The first epidemiological study of mental health disorders in Ukraine occurred in 2002 [1]. Face-to-face interviews were conducted with a probability-based sample of 4,725 adults, and the lifetime prevalence rates for nine disorders ranged from 0.3% (agoraphobia) to 14.6% (major depressive disorder [DD]). Overall, 31.6% met requirements for any disorder, with significantly higher rates in men. Men were nine times more likely to have an alcohol-related disorder, while women were about twice as likely to have a mood or anxiety disorder. Other demographic variables associated with having a mental health disorder included older age (mood disorders); living in the eastern and Kyiv regions versus the western region (mood, anxiety, and intermittent explosive disorders); being divorced or separated (all disorders); having less than a university education (mood, alcohol, and intermittent explosive disorders); not being employed (all disorders); and poorer financial status (mood disorders). More recent figures come from the 2017 Global Burden of Diseases study with rates of 3.4% for major DD, 6.0% for alcohol use disorder (AUD), and 0.7% for other drug use disorders being estimated [2].

The profound challenges that Ukraine has faced during the last decade may have affected the mental health of the population. In 2014, following the Maidan Revolution, Russia annexed Crimea and commenced a land war in the east of Ukraine giving rise to two million internally displaced people. Research with a representative sample of these people found that 27.4% met diagnostic requirements for post-traumatic stress disorder (PTSD), 20.6% for major DD, and 16.1% for generalized anxiety disorder (GAD), while 14.3% men and 1.7% of women screened positive for AUD [3]. In early 2020, Ukraine faced the COVID-19 pandemic and suffered its attendant social, economic, and public health effects. Following 2 years of social and economic disruption due to the pandemic, and 8 years of Russian aggression, Russia launched a full-scale invasion in February 2022. Research soon after this invasion revealed high levels of exposure to war-related stressors and post-traumatic stress symptoms in adults [4] and children [5], as well as sharp increases in anxiety and depression symptoms in adults [6] and children [7]. Although human beings are remarkably resilient to large-scale disasters [8], it is possible that these events have negatively affected the mental health of the population.

The primary objective of this study was to estimate the prevalence of mental distress in the general adult population of Ukraine 18 months after Russia’s full-scale invasion. The first objective was to determine a) the proportion of people meeting diagnostic requirements for PTSD, complex PTSD (CPTSD), prolonged grief disorder (PGD), DD, GAD, AUD, and/or cannabis use disorder (CUD), b) sex differences across all disorders and for any disorder, c) regional differences in the prevalence of disorders, and d) patterns of association between the disorders. The second objective was to identity the sociodemographic variables associated with meeting diagnostic requirements for each disorder. The third objective was to identify the sociodemographic variables associated with meeting diagnostic requirements for any disorder, and for multiple disorders.

Prevalence estimates are presented in Figure 1, ranging from 1.5% (CUD) to 15.2% (GAD). Overall, 36.3% met requirements for any disorder, with 20.1% meeting requirements for one disorder, and 16.2% for two or more disorders.Figure 1.

Percentage meeting criteria for each mental health disorder and of any mental health disorder for males, females, and entire sample.

Females were significantly more likely to meet requirements for GAD (χ ² (1) = 52.23, p < .001, OR = 2.51 [95% CI = 1.94, 3.24]) and DD (χ ² (1) = 17.41, p < .001, OR = 1.99 [95% CI = 1.44, 2.77]), whereas males were significantly more likely to screen positive for AUD (χ ² (1) = 12.99, p < .001, OR = 1.83 [95% CI = 1.31, 2.55]) and CUD (χ ² (1) = 4.10, p = .043, OR = 2.21 [95% CI = 1.01, 4.84]). Females were significantly more likely to screen positive for any disorder (39.0% vs. 33.8%, χ ² (1) = 5.86, p = .015, OR = 1.25 [95% CI = 1.04, 1.50]), and for two or more disorders (19.8% vs. 12.8%, χ ² (2) = 18.15, p < .001, φ = .09).

Table 2 presents the proportions meeting criteria for disorders in each region of Ukraine. Significant differences were evident for GAD (χ ² (4) = 9.60, p = .048, φ = .07), AUD (χ ² (4) = 10.59, p = .032, φ = .07), and any disorder (χ ² (4) = 12.56, p = .014, φ = .08). Rates of GAD were significantly higher than expected in the east and lower in the west. Rates of AUD were significantly higher in the north and lower in the south. Across all disorders, rates were significantly higher than expected in the east and lower than expected in the west.Table 2.

Percentages across different regions of Ukraine

Figure 2 presents the tetrachoric correlations between the seven disorders. All correlations were positive and 16 of 20 were statistically significant. The strongest correlation was between DD and GAD (r = .90). CUD had the weakest pattern of association with other disorders, only correlating significantly with AUD (r = .43) and GAD (r = .24).Figure 2.

