Stress, anxiety and ptsd prevalence among ukrainians grew dramatically during the first year of russian invasion: results of nationwide survey

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. 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 PSS-10, anxiety with GAD-7, and symptoms of posttraumatic stress disorder with PCL-5. 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. Findings Moderate and high stress was prevalent among 64.7% and 15.5% of NDPs, 64.4% and 21.6% of IDPs, and 68.2% and 25.2% of refugees, respectively. Moderate and severe anxiety was prevalent among 25.6% and 19.0% of NDPs, 25.7% and 23.4% of IDPs, and 26.2% and 25.8% of refugees. High levels of PTSD (33 and higher) were prevalent among 32.8% of NDPs, 39.4% of IDPs, and 47.2% of refugees. DSM-V criteria for PTSD diagnosis was met by 50.8% of NDPs, 55.4% of IDPs, and 62.2% of refugees. Interpretations 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, particularly for people who have directly witnessed the results of war. Fundings Ministry of Education and Science of Ukraine Evidence before this study Previously published evidence suggested an increase and specificity of stress, anxiety, and PTSD prevalence among Ukrainians by August 2022. Some research provided a data comparison between IDPs and refugees. However, to date, no study has reported a comparison of three groups of Ukrainians: NDPs, IDPs, and refugees abroad. Added value of this study This is the first study that provides evidence of the mental health state of Ukrainians after 9-12 months of the Russian invasion in 2022. Furthermore, the research presented was designed as a nationwide survey involving three groups for comparison: NDPs and IDPs within Ukraine, and refugees in other countries. The results of the study show a significant difference between these groups in stress, anxiety, and prevalence of PTSD symptoms. Implications of all available evidence The present study contributes to the comprehension of the dynamics in mental health of Ukrainians in response to the war. This data will be helpful both in mental health strategy development by governmental and international policy and in the local clinical work of mental health professionals working with Ukrainians. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Ministry of Education and Science of Ukraine ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Ethics Committee of Danylo Halytskyi National Medical University (protocol No 9, 22.11.2021) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript