Mental Health of Residents of Ukraine Exposed to the Russia-Ukraine Conflict

Importance: Quantifying the association between the ongoing Russia-Ukraine war and Ukrainians' mental health is crucial for guiding reconstruction and rebuilding efforts in the postwar period. Objective: To examine the association between war exposure and civilians' mental health in both the short and medium term and the potential channels through which these associations occur. Design, Setting, and Participants: This cohort study used data from 7 nationally representative surveys conducted by the Kyiv International Institute of Sociology between December 4, 2015, and July 18, 2022. Six surveys were conducted before the war and one during the ongoing conflict in July 2022. Each survey included approximately 2000 respondents aged 18 to 95 years in 110 localities. Exposure: The magnitude of war damage exposure was represented by an indicator variable set to 1 if an oblast (province) experienced severe war damage and 0 if the damage was moderate at the time of the survey. The classification of severe or moderate damage was based on the economic losses incurred. Main Outcomes and Measures: The main outcomes were respondents' self-reported thoughts of suicide and feelings of helplessness, both represented as dummy variables. Results: The sample included 14 140 respondents, with 3933 (27.8%) exposed to severe war damage and 10 207 (72.2%) to moderate war damage. These included 8174 female respondents (57.8%), with an overall mean (SD) age of 48.9 (16.8) years. The differences in the likelihood of reporting suicidal thoughts and feelings of helplessness between areas with severe vs moderate war damage increased by 2.2 percentage points (β estimate, 0.022 [SE, 0.006]; 95% CI, 0.009-0.036) and 4.9 percentage points (β estimate, 0.049 [SE, 0.019]; 95% CI, 0.009-0.088), respectively. Subsample analyses revealed that male respondents were more vulnerable to suicidal thoughts (β estimate, 0.030 [SE, 0.013]; 95% CI, 0.004-0.056), while female respondents were more at risk of feelings of helplessness (β estimate, 0.063 [SE, 0.024]; 95% CI, 0.013-0.113). Conclusions and Relevance: In this survey study of war exposure, bombing was associated with increased mental health concerns among civilians, including a higher likelihood of suicidal thoughts and feelings of helplessness, which may hinder postwar recovery. These findings suggest that policymakers should prioritize creating job opportunities and ensuring a safe living environment to support citizens' recovery in the aftermath of conflict.