The Psychological Trauma Caused by Russia's War against Ukraine Continues: More than 15 Million People need Help

Psychological Consequences of the Russian Attack on Ukraine

The consequence of the Russian large-scale invasion of the territory of Ukraine on February 24, 2022 was the destruction of its cities and villages, the country’s civil infrastructure, and the rapid deterioration of the index of people’s social well-being and self-realization. First of all, the psycho-emotional state of Ukrainian citizens was significantly affected, which in the conditions of the war of constant bombing, artillery, missile and other shelling is assessed as devastating.

The Ministry of Health of Ukraine predicts that more than 15 million Ukrainians will need psychological support because of the war. At the same time, about 3-4 million people will have to be prescribed drug treatment. After the war, at least one in five people will experience negative mental health effects. According to the Ministry of Health of Ukraine, 20–30% of people who have experienced traumatic events may develop post-traumatic stress disorder (PTSD). In addition, in 5-7 years, the number of people with drug, alcohol and other addictions is expected to increase. Due to the psycho-emotional stress caused by the Russian war against Ukraine, Ukrainians will age by 10-15 years, that is, diseases characteristic of adulthood and old age will occur 10-15 years earlier than before the war.

Director General of the Directorate of Medical Services of the Ministry of Health of Ukraine, Oleksandra Mashkevich, states: “According to the World Health Organization, 20% of the population living in areas affected by military conflicts over the past 10 years have some form of mental disorder - from mild depression and anxiety to psychosis, and almost every tenth person has a moderate or severe mental disorder. So, if we predict that 15.7 million people in Ukraine will need psychological help, then 3.5 million of them will have a certain mental health disorder, and 800,700 people will have a moderate or severe mental disorder” [1].

According to an expert at the headquarters of the World Health Organization (WHO) in Geneva, co-chair of the Reference Group on Mental Health and Psychosocial Support Fami Hanna, the risk of developing mental disorders such as depression and post-traumatic stress disorder as a result of the war is more than 8.5 million Ukrainians [2].

The Choice of People between Freedom and Security in Conditions of War

Generalized data of sociological surveys of the choice of Ukrainians between freedom and security were presented by Reznik O [3]. Thus, taking into account the fact that the main socio-psychological value around which personal identity is always structured is security, it is natural that in war conditions negative emotions are more pronounced than positive ones: sadness and anger prevail over joy and inspiration on a scale from 1 to 7: indices of 4.8 and 4.6 in wartime versus 4.1 and 4.3 compared to pre-war times. The most expressed emotion in war conditions is excitement - index 5.0.

However, democratic values remained very important for Ukrainians. In the “freedom-security” paradigm, as shown by the pre-war survey, two-thirds (65.9%) of the respondents were inclined to choose security, and less than a third (29.5%) - freedom. In the conditions of the war, Ukrainians’ responses to this difficult confrontation were conditionally divided. In particular, 38.8% of Ukrainians preferred security over freedom, while 34.6% of citizens chose the opposite priority - freedom over security. It is obvious that a large number of the population, despite the urgent need for security, is not ready to give up their freedoms.

In general, since the beginning of Russia’s full-scale war against Ukraine, Ukrainian society has demonstrated a high level of vitality, the value of this index has decreased minimally: 3.9 - during the war and 3.7 - before the Russian aggression. A significant increase in public self-esteem of citizens was recorded. The majority of respondents rated Ukraine’s situation above average - 4.6 points, which is 1.5 times higher than the 2021 indicator.

Before the war, in August 2021, no single systematically formed psychological marker was found in the interviewees, no emotion was emphasized by the majority of the interviewees. The ratio of choices of positive and negative experiences was more or less balanced. Positive emotions - pride, joy and interest were noted by 69% of respondents, negative - sadness, shame and fear - by 71%. At the same time, anger and indifference clearly had a peripheral character, since they were chosen by only 5% of respondents. However, a year later, the picture becomes different and reflects the changes that took place after the start of the war. A clear system-forming feeling appears - pride for Ukraine, which was noted by 75% of respondents, while its antithesis - shame, almost disappears from the palette of feelings (it was chosen by only 2%). The feeling of indifference also disappears. The balance of positive and negative (without anger) emotions changes radically and amounts to 113% versus 42%.

In the conditions of the war, generally accepted norms and values became more defined, so anomie moods ceased to dominate: the number of those who are dominated by anomie state (state of demoralization) decreased from 72 to 48% of the respondents. The biggest change has occurred regarding the improvement of the understanding of what rules to follow and what to believe today [3].

Problems of Psychiatric Care

At the same time, Seleznova V, et al. [4] note that the Ukrainian psychiatric care system suffers from a lack of financial and human resources, which hinders its ability to provide adequate support to those who need it. Addressing this issue requires a collaborative effort between Ukrainian mental health stakeholders and international governmental and non-governmental organizations to provide support and build capacity for mental health services in Ukraine.

