January 2023

Mental health problems of Ukrainian children in terms of Ukrainian-Russian war

The situation

We would like to dedicate this post to World Mental Health Day which takes place on 10th of October and to raise problems of mental state of Ukrainian children who are directly or indirectly affected by war actions.

How does this affect children and young people across Europe?

Since the 24th of February 2022 (date when full scale Russian aggression against Ukraine started) thousands of families with children fled to EU countries and other countries across the world, and to less dangerous regions of Ukraine. Some children continue living with their families abroad but mostly in an atmosphere of disturbing news from home and anxiety of older members of the family. Some of the families fled quickly after the start of the war and children didn’t hear any sounds of explosions or didn’t see any violence but they still can be traumatized by sudden change of their habits and living environment (new accommodation, unfamiliar language, loss of connection with friends and relatives). Some families are back to Ukraine after a few months in another country or have never left and continued living in relatively safe regions where children could have been frightened by the sounds of air raid alerts and explosions, because airstrikes have been and still happening throughout the whole country. And the most vulnerable group are those children whose families had stayed in zones which are situated close to direct war actions and especially those who appeared to be at the occupied territories. The last not only had faced violence very closely but also sometimes became victims themselves and those children who survived violence are at highest risk of developing PTSD and other stress related disorders.

Aside from those groups of children, whose fate is fully or partially known to us, we should also not forget about children who were transferred to russia against the will of their caretakers or under false pretenses. According to the governmental platform ‘Children of war’ [8], more than 12 000 of children were unlawfully displaced to date.

Short and long term effects of ongoing war on children of all ages and their future are yet to be discovered but there are plenty of investigations which analyze mental health of children who have been involved in other war conflicts (Afghanistan, Palestine, Syria, etc.). Let’s find out what we can learn from them.

The conflict in the Balkans is probably one of the most widely studied in recent years. Mental health of survivors of both sides was examined [1,2].

In a community sample of 2,796 children aged between 9 and 14 years, high levels of post-traumatic symptoms and grief symptoms were reported [3]. This was related to the amount and type of exposure. Girls reported more distress than boys.

In the study performed on young people from Cambodia, who were severely traumatized at ages 8 to 12, further evaluation of their mental state during 3-year follow up showed that 48% developed PTSD and 41% suffered from clinical depression [4].

During the last decade a large number of studies have reported high levels of psychosocial problems among children and adolescents in Palestine [1]. One of the studies revealed that the most prevalent types of trauma exposure for children were witnessing funerals, witnessing a shooting, seeing injured or dead strangers and family members injured or killed. Among children living in the area of bombardments, 54% suffered from severe, 33.5% from moderate and 11% from mild or doubtful levels of PTSD. Girls were more vulnerable [5].

Overall, the most common mental disorders reported among children exposed to war conflict are PTSD and depression. Other reported disorders include acute stress reactions, attention deficit hyperactivity disorder, panic disorder, anxiety and sleep disorders. In later childhood, children exposed to conflict-related trauma are predisposed to behavioral problems and conduct/oppositional defiant disorders. In addition, children exposed to armed conflict often experience comorbid psychopathologies, and symptoms of disorder may increase in number with age, with school-age children being the most vulnerable [6].

Also there is a strong relationship between family environment and risk of developing mental problems in children [7]. Parenting practices seem to play a crucial role for children’s psychological wellbeing in a war context, both as a risk and a protective factor.

What can be done?

Children who have suffered from direct and indirect impact of war are in need of psychological support which has to be provided as soon as possible to prevent development of mental disorders further in their lives. This support has to be not only child-oriented but also family-oriented, because the mental well being of older family members is crucial for a child’s comfort. Interventions should be suitable for children of all ages, including early childhood interventions for young children (up to 5 years) [7]. Interventions should focus on modifiable risk factors, such as child cognitive and behavioral deficits or parental caregiving skills and mental health.

Children with such needs can be located in every EU country, so it’s important for pediatric specialists to understand the necessity of transferring such a child to mental health specialists and for mental health specialists to provide them with all the needed support and guidance.

REFERENCES

1. Murthy RS, Lakshminarayana R. Mental health consequences of war: a brief review of research findings. World Psychiatry. 2006 Feb;5(1):25-30. PMID: 16757987; PMCID: PMC1472271.
2.  Westermeyer J. Health of Albanians and Serbians following the war in Kosovo: studying the survivors of both sides of armed conflict. JAMA. 2000;284:615–616.
3. Smith P. Perrin S. Yule W, et al. War exposure and children from Bosnia-Herzegovina: psychological adjustment in a community sample. J Traum Stress. 2002;15:147–156.
4. Kinzie JD. Sack WH. Angell RH, et al. Three-year follow-up of Cambodian young people traumatized as children. J Am Acad Child Adolesc Psychiatry. 1989;28:501–504.
5. Qouta S. Trauma, violence and mental health: the Palestinian experience. Doctoral dissertation; 2003; Amsterdam: Vrije Universiteit;
6. Frounfelker, Rochelle & Islam, Nargis & Falcone, Joseph & Farrar, Jordan & Ra, Chekufa & Antonaccio, Cara & Enelamah, Ngozi & Betancourt, Theresa. (2019). Living through war: Mental health of children and youth in conflict-affected areas. International Review of the Red Cross. 101. 481-506. 10.1017/S181638312000017X.
7. Catani C. Mental health of children living in war zones: a risk and protection perspective. World Psychiatry. 2018 Feb;17(1):104-105. doi: 10.1002/wps.20496. PMID: 29352542; PMCID: PMC5775132.
8. https://childrenofwar.gov.ua/en/

About the authors:

Dr Veronika Letychevska

Paediatrician, paediatric neurologist, Young EAP representative in Ukraine.