A local resident carries her son as she walks among the ruins of their home in Horlivka (Gorlovka) in the Donetsk region, in Russian-controlled Ukraine, which was destroyed by shelling, on Aug. 15.Alexander Ermochenko/Reuters
Over the past year, Svitlana Osypenko has been attending psychological group therapy on a regular basis. With her husband serving in the army and her home city of Kharkiv under constant bombardment, she began experiencing anxiety and depression.
“At the beginning, I thought it was normal to feel bad because I was worrying about my husband and spending the first months of the war in the basement. But when I just wanted to cry without a reason while I was walking with my dog and felt sad all the time, I realized something was wrong,” Ms. Osypenko said in an interview in Kharkiv.
The 36-year-old says that she feels constantly worried and – because of uncertainty about when the war will be over – she can’t totally recover. “One day, I feel better, but then an explosion happens in the city, and all feelings return.”
According to her, most of the participants in the group therapy take antidepressants, and a large percentage of them have one-on-one sessions with psychologists.
Before the start of Russia’s full-scale invasion of Ukraine in 2022, Ms. Osypenko worked as a theatre choreographer and had her own dance studio for children. “All of it does not exist any more. Theatres are mostly closed because of the danger of being attacked with rockets, and a lot of kids didn’t return to the city.”
To keep herself busy, she works as a fitness trainer, trying to support other women who are going through the same things. She says that her social circle has significantly decreased and many of her friends have left Kharkiv.
“Living through all of it, I started to have deteriorating sleep. I don’t want to eat, and I have sad thoughts. I know that it’s not my normal condition, but I can’t turn off the trigger – the war.”
Physical symptoms of mental-health concerns
Family doctor Oleksandr Prokopchuk says that when patients with physical symptoms come to his hospital in Zolotonosha, in central Ukraine, they often don’t understand that the problem is not in their internal organs at all. It can be hidden depression, an anxiety disorder or a psychosomatic illness.
“The patient thinks that the problem is with the heart or lungs or with something else, but in fact, the problem is with anxiety,” Dr. Prokopchuk said, adding that symptoms such as shortness of breath and chest pain very often hide mental disorders.
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He said that he sees these symptoms in different age groups. “We didn’t have such a large number of complaints before the full-scale invasion. Now we prescribe more antidepressants.”
Dr. Prokopchuk added that for civilians it is also difficult to talk about their mental health because if they say they aren’t feeling well, they’re often told, “It’s hard for you, but do you know how hard it is for our boys at the front?” This “devalues individual feelings and adds to the increasing number of mental problems in society,” he said.
Mental health in conflict zones a universal problem
According to World Health Organization estimates, just over one in five people living in a conflict zone have some form of a mental-health condition, ranging from mild depression or anxiety to psychosis. Roughly one in 10 are living with a moderate or severe mental-health condition.
“Applying these estimates to the population of Ukraine would mean that 9.6 million people may have a mental-health condition, of whom 3.9 million may have conditions that are moderate or severe,” says Vera Schroepel, a child protection specialist at Unicef.
People cover a roof with tarps after their house was hit by a Russian airstrike near the Russian-Ukrainian border in Sumy region, Ukraine, on Aug. 15.Evgeniy Maloletka/The Associated Press
A Unicef survey conducted in September, 2023, illustrates the continuing influence and widespread psychological impact of the war in Ukraine on children’s health.
“Caregivers are facing fear, uncertainty and financial challenges due to unemployment and rising costs that come with the visible signs of stress and increased anxiety/anxiousness in their children,” Ms. Schroepel said. “Forty-three per cent of parents have noticed changes in the mental states of their children and reported high levels of anxiety, sensitivity to loud noises and trouble sleeping among children.”
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Anxiety and stress were also exacerbated for internally displaced people, who have lost their houses, livelihoods and communities and have been forced to start again in new locations.
Tetiana Rudenko, a psychologist and the head of Vilnyy Vybir – a non-governmental organization focused on psychological support and rehabilitation for veterans – says mobile apps are becoming an additional tool for people to help with mental-health challenges.
Sometimes, they don’t have the opportunity to make an appointment with a specialist or are not ready for one-on-one therapy. The online tools help them understand what’s happening to them, Ms. Rudenko said. “When we are working with our clients on individual sessions, mostly they come with post-trauma tiredness, depression, problems in relationships, or are grieving.”
She says that experiencing traumatic situations and their continuation in the future prevent full rehabilitation because sufferers are continuing to deal with stress and troubling events.
Larysa Didkovska, a psychologist and psychotherapist, says Ukrainians have adapted to living in conditions of uncertainty. “At the beginning of a full-scale invasion, at every siren, we hid and ran to the shelter, constantly read the news,” she said. “But since it has lasted for three years, and we don’t have any guarantees or predictability regarding when we will regain control over our own lives – it’s creating exhaustion.”
People are living under stress, but the level of it depends on their location and the degree of danger around them, Dr. Didkovska says. “If we are talking about duration, then this is already chronic stress, because this is the third year of danger, the third year of unpredictability, and the third year of threat to human life.”
The Kharkiv Psychiatric Hospital has 15 to 20 new patients a day, says psychiatrist Vadym Manhubi. Two other psychiatric hospitals in the region are not operational any more – one of them has been totally destroyed. “But not all the people who need help come to us or are delivered by ambulance,” he says. “We still have a big number of people who stay at home.”
A study using the WHO-5 psychological well-being index revealed alarming statistics: 35 per cent of Ukrainians surveyed indicated poor well-being and quality of life, with scores suggesting potential psychological distress, marked by depressive symptoms, according to Unicef’s Ms. Schroepel.
While 30 per cent described their quality of life as decent or fair, only a small fraction – 10 per cent – reported the highest quality of life possible, she said.