Abstract
Introduction
War in Ukraine started in March 2014 when Russia annexed Crimea and continues today in the Donbass region of Eastern Ukraine. Over 1.5 million people in these regions have been displaced from their homes. We conducted this study 36 months after the conflict began and interviewed civilians residing in Ukraine.
Purpose
This study examines the prevalence of exposure to war trauma, rates of PTSD by symptom clusters, and whether socio-demographic factors are associated with positive scores for PTSD among civilian urban-dwelling and internally displaced persons in Ukraine during the ongoing conflict in its Donbass region.
Methods
Face-to-face interviews were conducted using a multi-stage random sample of the general population in two large cities (Kharkiv and Lviv) in Ukraine (n = 1247) and a purposive sample of internally displaced persons (n = 300), half living in each city. Exposure to trauma, symptom clusters for Posttraumatic Stress Disorder (PTSD), and overall PTSD were assessed.
Results
We found widespread direct exposure to conflict-related traumatic events (65%) among internally displaced people (IDPs) compared to a sizable minority (23%) of urban-dwelling people (UDPs). We found elevated prevalence of PTSD symptoms that were also uniformly spread within several socio-demographic factors. There were, however, significant differences in PTSD between (1) IDPs compared to UDPs and (2) those UDPs with Ukrainian compared to Russian ethnic identity, the former of each pair showing increased likelihoods of positive PTSD scores.
Conclusions
Ukraine’s adult civilians, enduring the prolonged engagement in war with Russia and Russian separatists, have elevated rates of PTSD. Moreover, those who have been displaced by the ongoing conflict (IDPs) have significantly higher levels of PTSD compared to UDPs.
Similar content being viewed by others
Availability of data and material
Data sharing is restricted under the IRB protocol for protection of human subjects. Authors are committed to complying with the American Sociological Association’s ethical standards of data sharing consistent with that protocol.
Code availability
NA.
References
Crash of Malaysia Airlines flight MH17: Hrabove, Ukraine, 17 July 2014. (2015) Dutch Safety Board, The Hague. https://www.webcitation.org/6cFSGnsRg?url=http://cdn.onderzoeksraad.nl/documents/report-mh17-crash-en.pdf. Accessed 25 May 2020
Office of the High Commissioner of Human Rights (2017) Report on the human rights situation in Ukraine 16 February to 15 May 2017. United Nations
Refugees UNHCR (2018) Global focus 2017 year-end: report operation: Ukraine. UNHCR. https://reporting.unhcr.org/sites/default/files/pdfsummaries/GR2017-Ukraine-eng.pdf. Accessed 26 June 2021
Charlson FJ, Flaxman A, Ferrari AJ, Vos T, Steel Z, Whiteford HA (2016) Post-traumatic stress disorder and major depression in conflict-affected populations: an epidemiological model and predictor analysis. Glob Ment Health 3(e4):1–11. https://doi.org/10.1017/gmh.2015.26
Hoppen TH, Morina N (2019) The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers. Eur J Psyhotraumatol 10(1):1–11. https://doi.org/10.1080/20008198.2019.1578637
Goldstein RB, Smith SM, Chou SP, Saha TD, Jung J, Zhang H, Pickering RP, Ruan WJ, Huang B, Grant BF (2016) The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol 51(8):1137–1148. https://doi.org/10.1007/s00127-016-1208-5
Duckers MLA, Alisic E, Brewin CR (2016) A vulnerability paradox in the cross-national prevalence of post-traumatic stress disorder. Br J Psychiatry 209:300–305. https://doi.org/10.1192/bjp.bp.115.176628
Morina N, Aktar A, Barth J, Schnyder U (2018) Psychiatric disorders in refugees and internally displaced persons after forced displacement: a systematic review. Front Psychol 9:433. https://doi.org/10.3389/fpsyt.2018.00433
Johnson RJ, Hobfoll SE, Beulaygue I (2017) Mental health and terrorism. In: Scheid TL, Wright ER (eds) A handbook for the study of mental health: social contexts, theories, and systems. Cambridge University Press, Cambridge
De Jong J, Komproe I, Ommeren MV, El Masriiiii M, Araya M, Khaled N, van De Put W, Somasundaram D (2001) Lifetime events and posttraumatic stress disorder in 4 postconflict settings. J Am Med Assoc 286:555–562
Porter M, Haslam N (2005) Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. J Am Med Assoc 294(5):602–612. https://doi.org/10.1001/jama.294.5.602
Hobfoll SE, Mancini AD, Hall BJ, Canetti-Nisim D, Bonanno GA (2011) The limits of resilience: distress following chronic political violence among palestinians. Soc Sci Med 72(8):1400–1408. https://doi.org/10.1016/j.socscimed.2011.02.022
