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

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. The aim of present study was to investigate the state of mental health among Ukrainians assessing the levels of stress, anxiety, and post-traumatic stress disorder (PTSD) prevalence in not displaced persons (NDPs), internally displaced persons (IDPs), and refugees abroad. 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 Perceived Stress Scale (PSS-10), anxiety with General Anxiety Disorder (GAD-7), and symptoms of post-traumatic stress disorder with PTSD Check List (PCL-5). Findings 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. Moderate and high stress was prevalent among 68.2% (1333/1954) and 15.5% (302/1954) of NDPs, 64.4% (325/505) and 21.6% (109/505) of IDPs, and 64.7% (462/714) and 25.2% (180/714) of refugees, respectively. Moderate and severe anxiety was prevalent among 25.6% (500/1954) and 19.0% (371/1954) of NDPs, 25.7% (130/505) and 23.4% (118/505) of IDPs, and 26.2% (187/714) and 25.8% (184/714) of refugees. High levels of PTSD (33 and higher) were prevalent among 32.9% (642/1954) of NDPs, 39.4% (199/1954) of IDPs, and 47.2% (337/714) of refugees. DSM-V criteria for PTSD diagnosis was met by 50.8% (992/1954) of NDPs, 55.4% (280/505) of IDPs, and 62.2% (444/ 714) of refugees. Only 7.2% of the respondents reported no or mild stress, anxiety, and PTSD levels within the sample. Interpretation 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 and witnessing. Funding Ministry of Education and Science of Ukraine. Copyright Crown Copyright (c) 2023 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Health 2024;36: Published https://doi.org/10. 1016/j.lanepe.2023. 100773