Medical and psychological consequences of war distress in Ukraine: what do we expect and what should be taken into account when providing medical aid?

August 18, 2022
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For the population of Ukraine, in the current conditions of full-scale Russian military aggression, the parallel formation of both individual and collective traumatization takes place, which, accordingly, hurts the level of both individual psychosomatic and public health. The war our society is currently experiencing, combined with the post-Covid situation, is the perfect incubator for the growing public health burden of mental disorders. On average, the prevalence of post-traumatic stress disorders (PTSD) and depression both among refugees and among the population that remained in the conflict zone is comparable and reaches up to 30%. PTSD commonly co-exists with other forms of psychopathology, and 90% of PTSD survivors have at least one co-morbid condition during their lifetime. The most common comorbidities are depression, alcohol abuse or dependence, other anxiety disorders, and psychosomatic illnesses. The intergenerational distress consequences of the war are significant when women and children become particularly vulnerable contingents, which indicates the need for long-term family medical and psychological support and rehabilitation of the affected families. Before the triangle of medical, psychological, and social assistance, the task of a comprehensive restoration of the psychosomatic and psychosocial health of the population of Ukraine appears, where rehabilitation is the most difficult and long-lasting stage. Early diagnostic and treatment interventions can reduce the prevalence of PTSD among trauma survivors. That is why the biggest burden and the biggest responsibility again falls on the shoulders of the primary health care unit. When applying for primary medical care for any reason, it is recommended to assess the presence of signs of PTSD for all survivors of a traumatic event (combatants, displaced persons, refugees, released from captivity, etc.). Management of conditions related to acute stress, PTSD, and grief in non-specialized health care facilities is carried out by a unique guide for providing such care (Assessment and Management of Conditions Specifically Related to Stress: mhGAP Intervention Guide Module, v. 1.0), developed within the framework of the WHO Action Program in the field of mental health. One of the key aspects of modern psychiatry and medical psychology is the search for possible early predictors of the occurrence of PTSD and effective early intervention strategies immediately after the impact of mental trauma. One of the latest developments in the prevention of PTSD is through a short-term psychological intervention in the first few hours after the trauma, namely «cognitive blockade» of traumatic images. In Ukraine, a holistic system of transdiagnostic medico-psychological trauma-focused methods of diagnosis, treatment, prevention, and rehabilitation of the population affected by war distress should be applied, including problem management plus an integrated approach to overcoming stress. An urgent issue has become the training of doctors at all levels of medical care in identifying and effective work with victims and especially effective rehabilitation.

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