Canetti D, Galea S, Hall BJ, Johnson RJ, Palmieri PA, Hobfoll SE (2010) Exposure to prolonged socio-political conflict and the risk of PTSD and depression among palestinians. Psychiatry 73(3):219–231. https://doi.org/10.1521/psyc.2010.73.3.219
Hall BJ, Murray SM, Galea S, Canetti D, Hobfoll SE (2015) Loss of social resources predict incident posttraumatic stress disorder during ongoing political violence within the Palestinian Authority. Soc Psychiatry Psychiatr Epidemiol 50(4):561–568. https://doi.org/10.1007/s00127-014-0984-z
Johnson RJ, Canetti D, Palmieri P, Galea S, Varley J, Hobfoll SE (2009) A Prospective study of risk and resilience factors associated with posttraumatic stress symptoms and depression symptoms among jews and arabs exposed to repeated acts of terrorism in Israel. Psychol Trauma 1(4):291–311. https://doi.org/10.1037/a0017586
Vojvoda D, Weine SM, McGlashan T, Becker DF, Southwick SM (2008) Posttraumatic stress disorder symptoms in Bosnian refugees 3 1/2 years after resettlement. J Rehabil Res Dev 45(3):421–426. https://doi.org/10.1682/JRRD.2007.06.0083
Priebe S, Bogic M, Ashcroft R, Franciskovic T, Galeazzi GM, Kucukalic A, Lecic-Tosevski D, Morina N, Popovski M, Roughton M, Schützwohl M, Ajdukovic D (2010) Experience of human rights violations and subsequent mental disorders: a study following the war in the Balkans. Soc Sci Med 71(2010):2170–2177. https://doi.org/10.1016/j.socscimed.2010.09.029
Kazour F, Zahreddine NR, Maragel MG, Almustafa MA, Soufia M, Haddad R, Richa S (2017) Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon. Compr Psychiatry 72:41–47. https://doi.org/10.1016/j.comppsych.2016.09.007
Gokay A, Unal A, Bulbul F, Sagaltici E, Bez Y, Altindag A, Dalkilic A, Savas HA (2015) Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study. Int J Psychiatry Clin Pract 19:45–50. https://doi.org/10.3109/13651501.2014.961930
Fuhr DC, Acarturk C, McGrath M, Ilkkursun Z, Sondorp E, Sijbrandij M, Ventevogel P, Culjpers P, McKee M, Roberts B (2020) Treatment gap and mental health service use among Syrian refugees in Sultanbeyli, Istanbul: a cross-sectional survey. Epidemiol Psychiatr Sci 29:e70. https://doi.org/10.1017/S2045796019000660
Roberts B, Makhashvili N, Javakhishvili J (2017) Hidden burdens of conflict: issues of mental health and access to services among internally displaced persons in Ukraine. International Alert/GIP-Tbilisi/London School of Hygiene and Tropical Medicine
The World Bank (2017) The world by income. https://datatopics.worldbank.org/world-development-indicators/the-world-by-income-and-region.html. Accessed Aug 8 2021
Bursik RJ Jr, Grasmick HG (1993) Neighborhoods and crime: the dimensions of effective community control. Lexington, Lanham, MD
Antonaccio O, Tittle CR (2008) Morality, self-control, and crime. Criminology 46(2):479–510. https://doi.org/10.1111/j.1745-9125.2008.00116.x
Galaur S (2015) Modular house settlement for IDPs from Donbass has opened in Kharkiv. Government Courier, January 28, 2015
Hobfoll SE, Canetti-Nisim D, Johnson RJ (2006) Exposure to terrorism, stress-related mental health symptoms, and defensive coping among Jews and Arabs in Israel. J Consult Clin Psychol 74(2):259–283. https://doi.org/10.1037/0022-006X.74.2.207
Almeida DM, Wethington E, Kessler RC (2002) The daily inventory of stressful events: an interview-based approach for measuring daily stressors. Assessment 9(1):41–55. https://doi.org/10.1177/1073191102009001006
Keles S, Friborg O, Idsøe T, Sirin SR, Oppedal B (2016) Depression among unaccompanied minor refugees: the relative contribution of general and acculturation-specific daily hassles. Ethn Health 21(3):300–317. https://doi.org/10.1080/13557858.2015.1065310
Foa EB, Riggs DS, Dancu CV, 1 BOR (1993) Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress 6(4):459–473
Bleich A, Gelkopf M, Melamed Y, Solomon Z (2006) Mental health and resiliency following 44 months of terrorism: a survey of an Israeli national representative sample. BMC Med. https://doi.org/10.1186/1741-7015-4-21
Hobfoll SE, Palmieri PA, Johnson RJ, Canetti-Nisim D, Hall BJ, Galea S (2009) Trajectories of resilience, resistance, and distress during ongoing terrorism: the case of Jews and Arabs in Israel. J Consult Clin Psychol 77(1):138–148. https://doi.org/10.1037/a0014360
Bleich A, Gelkopf M, Solomon Z (2003) Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. JAMA 290(5):612–620. https://doi.org/10.1001/jama.290.5.612
Gelkopf M, Berger R, Bleich A, Silver R (2012) Protective factors and predictors of vulnerability to chronic stress: a comparative study of 4 communities after 7 years of continuous rocket fire. Soc Sci Med 74(5):757–766
