Mental Health Conditions and Co-morbidities Among Internally Displaced Populations (IDPs) in Ukraine

Reliable epidemiological data on the burden of mental health conditions and key risk factors is crucial in helping to design appropriate trauma-informed mental health and psychosocial support responses for the estimated 1.4 million IDPs in Ukraine. The aim of the proposed study is to collect evidence on mental health and psychosocial support needs among IDPs in order to help inform mental health policy in Ukraine.

The specific objectives were to:

– measure the prevalence of mental health conditions of post-traumatic stress disorder (PTSD), depression, anxiety, and their co-morbidity;

– examine the characteristics associated with the mental disorders (e.g. gender, age, trauma exposure, socio-economic stressors);

– draft evidence-based recommendations for mental health and psychosocial support to relevant governmental and professional bodies in Ukraine.

The study used a cross-sectional survey conducted throughout Ukraine in 2016 with 2203 IDPs aged 18 years and over. Descriptive and multivariate regression analyses were used. PTSD prevalence was 32% (22% men; 36% women), depression–22% (16% men; 25% women), and anxiety prevalence was 17% (13% men; 20% women). There were also high levels of co-morbidity between PTSD, anxiety and depression. Key factors statistically significantly associated with mental disorders included female gender, older age, cumulative trauma exposure, more recent displacement and a bad household economic situation. The findings provided sufficient evidence to draft the trauma-informed mental health policy recommendations to key policy-makers in Ukraine.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Mental health care utilisation among internally displaced persons in Ukraine: results from a nation-wide survey

AimsThere are an estimated 1.5 million internally displaced persons (IDPs) in Ukraine because of the armed conflict in the east of the country. The aim of this paper is to examine utilisation patterns of mental health and psychosocial support (MHPSS) care among IDPs in Ukraine.

METHODS

A cross-sectional survey design was used. Data were collected from 2203 adult IDPs throughout Ukraine between March and May 2016. Data on mental health care utilisation were collected, along with outcomes including post-traumatic stress disorder (PTSD), depression and anxiety. Descriptive and multivariate regression analyses were used.

RESULTS

PTSD prevalence was 32%, depression prevalence was 22%, and anxiety prevalence was 17%. Among those that likely required care (screened positive with one of the three disorders, and also self-reporting a problem) there was a large treatment gap, with 74% of respondents who likely required MHPSS care over the past 12 months not receiving it. For the 26% (N = 180) that had sought care, the most common sources of services/support were pharmacies, family or district doctor/paramedic (feldsher), neurologist at a polyclinic, internist/neurologist at a general hospital, psychologists visiting communities, and non-governmental organisations/volunteer mental health/psychosocial centres. Of the 180 respondents who did seek care, 163 could recall whether they had to pay for their care. Of these 163 respondents, 72 (44%) recalled paying for the care they received despite government care officially being free in Ukraine. The average costs they paid for care was US$107 over the previous 12 months. All 180 respondents reported having to pay for medicines and the average costs for medicines was US$109 over the previous 12 months. Among the 74% had not sought care despite likely needing it; the principal reasons for not seeking care were: thought that they would get better by using their own medications, could not afford to pay for health services or medications, no awareness of where to receive help, poor understanding by health care providers, poor quality of services, and stigma/embarrassment. The findings from multivariate regression analysis show the significant influence of a poor household economic situation on not accessing care.

CONCLUSIONS

The study highlights a high burden of mental disorders and large MHPSS treatment gap among IDPs in Ukraine. The findings support the need for a scaled-up, comprehensive and trauma-informed response to provision of MHPSS care of IDPs in Ukraine alongside broader health system strengthening.

A comparison of DSM-5 and ICD-11 PTSD prevalence, comorbidity and disability: an analysis of the Ukrainian Internally Displaced Person's Mental Health Survey

OBJECTIVE

Recently, the American Psychiatric Association (DSM-5) and the World Health Organization (ICD-11) have both revised their formulation of post-traumatic stress disorder (PTSD). The primary aim of this study was to compare DSM-5 and ICD-11 PTSD prevalence and comorbidity rates, as well as the level of disability associated with each diagnosis.

METHOD

This study was based on a representative sample of adult Ukrainian internally displaced persons (IDPs: N = 2203). Post-traumatic stress disorder prevalence was assessed using the PTSD Checklist for DSM-5 and the International Trauma Questionnaire (ICD-11). Anxiety and depression were measured using the Generalized Anxiety Disorder Scale and the Patient Health Questionnaire-Depression. Disability was measured using the WHO Disability Assessment Schedule 2.0.

RESULTS

The prevalence of DSM-5 PTSD (27.4%) was significantly higher than ICD-11 PTSD (21.0%), and PTSD rates for females were significantly higher using both criteria. ICD-11 PTSD was associated with significantly higher levels of disability and comorbidity.

CONCLUSION

The ICD-11 diagnosis of PTSD appears to be particularly well suited to identifying those with clinically relevant levels of disability.