To the Editor — On 24 February 2022, Russia launched a full-scale invasion of Ukraine, marking a major escalation in hostilities. More than 4 million people have fled Ukraine into neighboring countries, causing Europe’s largest refugee crisis since the Second World War. The mental health problems and challenges among refugees and other populations affected by the war have received little attention, compared to political boycotts and economic sanctions. The rapid escalation of a mental health crisis warrants urgent attention.
It is inevitable that people living in conflict-affected areas will have short- and long-term mental health problems. Prior to fleeing their home countries, refugees usually experience various traumas, such as losing family and loved ones in conflict, fear of being killed in war and lack of basic necessities, all of which contribute to an increased vulnerability to mental health problems1. Certain risk factors, such as pre-existing psychiatric problems, may increase the risk of conflict-related mental health problems among vulnerable individuals2. During migration, ongoing danger to personal safety and uncertainty about the future can trigger mental health problems3. In addition to these short-term effects, long-term effects of conflict-associated migration may be due to the stress of acculturation, language and culture barriers, and social discrimination in the new country4.
Mental health problems will also affect people living in the conflict zones in Ukraine. They are exposed to a range of war traumas, such as witnessing or experiencing war injuries, explosions from bombs and loved ones being killed, often repeatedly, which can result in severe psychological traumas and psychiatric comorbidities, including posttraumatic stress disorder (PTSD) and depression5. A systematic review and meta-analysis showed that the prevalence of psychiatric disorders (including depression, anxiety disorder, PTSD, bipolar disorder and schizophrenia) was 22.1% at any point in time among conflict-affected populations, including those who leave or stay in their original countries6.
The war has also added to the challenges in the prevention and control of SARS-CoV-2. There is a low COVID-19 vaccination rate in Ukraine of around 35.7% (ref. 7), and the upheaval of the public health system caused by the war will negatively affect pandemic control measures. The relentless conflict combined with the COVID-19 pandemic will put extreme pressure on the health system in Ukraine and neighboring countries, compromising timely delivery of mental health services for refugees.
International psychiatric academic associations, including the European Psychiatric Association (EPA), American Psychiatric Association (APA) and World Psychiatric Association (WPA), have released statements on how the war will exacerbate mental health problems. Joint international collaboration is crucial to tackle the mental health crisis in Ukraine and so we propose the following actions, below.
First, health authorities in Ukraine, as well as those in surrounding countries hosting refugees, should provide universal mental health services for those impacted by the war. Online mental health surveys and counselling services could be suitable alternatives to face-to-face assessments and psychological first aid; evidence for their efficacy has come from combating mental health problems caused by the COVID-19 pandemic8.
Second, major international psychiatric associations, such as the WPA, APA, EPA and the Pacific Rim College of Psychiatrists (PRCP), should have an important role in addressing the mental health crisis caused by the war. The WPA has already called for donations to supply essential medications for mentally ill people in Ukraine9. Collaborative efforts should include: epidemiological surveys on the dual mental health crises caused by the war and COVID-19 pandemic among affected populations; facilitating the timely delivery of crisis intervention services; and developing expert consensus and crisis management guidelines to assist mental health professionals working in the affected countries.
Third, special attention should be given to vulnerable populations at high risk of mental health problems, such as the elderly (Ukraine is one of the fastest aging countries in the world). Finally, it is paramount to ensure the provision of culturally sensitive crisis interventions to all refugee populations, including Ukrainian refugees.
The mental health crisis caused by the war in Ukraine is driving an unprecedented humanitarian crisis both for refugees and for war survivors living in Ukraine. We call for a cohesive and timely collaboration, nationally and internationally, to address and minimize the mental health suffering of conflict-affected populations.
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A.J. is President of the World Psychiatric Association. C.H.N. is President of the Pacific Rim College of Psychiatrists. J.M. is Chair of the World Psychiatric Association - Urban Mental Health Section. All other authors declare no competing interests.
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Bai, W., Cai, H., Sha, S. et al. A joint international collaboration to address the inevitable mental health crisis in Ukraine. Nat Med 28, 1103–1104 (2022). https://doi.org/10.1038/s41591-022-01828-w