Hobfoll SE, Canetti-Nisim D, Johnson RJ, Palmieri PA, Varley JD, Galea S (2008) The association of exposure, risk, and resiliency factors with PTSD among Jews and Arabs exposed to repeated acts of terrorism in Israel. J Trauma Stress 21(1):9–21. https://doi.org/10.1002/jts.20307
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, vol 5. Washington, DC
Osório C, Jones N, Jones E, Robbins I, Wessely S, Greenberg N (2017) Combat experiences and their relationship to post-traumatic stress disorder symptom clusters in UK military personnel deployed to Afghanistan. Behav Med. https://doi.org/10.1080/08964289.2017.128860
International Institute for Strategic Studies (2017) Chapter five: Russia and Eurasia. Milit Balance 117(1):183–236. https://doi.org/10.1080/04597222.2017.1271211
Burri A, Maercker A (2014) Differences in prevalence rates of PTSD in various European countries explained by war exposure, other trauma and cultural value orientation. BMC Res Note. https://doi.org/10.1186/1756-0500-7-407
Graham J, Legarreta M, North L, diMuzio J, McGlade E, Yurgelun-Todd D (2016) A preliminary study of DSM-5 PTSD symptom patterns in veterans by trauma type. Milit Psychol 28(2):115–122. https://doi.org/10.1037/mil0000092
Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker MJVO, Preisig M, Salvador-Carulla L, Simon R, Steinhausen H-C (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21:655–679. https://doi.org/10.1016/j.euroneuro.2011.07.018
Steel Z, Chey T, Silove D, Marnane C, Bryant RA, Mv O (2009) Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302(5):537–549. https://doi.org/10.1001/jama.2009.1132
Luitel NP, Jordans MJD, Sapkota RP, Tol WA, Kohrt BA, Thapa SB, Komproe IH, Sharma B (2012) Conflict and mental health: a cross-sectional epidemiological study in Nepal. Soc Psychiatry Psychiatr Epidemiol 48:183–193. https://doi.org/10.1007/s00127-012-0539-0
Hall BJ, Murray SM, Galea S, Canetti D, Hobfoll SE (2015) Loss of social resources predicts incident posttraumatic stress disorder during ongoing political violence within the Palestinian Authority. Soc Psychiatry Psychiatr Epidemiol 50(4):561–568. https://doi.org/10.1007/s00127-014-0984-z
Hobfoll SE (1989) Conservation of resources: a new attempt at conceptualizing stress. Am Psychol 44:513–524. https://doi.org/10.1037/0003-066X.44.3.513
Hobfoll SE (2011) Conservation of resources theory: Its implication for stress, health, and resilience. In: Folkman S (ed) The Oxford handbook of stress, health and coping. Oxford University Press, New York
Bal A, Jensen B (2007) Post-traumatic stress disorder symptom clusters in Turkish child and adolescent trauma survivors. Eur Child Adolesc Psychiatry 16(7):449–457
Bonanno GA, Mancini AD, Horton JL, Powell TM, LeardMann CA, Boyko EJ, Wells TS, Hooper TI, Gackstetter GD, Smith TC (2012) Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study. Br J Psychiatry 200(4):317–323
Bonanno GA, Galea S, Bucciarelli A, Vlahov D (2007) What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. J Consult Clin Psychol 75(5):671–682. https://doi.org/10.1037/0022-006X.75.5.671
Hobfoll SE, London P (1986) The relationship of self-concept and social support to emotional distress among women during war. J Soc Clin Psychol 4(2):189–203
Canetti-Nisim D, Halperin E, Sharvit K, Hobfoll SE (2009) A new stress-based model of political extremism: personal exposure to terrorism, psychological distress, and exclusionist political attitudes. J Confl Resolut 53(2):363–389. https://doi.org/10.1177/0022002709333296
Halperin E, Canetti D, Hobfoll SE, Johnson RJ (2009) Terror, resource gains and exclusionist political attitudes among new immigrants and veteran Israelis. J Ethn Migr Stud 35(6):997–1014. https://doi.org/10.1080/13691830902957759
Funding
Research support was provided by intramural funding awards to the first three authors from their universities.
Author information
Authors and Affiliations
Contributions
The first three authors made substantial contributions to the conception or design of the work, and all authors made contributions to the interpretation of the data, drafted the work, or revised it critically for important intellectual content. All authors made comments and gave approval for publication. We agree to be accountable for aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Johnson, R.J., Antonaccio, O., Botchkovar, E. et al. War trauma and PTSD in Ukraine’s civilian population: comparing urban-dwelling to internally displaced persons. Soc Psychiatry Psychiatr Epidemiol 57, 1807–1816 (2022). https://doi.org/10.1007/s00127-021-02176-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-021-02176-9