War refugees and veterans have been known to frequently develop neuropsychiatric conditions including depression, post-traumatic stress disorder (PTSD), and anxiety disorders that tend to leave a long-lasting scar and impact their emotional response system. The shear stress, trauma, and mental breakdown from overnight displacement, family separation, and killing of friends and families cannot be described enough. Victims often require years of mental health support as they struggle with sleep difficulties, recurring memories, anxiety, grief, and anger. Everyone develops their coping mechanism which can involve dependence and long-term addiction to alcohol, drugs, violence, or gambling. The high prevalence of mental health disorders during and after the war indicates an undeniable necessity for screening those in need of treatment. For medical health professionals, it is crucial to identify such vulnerable groups who are prone to developing neuropsychiatric morbidities and associated risk factors. It is pivotal to develop and deploy effective and affordable multi-sectoral collaborative care models and therapy, which primarily depends upon family and primary care physicians in the conflict zones. Herein, we provide a brief overview regarding the identification and management of vulnerable populations, alongside discussing the challenges and possible solutions to the same.

Carol Davila University of Medicine and Pharmacy Bucharest Romania

Charles University Hradec Králové Czechia

Eötvös Loránd University Budapest Hungary

Genesis Institute of Dental Sciences and Research Ferozepur Punjab India

Medical University of Łódź Łódź Poland

Medical University of Warsaw Warsaw Poland

National and Kapodistrian University of Athens Athens Greece

National Pirogov Memorial Medical University Vinnytsya Ukraine

Omsk State Medical University Omsk Russian Federation

Riga East University Hospital Riga Latvia

Riga Stradiņš University Riga Latvia

Sherwood Forest Hospitals NHS Foundation Trust Nottinghamshire UK

Teaching University Geomedi LLC Tbilisi Georgia

Victor Babes University of Medicine and Pharmacy Timisoara Timișoara Romania

Zobrazit více v PubMed

Khorram-Manesh A, Burkle FM, Goniewicz K, Robinson Y. Estimating the number of civilian casualties in modern armed conflicts: a systematic review. Front Public Health. 2021;9:765261. doi:10.3389/fpubh.2021.765261 PubMed DOI PMC

Leitenberg M. Deaths in Wars and Conflicts in the 20th Century. Cornell University, Peace Studies Program; 2006.

Stockholm International Peace Research Institute (SIPRI). Sipri Yearbook 2021: Armaments, Disarmament and International Security. Stockholm International Peace Research Institute; n.d.

Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum Rights. 2015;15:29. doi:10.1186/s12914-015-0064-9 PubMed DOI PMC

Mysliwiec V, McGraw L, Pierce R, Smith P, Trapp B, Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. Sleep. 2013;36(2):167-174. doi:10.5665/sleep.2364 PubMed DOI PMC

Inoue C, Shawler E, Jordan CH, Jackson CA. Veteran and Military Mental Health Issues. StatPearls Publishing; 2022. PubMed

Kuzma JM, Black DW. Chronic widespread pain and psychiatric disorders in veterans of the first Gulf war. Curr Pain Headache Rep. 2006;10(2):85-89. doi:10.1007/s11916-006-0017-z PubMed DOI

Kane NS, Anastasides N, Litke DR, et al.. Under-recognition of medically unexplained symptom conditions among US veterans with Gulf war illness. PLoS One. 2021;16(12):e0259341. doi:10.1371/journal.pone.0259341 PubMed DOI PMC

Bhui K, Abdi A, Abdi M, et al.. Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees—preliminary communication. Soc Psychiatry Psychiatr Epidemiol. 2003;38(1):35-43. doi:10.1007/s00127-003-0596-5 PubMed DOI

Murthy RS, Lakshminarayana R. Mental health consequences of war: a brief review of research findings. World Psychiatry. 2006;5(1):25-30. PubMed PMC

Chertoff J. Psychodynamic assessment and treatment of traumatized patients. J Psychother Pract Res. 1997;7(1):35-46. PubMed PMC

Saraiya T, Lopez-Castro T. Ashamed and afraid: a scoping review of the role of shame in post-traumatic stress disorder (PTSD). J Clin Med. 2016;5(11):94. PubMed PMC

Morina N, Akhtar A, Barth J, Schnyder U. Psychiatric disorders in refugees and internally displaced persons after forced displacement: a systematic review. Front Psychiatry. 2018;9:433. doi:10.3389/fpsyt.2018.00433 PubMed DOI PMC

Sigvardsdotter E, Malm A, Tinghög P, Vaez M, Saboonchi F. Refugee trauma measurement: a review of existing checklists. Public Health Rev. 2016;37:10. doi:10.1186/s40985-016-0024-5 PubMed DOI PMC

Hollifield M, Verbillis-Kolp S, Farmer B, et al.. The Refugee Health Screener-15 (RHS-15): development and validation of an instrument for anxiety, depression, and PTSD in refugees. Gen Hosp Psychiatry. 2013;35(2):202-209. doi:10.1016/j.genhosppsych.2012.12.002 PubMed DOI

Macksoud MS, Aber JL. The war experiences and psychosocial development of children in Lebanon. Child Dev. 1996;67(1):70-88. PubMed

Haer R. Children and armed conflict: looking at the future and learning from the past. Third World Q. 2019;40(1):74-91. doi:10.1080/01436597.2018.1552131 DOI