Karatzias T, et al. [5] note that “all participants were exposed to at least one war-related stressor, and the mean number of exposures was 9.07 (range = 1–26). Additionally, 25.9% (95% CI = 23.9%, 27.8%) met diagnostic requirements for PTSD and 14.6% (95% CI = 12.9%, 16.0%) met requirements for CPTSD. There was evidence of a strong dose–response relationship between war-related stressors and meeting criteria for PTSD and CPTSD. Participants who had the highest exposure to war-related stressors were significantly more likely to meet the requirements for PTSD (OR = 4.20; 95% CI = 2.96–5.95) and CPTSD (OR = 8.12; 95% CI = 5.11–12.91) compared to the least exposed” [5].

Our observations coincide with the observations of colleagues regarding a certain “habituation” to war, which has both a positive and a negative side. Positive - the Ukrainians did not get stuck in the first shock phases of perceiving the horrors of war, they adapted to them in a certain way, began to perceive the war as a new reality, negative - an illusory decrease in the sense of threat from the occupier, which shifts aggression - from an external enemy to a search for an internal one. A certain result of this is a decrease in the share of Ukrainians who believe that Ukraine is moving in the right direction. After the start of Russia’s full-scale aggression against Ukraine, the share of citizens who believe that events in Ukraine are developing in the right direction has increased significantly. After that, there is a tendency to decrease this indicator, but according to the latest (January 2024) survey, the shares of those who believe that events in Ukraine are developing in the right direction and those who hold the opinion that they are developing in the wrong direction are statistically significant do not differ.

Destruction of Life Experience and Acquisition of New Identities

One of the most tragic consequences of the war is the deconstruction of a person’s life experience as the determining basis for the formation of almost all types of identity as a complex socio-cultural phenomenon that combines personal, social and cultural aspects. In the conditions of war, the existential meaning of the concept of identity is expressed, which is evidenced by the determination of Ukrainians to defend their own cultural and life world, even at the cost of their own lives. Such an extreme experience later turns out to be quite sufficient for erasing old ones and forming new identities. As a result, along with the identity of self-sacrifice in the name of protecting one’s Motherland, there are people who are indifferent to their own self-determination, with a split or blurred consciousness among pro-Russian people, of whom about 15-20% in Ukraine.

As a result of the Russian-Ukrainian war, a clear definition in the coordinate system of “own - foreign” has appeared in society, which leads to a clear idea of what needs to be done about it. A marker of the transformation of identities in the conditions of war is the predominance of the public over the individual, if the former is expressed in the form of the state or other official power structures. As of the end of 2021, there was, in a certain sense, pathological negativism in the perception of the state. Two-thirds of all respondents demonstrated either strongly negative or moderately negative attitudes. The war destroyed this dominant negativism, showing Ukrainians that by losing their state, they would lose much of what they were used to and what they valued. In the first measurement after 02/24/2022, we can see that negative attitudes decreased by more than three times, and positive ones increased by 6 times. Among social institutions, Ukrainians have the most trust in the Armed Forces, humanitarian and charitable organizations, the Church, women’s and environmental organizations, television and the press.

Full-scale Russian aggression also significantly changed the factors of self-identification of citizens: if earlier the vast majority of respondents indicated the priority of family inheritance, then the consequence of the war was the preference over the inheritance of civil union. If in 2017, 68% of respondents stated that they simply inherited their nationality from their parents or one of their parents, then in 2022, only 48% of respondents said so. That is, people increasingly call themselves Ukrainian precisely because they live in Ukraine, regardless of origin, and transfer this civic self-identification to the category of identity, which was traditionally ethnic.

This means that identity today is no longer a purely ethnic category, and its distribution does not reflect its ethnic map. Identity today should be considered a socio-cultural phenomenon, that is, a combination of ethnic and civic self- determination of a person with the advantage of the latter. Based on this, it can be assumed that Ukraine has ceased to be a multi-ethnic country because non-titular ethnic groups make up only a few percent of its population. Accordingly, ethnopolitics will not play a significant role in the nationwide socio-political process, although it will remain a factor in certain regions and in Ukraine’s relations with international organizations that care for the rights of minorities.

Resilience of Military Solidarity

The ordeal of the war strengthened citizens’ need for solidarity - with the residents of their city, village, region, country as a whole, even Europe and the world. Thus, the share of those who answered that they feel very close to the residents of their city (village) increased from 49% in 2020 to 75% in 2022, with the region - from 31% to 60%, with the country - 33% to 69%, with Europe - from 9% to 23%. According to the sociological research of the Razumkov Center, conducted in May 2023, Ukrainians feel the greatest social closeness (in terms of character, customs, traditions) to the residents of Kyiv (8.4), the Central region (8.3), Slobozhanshchyna (7, 6), Southern region without Crimea (7.4), Western Ukraine (7.3–7.1). Somewhat less social closeness is felt in relation to the residents of Crimea (6.4) and Donbass (5.7).

It can be assumed that it was the feeling of solidarity that ensured the preservation of emotional stability and optimism of Ukrainians. And it is quite possible that unity in the most difficult time for the country is a mental trait of the Ukrainian nation that gives it strength and indomitability in difficult times. It was like that in 2014 and in 2004-2005, and it is like that now - “...together there are many of us, and we cannot be overcome.” This solidarity is manifested primarily in the joint struggle against Russian aggression. In particular, this is help with resources to the defenders of Ukraine, participation in the informational struggle against Russian propaganda, volunteering, defense of the state with weapons in hand, etc.