The Ukrainian paediatric mental health system: challenges and opportunities from the Russo-Ukrainian war

Development and validation of the caregiver-report version of the international depression questionnaire (IDQ-CG) and international anxiety questionnaire (IAQ-CG)

The International Depression Questionnaire (IDQ) and International Anxiety Questionnaire (IAQ) are self-report measures of ICD-11 single episode depressive disorder (DD) and generalised anxiety disorder (GAD). The present study sought to describe the development and psychometric evaluation of the caregiver-report versions of the IDQ and IAQ for children, referred to as the IDQ-CG and IAQ-CG, respectively. Participants were 639 parents living in Ukraine who provided data on themselves and one child in their household as part of "The Mental Health of Parents and Children in Ukraine Study: 2023 Follow-up" study. The latent structure of the IDQ-CG and IAQ-CG were tested using confirmatory factor analysis (CFA), composite reliability (CR) estimates were estimated, and convergent validity was assessed. Prevalence rates of probable ICD-11 DD and GAD were also estimated. CFA results indicated that the IDQ-CG and IAQ-CG were unidimensional, while the internal reliability of both scales was excellent. Convergent validity was established via associations with external measures of internalizing, externalizing, and attention problems as well as trauma exposure. Factors associated with increased IDQ-CG and IAQ-CG scores included pharmacological support for emotional or behavioural problems, delayed milestone development, being forced to move to another part of Ukraine, serious life disruption due to the war, and having experienced a bereavement. Of the total sample, 1.6% met diagnostic requirements for ICD-11 DD and 5.8% met diagnostic requirements for ICD-11 GAD. This study supports the psychometric properties of the IDQ-CG and IAQ-CG. These measures can be effectively used to identify young people in need of mental health support.

Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War

OBJECTIVE

More than 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, to examine the strength of the evidence base, and to inform the development of future interventions.

METHOD

Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to September 30, 2022, identifying k = 6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network.

RESULTS

The systematic search identified 6 relevant studies: 1 study evaluating digital mental health interventions for children and adolescents affected by war, and 5 studies for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents or carers/caregivers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear.

CONCLUSION

There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions.

DIVERSITY & INCLUSION STATEMENT

We actively worked to promote sex and gender balance in our author group.

STUDY PREREGISTRATION INFORMATION

Digital mental health interventions for children and young people affected by war: a scoping review; https://osf.io/; hrny9.

Mental Health of Adolescents Exposed to the War in Ukraine

Importance

With exposure to traumatic events and reduced access to mental health care, adolescents of Ukraine during the Russian invasion since February 2022 are at high risk of psychiatric conditions. However, the actual mental health burden of the war has scarcely been documented.

Objective

To investigate the prevalence of a positive screen for psychiatric conditions among adolescents amidst the ongoing war in Ukraine as well as their associations with war exposure.

Design, Setting, and Participants

This cross-sectional study reports the results from the first wave of the Adolescents of Ukraine During the Russian Invasion cohort, the largest cohort study on Ukrainian adolescents' mental health during the Russian invasion since 2022. Using self-reported questionnaires, the national-level prevalence of a positive screen for various psychiatric conditions was estimated among adolescents aged 15 years or older attending secondary school in Ukraine in person or online (including those residing abroad but attending Ukrainian secondary school online) and the prevalence among Ukrainian adolescents living abroad due to the war.

Exposure

Self-reported exposure to war.

Main Outcomes and Measures

A positive screen for psychiatric conditions. The association between self-reported war exposure and a positive screen for each of the psychiatric conditions was also evaluated.

Results

A total of 8096 Ukrainian adolescents (4988 [61.6%] female) living in Ukraine or abroad were included in the analyses. Based on national-level estimates, 49.6% of the adolescents were directly exposed to war, 32.0% screened positive for moderate or severe depression, 17.9% for moderate or severe anxiety, 35.0% for clinically relevant psychological trauma, 29.5% for eating disorders, and 20.5% for medium risk or higher of substance use disorder. The burden of psychiatric symptoms was similarly large among Ukrainian adolescents living abroad. Adolescents exposed to war were more likely to screen positive for depression (prevalence ratio [PR], 1.39; 95% CI, 1.29-1.50), anxiety (PR, 1.62; 95% CI, 1.45-1.81), clinically relevant psychological trauma (PR, 1.41; 95% CI, 1.32-1.50), eating disorders (PR, 1.21; 95% CI, 1.12-1.32), and substance use disorder (PR, 1.11; 95% CI, 0.98-1.25).

Conclusions and Relevance

The findings of this study suggest that the mental health burden of Ukrainian adolescents amidst the Russian invasion of Ukraine is substantial. Mental health care efforts to alleviate the mental health burden of Ukrainian adolescents are needed.

Change in child mental health during the Ukraine war: evidence from a large sample of parents

The ongoing war in Ukraine is expected to negatively impact the mental health of the country's population. This study aims to provide a preliminary estimate of the degree of change in the mental health problems of Ukrainian children following Russia's invasion in February 2022, and to identify the sociodemographic and war-related risk factors associated with these changes. A nationwide, opportunistic sample of 1238 parents reported on a single randomly chosen child within their household as part of The Mental Health of Parents and Children in Ukraine Study. Data were collected between July 15th and September 5th, 2022. Participants completed modified versions of the Pediatric Symptom Checklist (PSC-17) which was adapted to capture change in the frequency of symptoms since the beginning of the war. Parents reported increases across all 17 indicators of internalizing, externalizing, and attention problems of the PSC-17. Increased problems were most pronounced within the internalizing domain, with 35% of parents reporting that their child worried more since the beginning of the war. A number of individual, parental, and war-related factors were associated with increases across the three domains. Exposure to war trauma, pre-existing mental health problems, and child age were among the strongest predictors of change. This survey provides preliminary evidence that the Russian war on Ukraine has led to an increase in common mental health problems among children in the general population. Further research is required to determine the extent and sequela of this increase, and to develop intervention strategies for those most in need.

