Since Russia invaded Ukraine on February 24, Ukrainians have been living in conditions of a long-term and unpredictable threat to their lives. The body and psyche are overloaded with stress. Every day, the mass media informs the public about new horrific details of torture, rape, and murder. As the coordinator of a training program for Ukrainian mental health professionals, working with providers on the frontlines, I’ve heard stories beyond only those in the mainstream media. I understand the depth of the enduring psychological pain and anguish.
At the beginning of the full-scale war, the main psychological threat was post-traumatic stress disorder (PTSD). But this is not the only consequence the war will leave behind. Let’s consider what other conditions and diseases can occur during or after war.
Psychological Impact of the War
For the population of Ukraine, the modern conditions of Russian military aggression contribute to the simultaneous formation of individual and collective trauma. Trauma negatively affects personal, psychosomatic, and social conditions. War with the enemy, following the COVID-19 quarantine, became the perfect incubator for growing mental health challenges.
Average estimates suggest that about a third of refugees in other countries suffer from post-traumatic stress disorders (PTSD), depression, and anxiety. Research suggests a similar prevalence among Ukrainian refugees in the current conflict, as well as a similar prevalence among the population that remained in the conflict zone. PTSD usually coexists with other forms of psychopathology. Among PTSD survivors, 90% have at least one comorbid mental illness during their lifetime. The most common concomitant disorders are anxiety disorders, depression, alcohol abuse or dependence, and psychosomatic disorders. Women and children are the most vulnerable, so long-term family, medical, and psychological support and rehabilitation of affected families is necessary.
Burden of Trauma
Among the Ukrainian population, key factors of collective traumatization include:
- Significant prevalence: It covers the entire population (directly and through online sources), regardless of direct relation to traumatic events.
- Significant public irritability: Because interaction between people is much more significant than natural and technical factors.
- A collective and comprehensive feeling of being wronged: Painful awareness of the innocence of the victims (e.g., disability of children) and inability of the aggressors to resist (e.g., rape of babies). Where the objects of traumatization are social groups, not just individuals. The entire community feels traumatized. Especially those who managed to leave in time and who were not personally affected by the tragedy (Bucha, Gostomel, Irpin, Moschun, Mariupol, Izyum, etc.). Where the limbs of children, parts of genitalia, and pierced skulls were found in mass graves.
- The impossibility of quick reaction: The waiting period is extended, people are forced to wait in enduring tension (current events are superimposed on the 8-year period of the war and are further strengthened due to the traumatic memory of past generations).
- The long-term nature of the traumatization: The war continues, there is no period of processing the trauma. Untreated traumas have many invisible psychosomatic effects.
The Current State of the War Through a Psychological Lens
The four phases of war reflect:
- Stage of heroism: We want to succeed. That’s why there is an influx of energy, and during this phase, many people become volunteers. But we also do reckless things.
- Stage of the “honeymoon”: The goal of independence unites everyone, leading volunteers to perform great feats and the military to achieve extraordinary results.
- Stage of disappointment: The people get tired and feel depressed; they look for the culprits and where to vent their anger. People begin to get physically sick. They think about reality and become disappointed.
- Stage of recovery: Understanding that basic needs must be satisfied, this stage helps people make decisions more responsibly and take care of one another. Everyone fights according to their abilities — a soldier fights on the battlefield, a teacher fights for his country and teaches children, a doctor treats patients, a cook feeds. Together we form a united front that becomes an extraordinary force.
These stages often keep going round and round. New difficulties appear, the first stage starts, the Ukrainians go to fight heroically and support each other. Then they become disappointed when they lack strength and opportunities. And again they get up and learn new behavior, listen to their needs, try new strategies, because war brings new challenges all the time.
Addressing Psychological Consequences After the War
According to forecasts of the Ministry of Health of Ukraine, about 15 million Ukrainians will need psychological support in the future, of which about 3-4 million will need to be prescribed medication. The colossal number of cases of PTSD and/or depression in war survivors has negative consequences, including significant distress for individuals and families, the potential for increased individual or domestic violence, and chronic mental health challenges.
In response, the provision of medical, psychological, and social assistance is critical. Along with two organizations, I’m working to train mental health professionals to provide support to Ukrainian survivors. For those seeking primary medical and psychological help, trained professionals should assess the presence of signs of PTSD for all those who have experienced a traumatic situation (refugees, participants in hostilities, displaced persons, tortured, raped, released from captivity, etc.). Diagnostic and treatment interventions can reduce the prevalence and severity of PTSD among trauma survivors. Modern prevention of PTSD is a short-term psychological intervention in the first few hours after a traumatic event; this is a “cognitive block” of traumatic images, and cognitive and emotional processing of a traumatic event.
Beyond immediate intervention, a comprehensive system of psychological first aid and crisis intervention should be applied in Ukraine. We’re expanding the galaxy of medical and psychological trauma-focused methods of diagnosis, treatment, prevention, and rehabilitation of victims.
Psychological techniques help refugees move past the distress of war. These include problem management and a multidimensional approach to stress management. The problem of training doctors and psychologists to identify and effectively work with refugees and victims of war, and especially effective rehabilitation, has become extremely important. For example, a crisis intervention program in the Acceptance and Responsibility Therapy method was widely used. Thanks to the simplicity and effectiveness of this program, it was possible to train a huge number of specialists throughout Ukraine in a short period of time.
Positive Outcomes of War for the Human Psyche
In an effort to look at the positive, we must consider whether any good can come of this atrocious crisis. As soon as 4-6 months after the start of the war, awareness of new life priorities for personal development will appear. There will be a rethinking of the acquired experience, and awareness of desires and values.
We can see this in the development of organizations and expansion of treatment methods. But more importantly, it will manifest itself in the quality of a person’s daily life. For example, after a soldier lost his leg in the war, thanks to newfound friends, love, and a great job that paid him fair wages, he was able to take his mother to the theater for the first time in his life. This side of war inspires and sustains our hearts.
It was also extremely pleasant to learn that so many people around the world — including so many doctors, first responders, and mental health counselors — are ready to help, even at the expense of their health and time with their family. A low bow to you for this.
Oksana Martsyniak-Dorosh, PhD, is associate professor of the Department of Theoretical and Practical Psychology at Lviv Polytechnic State University, and Head of the Academy of CBT in Ukraine.