were bereaved) were upward of 2.5 times more likely to screen positive for each disorder (other than CUD) and to screen positive for two or more disorders. Nearly half the sample (47%) reported feeling “extremely” or “very” worried about their financial security, and financial worries were associated with almost all disorders. Financial insecurity is increasingly recognized as a major risk factor for mental disorder [Reference Richardson, Elliott and Roberts26,Reference Shevlin, Redican, Hyland, Butter, McBride and Hartman27]. Solutions to mental health problems are often thought to lie in psychotherapeutic or pharmacological interventions, but if a major cause of distress is financial insecurity, a solution might also be found in political and economic interventions. Ensuring the continued financial security of the people of Ukraine is therefore a key humanitarian task for the international community.

Positive memories of home and family life were associated with a lower likelihood of meeting criteria for every disorder (except PTSD) and, notably, the effect was especially strong for CUD. Positive childhood experiences are known to play a key role in protecting people from developing mental health disorders later in life [Reference Narayan, Rivera, Bernstein, Harris and Lieberman28], even in those with histories of childhood trauma [Reference Karatzias, Shevlin, Fyvie, Grandison, Garozi and Latham29]. In the current sample, scores on this variable were highly negatively skewed, meaning that most people reported very positive memories of their home and family life. This is encouraging and may be one factor in explaining the resilience of the population. Moreover, this variable may offer a useful means of identifying those most at risk for a mental health disorder, especially CUD.

We found that younger adults (i.e., those aged 18–40) were more than twice as likely to meet requirements for GAD than those over 60 years, and the youngest cohort (i.e., 18–29 years old) were more than twice as likely to screen positive for two or more disorders. Previous work in Ukraine indicated that older adults were somewhat more likely to have a mental health disorder [Reference Bromet, Gluzman, Paniotto, Webb, Tintle and Zakhozha1]; a finding inconsistent with the wider literature [Reference Jones30]. It is possible these discrepant findings can be explained by cohort effects, but regardless of the reason, current findings suggest that younger adults in Ukraine are most likely to report mental health problems. Those with a university education were nearly five times less likely than those without a university education to screen positive for CUD, and full-time students were less likely to screen positive for AUD. This suggests that alcohol and substance misuse is strongly related to lower educational attainment in Ukraine. Finally, individuals who were divorced, separated, or widowed were nearly twice as likely to meet criteria for CPTSD and PGD than those who were married or in a committed relationship, and were 64% more likely to meet requirements for two or more disorders. It is noteworthy that single people were no more likely to have a disorder, meaning that being in a relationship is not necessarily protective; rather, the dissolution of a relationship seems to be key [Reference Bromet, Gluzman, Paniotto, Webb, Tintle and Zakhozha1].

This study contains several limitations. Non-probability-based sampling methods were used, and we were unable to recruit our desired quota of older adults or people from some areas of Ukraine under Russian occupation (e.g., Crimea). While we endeavored to construct the sample in a way that was representative of the population across several demographic variables, it is unlikely that our sample completely represents the population. Second, we were only able to measure seven disorders, and these do not represent the entire spectrum of mental health problems. Third, our prevalence estimates were derived from self-report data, which can yield higher estimates relative to clinical assessment, but we used diagnostic algorithm scoring methods, where possible (i.e., PTSD, CPTSD, PGD, GAD, DD), and employed conservative cut-off scores where diagnostic algorithms were not available (i.e., AUD, CUD) to minimize possible type 1 errors. Finally, the cross-sectional design means no causal interpretations can be made regarding the relationships between the sociodemographic and mental health variables.

This study provides important information about the state of mental health in the adult population of Ukraine in 2023. It appears that about one-third of adults have clinically relevant problems related to anxiety, traumatic stress, bereavement, low mood, and substance misuse. Key risk factors for these mental health problems include younger age, lower education attainment, greater financial worries, no longer being in a committed relationship, having fewer positive childhood experiences within one’s family context, and experiencing serious disruption to one’s life due to Russian aggression. Meeting this level of need is going to be challenging because the Ukrainian mental healthcare system was considered to be severely under-resourced before the onset of the full-scale invasion, and has experienced serious infrastructure and personnel damage since then [Reference Goto, Pinchuk, Kolodezhny, Pimenova and Skokauskas31]. It is our hope that these findings help in some way to understand the level of need, and who is in need, so that limited resources can be used most effectively.