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Child Psychiatrist /Adult Psychiatrist

Adverse Mental Health Outcomes Among Adolescents Exposed to the War in Ukraine

Keypoint: War exposure was associated with a 62% greater prevalence of moderate or severe depression among Ukrainian adolescents.

War in Ukraine

The mental health of Ukrainian adolescents has been substantially affected by the Russian invasion of Ukraine, according to results recently published in JAMA Pediatrics. Adolescents exposed to the war were more likely to screen positive for post-traumatic stress disorder (PTSD), depression, anxiety, substance use disorder, and eating disorders.

Since the Russian invasion of Ukraine in February 2022, citizens in Ukraine have been increasingly exposed to traumatic events and have reduced access to mental health care. However, there has been a lack of quantitative research on the mental health consequences of this ongoing conflict, particularly among vulnerable populations such as adolescents. Therefore, investigators conducted the current study to evaluate the mental health burden among Ukrainian adolescents who were exposed to the war.

The investigators recruited Ukrainian adolescents 15 years of age and older who were attending secondary schools (both within Ukraine and abroad) to establish the Adolescents of Ukraine During the Russian Invasion (AUDRI) cohort. Participants were asked about their demographic information, psychiatric conditions, displacement status, current place of residence, and whether they had been separated from their parents due to the war. Additionally, the investigators used validated tools to screen for PTSD, depression, anxiety, substance use disorders, and eating disorders.

Overall, 12,522 adolescents responded to the survey and 8096 responses were eligible for analysis. A total of 7493 responses were from adolescents residing in Ukraine, while 603 responses were from adolescents living abroad. Most responses were from adolescents aged 15 (41.7%), 16 (31.3%), or 17 (16.6%) years, and 61.6% of respondents were girls.

According to national-level estimates, nearly half (49.6%) of the respondents were directly exposed to war and 92.3% were exposed to any type of psychological trauma. Additionally, 33.2% of adolescents reported that they had been displaced and 20.7% indicated that they had been separated from their parents.

The investigators observed that 35.0% of respondents met criteria for having been exposed to clinically relevant psychological trauma. For mood disorders, 25.0% of adolescents screened positive for moderate depression, 6.9% screened positive for severe depression, 11.9% were positive for moderate anxiety, and 5.9% were positive for severe anxiety. Additionally, substance use disorders were detected in 20.5% of respondents and 29.5% of adolescents qualified for an eating disorder.

In regression models, the investigators found that that exposure to war was associated with a 62% greater prevalence (95% CI prevalence ratio, 1.45-1.81) and an 8.7 percentage point greater prevalence (95% CI prevalence difference, 6.6-10.9 percentage points) of moderate or severe anxiety. Furthermore, war exposure was associated with a 39% greater prevalence (95% CI prevalence ratio, 1.29-1.50) and 11.1 percentage point greater prevalence (95% CI prevalence difference, 8.6-13.7 percentage points) of moderate or severe depression. This increased prevalence was similar among adolescents living in Ukraine and those living abroad.

These findings indicate that the prevalence of a positive screen for psychiatric conditions among adolescents in Ukraine is high. The investigators stated, “The Russian invasion of Ukraine in 2022 has put substantial mental health burden on Ukrainian adolescents within Ukraine and abroad.” Study authors concluded, “Mental health care efforts to alleviate the mental health burden of Ukrainian adolescents need to be scaled up to protect the country’s future.”

Study limitations include regional variations in survey response rates, a gender imbalance of respondents, reliance on self-reported data, and an inability to distinguish between mental health burdens due to healthcare shortages vs war exposure.

Note: This article originally appeared on Psychiatry Advisor

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