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The Mental Health of IDPs and the general population in Ukraine

Authors:
Irina Kuznestsova at University of Birmingham
Irina Kuznestsova
Oksana Mikheieva at Gastwissenschaftlerin "UNET" (ZOiS); Europa-Universität Viadrina Frankfurt (Oder)
Oksana Mikheieva
  • Gastwissenschaftlerin "UNET" (ZOiS); Europa-Universität Viadrina Frankfurt (Oder)
Jonathan C Catling at University of Birmingham
Jonathan C Catling
John Round
John Round
John Round
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Abstract

The briefing paper presents a summary of the results of an epidemiological survey in Ukraine conducted in 2018. The research’s overarching objective was to explore the level of mental health issues and the situation surrounding the provision of mental health care utilization as a result of the conflict in eastern Ukraine. A key finding from the survey is that 20% of IDPs and 12% of the general population have moderately severe or severe anxiety. The prevalence of moderately severe or severe depression was 25% of IDPs and 15% of the general population. Within this 16% of IDPs and 8% of the general population are either moderately severely, or severely, anxious and depressed. The recommendations are provided.
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THE$MENTAL$HEALTH$OF$IDPS$AND$THE$GENERAL$POPULATION$IN$UKRAINEBRIEFING$
PAPER$$
BRIEFING$PAPER$
Irina$Kuznetsova,$Oksana$Mikheieva,$Jon$Catling,$John$Round,$Svitlana$Babenko$
January'2019'
SUMMARY$$
The'research’s'overarching'objective'is'to'explore'
the'level'of'mental'health'issues'and'the'situation'
surrounding'the'provision'of'mental'health'care'
utilization'as'a'result'of'the'conflict'in'eastern'
Ukraine.'This'includes'both'Internally'Displaced'
People'(IDPs)'in'Ukraine'and'people'who'were'not'
affected'by'war'(the'general'population)'in'
government'controlled'areas.'A'mixed'
methodology'was'used,'consisting'of'national'
surveys'with'IDPs'(n=1000)'and'the'general'
population'the'(n=1000)'with'a'representative'
sample'reflecting'age,'gender,'and'a'territory.'
Also,'interviews'with'professionals'in'mental'
health'support'and'representatives'of'charities'
and'international'organisations'were'conducted'
(n=21).''
A$key$finding$from$the$survey$is$that$20%$of$IDPs$
and$12%$of$the$general$population$have$
moderately$severe$or$severe$anxiety.$The$
prevalence$of$moderately$severe$or$severe$
depression$was$25%$of$IDPs$and$15%$of$the$
general$population.$Within$this$16%$of$IDPs$and$
8%$of$the$general$population$are$either$
moderately$severely,$or$severely,$anxious$and$
depressed.'The'mental'health'of'women'is'more'
affected'by'displacement'in'respect'to'anxiety'
than'men.'Despite'these'very'high'figures'only'
1.2%'of'IDPs'and'0.3%'of'the'general'population'
self-reported'mental'health'issues'when'
answering'a'survey'question'if'their'day-to-day'
activities'are'limited'because'of'a'health'problem'
or'disability'which'has'lasted,'or'is'expected'to'
last,'at'least'12'months.'In'terms'of'general'health'
problems'18.5%'of'IDPs'have'issues'in'mobility,'
7.4%'significant'problems'with'vision,'6.1%'with'
hearing'and'15%'have'other'impairments'which'
limits'their'day-today'activities.'
'
Only$21.7%$of$IDPs$and$9.5%$of$the$general$
population$who$have$clinically$significant$anxiety$
and$depression$have$tried$to$obtain$mental$
health$support.'Most'of'those'who'receive'
professional'psychological'help,'did'so'only'once.'
Women'sought'psychological'help'slightly'more'
often'than'man'and'most'of'IDPs'and'the'general'
population'were'satisfied'with'the'help'they'
received.'The'most'significant'ways'to'improve'the'
situation'in'relation'to'mental'health'support'are'
not'only'in'establishing'free'psychological'services'
but'also'in'providing'accommodation'and'access'
to'pensions.'
The'most'common'tactics'amongst'IDPs'and'the'
general'population'in'dealing'with'long-term'
anxiety'and'stress'are'talking'with'friends'(63.7%),'
music/films'(45%),'walking/hiking'(35.3%).'Alcohol'
and'smoking'are'popular'ways'to'deal'with'stress'
for'only'16.7%'of'informants,'while'addressing'
psychologists'among'the'least'used'practices'with'
only'2.8%'of'informants'approaching'them.'The'
professionals'who'were'interviewed'noted'
numerous'barriers'stopping'more'people'from'
seeking'help.'These'include,'the'prevalence'of'‘old’'
structures'such'as'the'Soviet'legacy'of'treating'
mental'health'issues'with'inpatient'care,'the'lack'
of'measures'to'prevent'mental'health'issues,'the'
poor'organisation'of'patients’'support'system,'a'
lack'of'specialists'and'affordable'and'qualitative'
programs'for'professional'training'and'obsolete'or'
inaccurate'protocols.'Experts'stressed'that'among'
the'population'there'is'little'recognition'of'the'
importance'of'mental'health,'and'coping'tactics'in'
most'cases'do'not'include'addressing'to'health'
care'professionals'due'to'the'prejudice'and'stigma'
that'surrounds'seeking'such'help.'
