Changes in Post-Traumatic Symptom Pattern during and after Exposure to Extreme War Stress: An Uncontrolled, Preliminary Study Supporting the Dose-Response Model

(Complex) PTSD in Ukrainian refugees: Prevalence and association with acts of war in the Danish refugee cohort (DARECO)

BACKGROUND

The Russian invasion of Ukraine has driven millions of Ukrainians away from their homes. Among these, the majority have likely experienced war-related potentially traumatic events, and some will experience symptoms of posttraumatic stress disorder (PTSD). The aims of the study are to estimate the prevalence of PTSD and Complex PTSD (CPTSD) in displaced Ukrainians and examine associations between war- and other potentially traumatic exposures and (C)PTSD.

METHODS

Questionnaires were distributed to all registered adult Ukrainians (18+) who arrived in Denmark between February 24th 2022 and February 15th 2023 (N = 18,389). We estimate the prevalence of war exposures, other potentially traumatic exposures, and (C)PTSD. In logistic regression analyses, we test if exposure to war and other potentially traumatic events are associated with PTSD and CPTSD.

RESULTS

The final sample size was 6993 (38.0 %). Responders were more likely to be female and younger than non-responders. Prevalence of PTSD and CPTSD was 15.9 % and 13.5 %, respectively. Female gender, high education, and loss of a relative due to the war were associated with (C)PTSD. Direct and indirect exposure to war and combat was related to PTSD but not CPTSD, while exposure to war prior to the 2022 invasion was related to CPTSD but not PTSD.

LIMITATIONS

The study is cross-sectional and based on self-report.

CONCLUSION

Close to one third of the sample fulfill the criteria of PTSD or CPTSD. War exposures are differentially related to PTSD and CPTSD. The findings illustrate that trauma-related psychopathology is a pertinent problem in displaced Ukrainians.

Quality or quantity of coping resources: Why not both? An integration of common stress theories

Threatening situations may cause distress (e.g., armed conflicts, natural disasters, etc.) and provoke Psychological Distress and Post-Traumatic Stress Symptoms. National resources may mitigate threats or damage in certain situations. This research suggests that in doing so, such resources deployed in concert with personal resources, may reduce levels of these symptoms. Two major stress theories are integrated in theoretical support of the role of national resources: The Conservation of Resource theory (Hobfoll, 1989) and the Cognitive Appraisal Theory (Lazarus and Folkman, 1984). Hobfoll's theory is extended beyond personal resources to encompass national resources. We offer the case of the Iron Dome as an example of a national resource. Iron Dome is an Israeli missile defense system successfully used during Operation Protective Edge in 2014 in response to rocket attacks from Gaza. A cross-sectional study was conducted during the operation in the form of an online survey in which 910 Israeli civilians were assessed using a Psychological Distress and the Impact of Event Scale. They reported on their personal resources and perception of the Iron Dome as a national security resource. Our findings revealed that resource quantity significantly predicted Psychological Distress and Post-Traumatic Stress Symptoms. In addition, it was found that the national security resource significantly contributed to decreased Psychological Distress and Post-Traumatic Stress Symptom predictions beyond all personal resources examined. Research contributions and practical implications are discussed.

Vulnerability and Resilience in a Group Intervention with Hospital Personnel during Exposure to Extreme and Prolonged War Stress

The current study presents a pilot demonstration of a new therapeutic procedure to mitigate symptoms of post-traumatic stress disorder (PTSD). The pilot took place during the Second Lebanon War. Vulnerability and resilience statements, as well as post-traumatic symptoms, were measured among special army administrative staff (SAAS) who worked in a hospital setting during extreme and prolonged war stress. All 13 soldiers in the unit studied participated in seven group therapy intervention sessions. It was hypothesized that shifting the focus of therapeutic intervention from the scenes of the events to the personal and professional narratives of preparing for the event would change the content of the soldiers’ narratives. It was believed that subtracting the number of positive statements from the number of negative statements would yield increasingly higher “resilience scores” during and after the war. It also was believed that such a change would be reflected in reduction of post-traumatic symptoms. As expected, the participants showed a decrease in vulnerability and an increase in resilience contents, as well as a decrease in traumatic symptoms during and after the war. These findings may reflect the effects of the ceasefire, the mutually supportive attitude of the participants, and the therapeutic interventions.