Tetrachoric correlations among all mental health disorders. Note: No correlation was provided for PTSD and CPTSD as these disorders are independent by the nature of their diagnostic rules; DD, depressive disorder; GAD, generalized anxiety disorder; PTSD, ICD-11 post-traumatic stress disorder; CPTSD, ICD-11 complex PTSD; PGD, prolonged grief disorder; AUD, alcohol use disorder; CUD, cannabis use disorder.

The adjusted associations between the predictor variables and meeting requirements for each disorder are presented in Table 3, and all logistic regression models were statistically significant (p < .001).Table 3.

Odds ratios for risk factors associated with meeting diagnostic requirements for each disorder

Regarding the stress-related disorders, meeting criteria for PTSD was associated with living in central Ukraine and being affected by the 2014 Russian invasion. Meeting criteria for CPTSD was associated with having a university education, greater financial worries, being divorced, separated, or widowed, being affected by the 2014 Russian invasion, being displaced by the 2022 Russian invasion, and having fewer positive memories of home and family life. Meeting criteria for PGD was associated with greater financial worries, being divorced, separated, or widowed, being affected by the 2014 Russian invasion, and fewer positive memories of home and family life.

Regarding the anxiety and mood disorders, meeting requirements for GAD was associated with being female, being aged 18–29 and 30–39 years, greater financial worries, being affected by the 2014 Russian invasion, and fewer positive memories of home and family life. Meeting requirements for DD was associated with being female, greater financial worries, being affected by the 2014 Russian invasion, and fewer positive memories of home and family life.

Finally, regarding the substance misuse disorders, screening positive for AUD was associated with being male, being affected by the 2014 Russian invasion, and fewer positive memories of home and family life. Additionally, screening positive for AUD was less likely among students, those retired, and those living in the south of Ukraine. Screening positive for CUD was associated with being male, not having a university education, being displaced by the 2022 Russian invasion, and fewer positive memories of home and family life.

The multinomial logistic regression model predicting those meeting diagnostic requirements for one and two or more disorders versus zero disorders was statistically significant (χ ² (44) = 285.39, p < .001). Adjusted associations are reported in Table 4.Table 4.

Odds ratios associated with meeting diagnostic requirements for different numbers of disorders

Meeting criteria for a single disorder was associated with having more children, living in northern, eastern, and southern Ukraine, being affected by the 2014 Russian invasion, and having lower levels of positive memories of home and family life. Meeting criteria for two or more disorders was associated with being female, being aged 18–29 years, having more financial worries, being divorced, separated, or widowed, being affected by the 2014 Russian invasion, and having fewer positive memories of home and family life.

This study was conducted to estimate the level of psychological distress in the Ukrainian population 18 months after Russia’s full-scale invasion. Approximately one in three adults reported problems consistent with meeting diagnostic requirements for one of seven disorders. The most common problem was GAD (15.2%), while CUD was the least common problem (1.5%). Between 8% and 12% of people screened positive for the other stress, mood, and substance misuse disorders. Comorbidity between disorders was common, and half of those meeting criteria for one disorder met criteria for at least one other disorder. Methodological differences mean it is impossible to compare current findings to prior studies from Ukraine [1], but both studies found that about one-third of adults were experiencing clinically relevant mental health problems. This suggests that the overall prevalence of mental health disorders in Ukraine is not markedly different from what is seen in other Western and European nations [23,24]. These findings may be taken as a sign of the remarkable resilience of the Ukrainian population, given the immense challenges they have faced in recent years.

We observed the typical pattern of sex differences in disorders that has been found in Ukraine [1,2], and internationally [25]. Women were 2–2.5 times more likely to meet diagnostic requirements for GAD and DD while men were about two times more likely to screen positive for AUD and CUD. These differences remained when controlling for all other sociodemographic variables, and in the case of CUD, the effect increased in magnitude such that men were nearly 3.5 times more likely to screen positive. Notably, we found that women were more likely than men to screen positive for any disorder, and for two or more disorders. Adjusting for all other sociodemographic variables, the effect of screening positive for two or more disorders remained significant. Among Ukrainian adults, it was previously found that men were significantly more likely than women to have a disorder, but this was likely due to the stark differences in alcohol misuse disorders [1]. Current findings suggest that women differ from men not only in the type of disorders they are more likely to report, but also in their risk for disorder comorbidity.