'
'
THE$KEY$RECOMMENDATIONS$
1)'Create'stronger'links'between'institutional'
support'and'that'of'the'Non-governmental'sector'
–'with'the'inclusion'of'family'doctors'into'the'
mental'health'provision'sphere'
2)'Introduce'a'licencing'system'for'those'
undertaking'psychological'provision'and'bring'
together'professionals'and'communities'to'
develop'innovative'approaches'in'mental'health'
care'
3)'Improve'the'accessibility'of'services'–'especially'
for'IDPs'
4)'Ensure'that'gender'and'age'specific'approaches'
to'supporting'mental'health'are'developed'and'
well'publicised'–'the'State'to'lead'a'cultural'shift'
on'reducing'stigma'around'mental'health'issues'
$
$
$
$
$
$
FUNDING$
The'survey'and'interviews'with'practitioners'were'
funded'by'the'UK'Wellcome'Trust'Institutional'
Strategic'Support'Fund'for'the'project'‘Mental'
health'and'well-being'of'internally'displaced'
people:'copying'tactics'and'resilience'in'conflict-
affected'societies’,'and'the'project'on'social'
consequences'of'population'displacement'by'Arts'
and'Humanities'Research'Council'UK'with'the'
Partnership'for'Conflict,'Crime'and'Security'
Research'for'their'funding'of'the'research'(grant'
AH/P008305/1).''
If'you'have'any'questions'regarding'this'project'
please'contact'Dr'Irina'Kuznetsova,'School'of'
Geography,'Earth'and'Environmental'Studies,'the'
University'of'
Birmingham'''i.kuznetsova@bham.ac.uk.''
Web-site'www.idpukraine.com''
'
How$to$cite:'Kuznetsova'I.,'Mikheieva'O.,'Catling'
J.,''Round'R.,'Babenko'S.'(2019)'The'Mental'Health'
of'IDPs'and'the'general'population'in'Ukraine:'the'
Results'of'a'National'Survey'and'Interviews'with'
Professionals.'Briefing'paper.''
DOI:'10.5281/zenodo.2585564'''
'
... The prevalence of depression in these displaced people is estimated to be 25%. [20] Our participants from Indonessia and Vietnam were primarily men, which may have led to a lower estimate of depression prevalance given that gender is a recognized risk factor for depression, with women at increased risk. [1,[21][22][23][24] In Vietnam, we detected lower depression prevalence (14%) than was recently described in a study among men living with HIV who inject drugs where 40% reported severe depressive symptoms on the CES-D scale. ...
Depressive symptoms and use of HIV care and medication-assisted treatment among people living with HIV who inject drugs
Article
Full-text available
  • Nov 2020
Objective: Vietnam, Indonesia, and Ukraine have major burdens of injection drug use (IDU) and HIV. We estimated prevalence of depressive symptoms at baseline among people living with HIV (PLWH) who inject drugs, evaluated associations between depression at baseline and 12-month HIV care outcomes and medication-assisted treatment (MAT), and evaluated the study intervention effect by baseline depression subgroups. Design: HPTN 074 was a randomized study. The study intervention included psychosocial counseling, systems navigation, and antiretroviral treatment (ART) at any CD4 count. Methods: Moderate-to-severe depression was defined as a Patient Health Questionnaire (PHQ-9) score of 10 or above. ART and MAT were self-reported. Eligibility criteria were: 18-60 years of age, active IDU, and viral load ≥1000 cp/mL. Adjusted probability differences (aPD) were estimated using inverse-probability weighting. Results: 502 participants enrolled from April 2015-June 2016. Median age was 35 years; 85% identified as men. Prevalence of baseline moderate-to-severe depression was 14% in Vietnam, 14% in Indonesia, and 56% in Ukraine. No evident associations were detected between baseline depression and ART, viral suppression, or MAT at 12-month follow-up. The study intervention improved the proportions of PWID achieving 12-month viral suppression in both the depressed (intervention 44%; standard of care (SOC) 24%; estimated aPD = 25% [95%CI: 4.0%, 45%]) and non-depressed subgroups (intervention 38%; SOC 24%; aPD = 13% [95%CI: 2.0%, 25%]). Conclusions: High levels of depressive symptoms were common among PLWH who inject drugs in Ukraine but were less common in Vietnam and Indonesia. The study intervention was effective among participants with or without baseline depression symptoms.
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