Effects of blast exposure on anxiety and symptoms of post-traumatic stress disorder (PTSD) among displaced Ukrainian populations

Generalized anxiety and symptoms of post-traumatic stress disorder (PTSD) are common among individuals forcibly displaced during war and conflict. Blast exposure may be one important contributor of such symptoms. The aims of this study were to provide data on blast-related experiences of internally displaced persons (IDPs) and refugees following Russia's invasion of Ukraine, and to assess the influence of blast exposure on generalized anxiety, and PTSD flashbacks and nightmares. An online health needs survey was distributed to Ukrainian IDPs and refugees between April and July 2022 using Facebook Ads Manager. Participants reported whether they experienced blast exposure since the beginning of the invasion, and whether they took medication for a mental health condition before the war started. Finally, they completed measures of generalized anxiety (GAD-2), and PTSD flashbacks and nightmares. Analyses included 3253 IDPs and 5073 refugees (N = 8326). Results revealed that 67.6% of total participants- 79.9% of IDPs and 61.7% of refugees-reported blast exposure since Russia's invasion. Further, 69.1% (95% CI: 68.05, 70.15) of total participants met the cut-off for generalized anxiety in which further diagnostic evaluation was warranted. Compared to refugees, IDPs reported higher generalized anxiety and greater frequency of PTSD symptoms, specifically flashbacks and nightmares. Further analyses revealed that the impact of blast exposure on flashback frequency was stronger among IDPs compared to refugees (β = 0.51; t(8322) = 11.88, p < .0001, 95% CI: 0.43, 0.60) and among participants with pre-existing mental health conditions compared to those without (β = 0.18; t(8157) = 2.50, p = .013, 95% CI: 0.04, 0.33). Mental health and psychosocial support must be prioritised within humanitarian relief for both IDPs and refugees and especially among people with underlying mental health conditions.

Potential impacts of Russo-Ukraine conflict and its psychological consequences among Ukrainian adults: the post-COVID-19 era

Background

Since February 2022, the nation of Ukraine has become entangled in an escalating conflict that erupted after coronavirus outbreak fostering a situation of indeterminacy and precariousness, which adversely affected several facets, especially psychological well-being. However, there is a lack of empirical evidence on the psychological well-being of Ukrainians during the Russo-Ukraine war, as well as their coping strategies in response to the war's repercussions. Consequently, this investigation endeavors to explore the prevalence of symptoms associated with depression, anxiety, stress, and insomnia and to correlate these symptoms with Ukrainians' effective coping mechanisms during the ongoing war.

Methods

An online survey was administered in Ukraine from June to August 2022 due to the ongoing Russo-Ukraine conflict. The survey employed a quota sampling technique, targeting 2,664 individuals (≥18 years). Out of the total sample, 1,833 valid responses were obtained, yielding a response rate of 68. 81%. Depression, anxiety, and stress were measured using the depression, anxiety, and stress scale-21 (DASS-21), while the Pittsburgh sleep quality index (PSQI) was utilized to evaluate insomnia symptoms. In addition, Brief-COPE was adopted to evaluate the coping mechanisms of the selected study participants.

Results

Of 1,833 Ukrainian adults, 60.5% had symptoms of stress; 62.4% of them reported symptoms of anxiety; and 58.2% reported symptoms of depression. Symptom criteria for insomnia were found in about 21.8% of the study sample. The factors of sex, living area, area occupied by Russian forces, and having older adults and children in the house were statistically significant with symptoms of depression, anxiety, stress, and insomnia. The productive coping strategies of self-distraction, using instrumental support, planning, and behavioral disengagement, were observed as statistically significant with four psychological constructs.

Conclusion

The study outcomes highlight a substantial prevalence of symptoms related to depression, anxiety, stress, and insomnia attributed to the accumulated consequences of ongoing conflict and the COVID-19 outbreak. The aforementioned findings emphasize the imperative of providing healthcare services and facilitating effective coping strategies among Ukrainians amid the ongoing war.

Editorial: Measuring and Buffering the Mental Health Impact of the War in Ukraine in Young People

The Russian invasion of Ukraine on February 24, 2022, has caused social, political, and financial instability worldwide. In Ukraine, the war has brought the greatest levels of violence, devastation, and disruption seen in Europe since World War II. Of course, the impact of war on the mental health of Ukrainian young people is likely substantial. Yet, more specific information about the prevalence and distribution of mental health disorders in young people is essential to document their needs, to select the best interventions, and to deliver these through international humanitarian efforts. The study by Osokina and Silwal et al.¹ presents some of the best evidence to date about the mental health impact of the war in Ukraine on young people.

The mental health consequences on children of the war in Ukraine: A commentary

The news from Ukraine is currently full of heart-wrenching stories accompanied by graphic images of civilian casualties and massacres that are telecast world-wide on a daily basis. It is hard to fathom the magnitude of the devastation and disruption to regular lives and everyday routines that war brings with it, the witnessing of countless deaths, the associated trauma of living in perpetual fear, and the daily experience of many families and orphans who are crowded into basement bomb shelters now for months on end. These issues make us contemplate the mental health consequences, among other lasting effects, of this costly war in Ukraine, and wars in other countries not so widely featured in Western news. Despite people of all ages being affected by war, children are especially vulnerable. This commentary outlines some of the epidemiology of the consequences of war, the mental health sequelae specifically, and the complexity of providing culturally and contextually relevant interventions that meet the needs of children.