There were some differences in disorder prevalence across geographical regions of Ukraine, with people living in the east most likely to screen positive for a disorder, and people in the west the least likely. This is perhaps not surprising given that the east of Ukraine has been under Russian attack since 2014 and continues to be on the front line of the ongoing war. Adjusting for all other sociodemographic variables, we found that people living in the east, south, and north of Ukraine were more likely to screen positive for a mental health disorder than people living in the west. These findings should be interpreted cautiously. Although we were able to recruit people living in the eastern and southern parts of Ukraine, people most severely affected by the war in these areas may not have been contactable due to the requirement for internet access. Furthermore, millions of people have left the most severely affected regions of Ukraine (east and south) since 2014 for refuge in other, safer parts of the country meaning the composition of different regions is changing rapidly over short time scales. It is difficult therefore to offer a simple explanation for why some disorders may be higher in one region than another, but we hope these findings have some value in indicating where mental health resources may be most needed.

Across our analyses, several other sociodemographic variables emerged as robust correlates of different disorders. Aligning with prior research [3], people who indicated that their lives were disrupted by Russia’s 2014 invasion (meaning they were forced to move, lost property, became disabled, or were bereaved) were upward of 2.5 times more likely to screen positive for each disorder (other than CUD) and to screen positive for two or more disorders. Nearly half the sample (47%) reported feeling “extremely” or “very” worried about their financial security, and financial worries were associated with almost all disorders. Financial insecurity is increasingly recognized as a major risk factor for mental disorder [26,27]. Solutions to mental health problems are often thought to lie in psychotherapeutic or pharmacological interventions, but if a major cause of distress is financial insecurity, a solution might also be found in political and economic interventions. Ensuring the continued financial security of the people of Ukraine is therefore a key humanitarian task for the international community.

Positive memories of home and family life were associated with a lower likelihood of meeting criteria for every disorder (except PTSD) and, notably, the effect was especially strong for CUD. Positive childhood experiences are known to play a key role in protecting people from developing mental health disorders later in life [28], even in those with histories of childhood trauma [29]. In the current sample, scores on this variable were highly negatively skewed, meaning that most people reported very positive memories of their home and family life. This is encouraging and may be one factor in explaining the resilience of the population. Moreover, this variable may offer a useful means of identifying those most at risk for a mental health disorder, especially CUD.

We found that younger adults (i.e., those aged 18–40) were more than twice as likely to meet requirements for GAD than those over 60 years, and the youngest cohort (i.e., 18–29 years old) were more than twice as likely to screen positive for two or more disorders. Previous work in Ukraine indicated that older adults were somewhat more likely to have a mental health disorder [1]; a finding inconsistent with the wider literature [30]. It is possible these discrepant findings can be explained by cohort effects, but regardless of the reason, current findings suggest that younger adults in Ukraine are most likely to report mental health problems. Those with a university education were nearly five times less likely than those without a university education to screen positive for CUD, and full-time students were less likely to screen positive for AUD. This suggests that alcohol and substance misuse is strongly related to lower educational attainment in Ukraine. Finally, individuals who were divorced, separated, or widowed were nearly twice as likely to meet criteria for CPTSD and PGD than those who were married or in a committed relationship, and were 64% more likely to meet requirements for two or more disorders. It is noteworthy that single people were no more likely to have a disorder, meaning that being in a relationship is not necessarily protective; rather, the dissolution of a relationship seems to be key [1].

This study contains several limitations. Non-probability-based sampling methods were used, and we were unable to recruit our desired quota of older adults or people from some areas of Ukraine under Russian occupation (e.g., Crimea). While we endeavored to construct the sample in a way that was representative of the population across several demographic variables, it is unlikely that our sample completely represents the population. Second, we were only able to measure seven disorders, and these do not represent the entire spectrum of mental health problems. Third, our prevalence estimates were derived from self-report data, which can yield higher estimates relative to clinical assessment, but we used diagnostic algorithm scoring methods, where possible (i.e., PTSD, CPTSD, PGD, GAD, DD), and employed conservative cut-off scores where diagnostic algorithms were not available (i.e., AUD, CUD) to minimize possible type 1 errors. Finally, the cross-sectional design means no causal interpretations can be made regarding the relationships between the sociodemographic and mental health variables.

This study provides important information about the state of mental health in the adult population of Ukraine in 2023. It appears that about one-third of adults have clinically relevant problems related to anxiety, traumatic stress, bereavement, low mood, and substance misuse. Key risk factors for these mental health problems include younger age, lower education attainment, greater financial worries, no longer being in a committed relationship, having fewer positive childhood experiences within one’s family context, and experiencing serious disruption to one’s life due to Russian aggression. Meeting this level of need is going to be challenging because the Ukrainian mental healthcare system was considered to be severely under-resourced before the onset of the full-scale invasion, and has experienced serious infrastructure and personnel damage since then [31]. It is our hope that these findings help in some way to understand the level of need, and who is in need, so that limited resources can be used most effectively.