Yehuda R, Lehrner A. Intergenerational transmission of trauma effects: putative role of epigenetic mechanisms. World Psychiatry. 2018;17(3):243-257. doi:10.1002/wps.20568 PubMed DOI PMC

Youssef NA, Lockwood L, Su S, Hao G, Rutten BPF. The effects of trauma, with or without PTSD, on the transgenerational DNA methylation alterations in human offsprings. Brain Sci. 2018;8(5):83. doi:10.3390/brainsci8050083 PubMed DOI PMC

Pierce JB, Kershaw KN, Kiefe CI, et al.. Association of childhood psychosocial environment with 30-year cardiovascular disease incidence and mortality in middle age. J Am Heart Assoc. 2020;9(9):e015326. doi:10.1161/JAHA.119.015326 PubMed DOI PMC

Nygren M, Carstensen J, Koch F, Ludvigsson J, Frostell A. Experience of a serious life event increases the risk for childhood type 1 diabetes: the ABIS population-based prospective cohort study. Diabetologia. 2015;58(6):1188-1197. doi:10.1007/s00125-015-3555-2 PubMed DOI

Kuzminskaite E, Penninx BWJH, van Harmelen AL, Elzinga BM, Hovens JGFM, Vinkers CH. Childhood trauma in adult depressive and anxiety disorders: an integrated review on psychological and biological mechanisms in the NESDA cohort. J Affect Disord. 2021;283:179-191. doi:10.1016/j.jad.2021.01.054 PubMed DOI

Punamäki R-L, Peltonen K, Diab M, Qouta SR. Psychosocial interventions and emotion regulation among war-affected children: randomized control trial effects. Traumatology. 2014;20(4):241-252. doi:10.1037/h0099856 DOI

Yule W, Dyregrov A, Raundalen M, Smith P. Children and war: the work of the Children and War Foundation. Eur J Psychotraumatol. 2013;4:18424. doi:10.3402/ejpt.v4i0.18424 PubMed DOI PMC

Refugees Well School. Teaching recovery techniques + in-service teacher training. Accessed March 30, 2022. https://refugeeswellschool.org/intervention/teaching-recovery-techniques-in-service-teacher-training/

Sarkadi A, Ådahl K, Stenvall E, et al.. Teaching recovery techniques: evaluation of a group intervention for unaccompanied refugee minors with symptoms of PTSD in Sweden. Eur Child Adolesc Psychiatry. 2018;27(4):467-479. doi:10.1007/s00787-017-1093-9 PubMed DOI PMC

Goldstein JS. Fatalities From War and Other Violence, by Age and Gender 1990 in War and Gender: How Gender Shapes the War System and Vice Versa, 1st ed. Cambridge University Press; 2001: 401.

Rehn E, Sirlea EJ. Chapter 3: war and the health of women. In: Jacobs G. (ed.) Women, War, and Peace: The Independent Experts’ Assessment on the Impact of Armed Conflict on Women and Women’s Role in Peacebuilding, 1st ed. United Nations Development Fund for Women; 2002: 31-46. Accessed May 22, 2022. https://www.unfpa.org/sites/default/files/pub-pdf/3F71081FF391653DC1256C69003170E9-unicef-WomenWarPeace.pdf

Shen CC, Yang AC, Hung JH, Hu LY, Chiang YY, Tsai SJ. Risk of psychiatric disorders following pelvic inflammatory disease: a nationwide population-based retrospective cohort study. J Psychosom Obstet Gynaecol. 2016;37(1):6-11. doi:10.3109/0167482X.2015.1124852 PubMed DOI

Khan MR, Kaufman JS, Pence BW, et al.. Depression, sexually transmitted infection, and sexual risk behavior among young adults in the United States. Arch Pediatr Adolesc Med. 2009;163(7):644-652. doi:10.1001/archpediatrics.2009.95 PubMed DOI PMC

WHO UNFPA, UNICEF AMDD. Monitoring Emergency Obstetric Care a Handbook, Vol. 2. World Health Organization; 2009. Accessed May 22, 2022. https://apps.who.int/iris/bitstream/handle/10665/44121/9789241547734_eng.pdf

Sikder SS, Labrique AB, Shamim AA, et al.. Risk factors for reported obstetric complications and near misses in rural northwest Bangladesh: analysis from a prospective cohort study. BMC Pregnancy Childbirth. 2014;14:347. doi:10.1186/1471-2393-14-347 PubMed DOI PMC

Akol AD, Caluwaerts S, Weeks AD. Pregnant women in war zones. BMJ. 2016;353:i2037. doi:10.1136/bmj.i2037 PubMed DOI

Sürücü HA, Besen DB, Duman M, Yeter Erbil E. Coping with stress among pregnant women with gestational diabetes mellitus. J Caring Sci. 2018;7(1):9-15. doi:10.15171/jcs.2018.002 PubMed DOI PMC

Heslehurst N, Brown H, Pemu A, Coleman H, Rankin J. Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews. BMC Med. 2018;16(1):89. doi:10.1186/s12916-018-1064-0 PubMed DOI PMC

Iliadou M, Papadakaki M, Sioti E, et al.. Addressing mental health issues among migrant and refugee pregnant women: a call for action. Eur J Midwifery. 2019;3:9. doi:10.18332/ejm/108626 PubMed DOI PMC

Bałkowiec-Iskra E, Mirowska-Guzel DM, Wielgoś M. Effect of antidepressants use in pregnancy on foetus development and adverse effects in newborns. Ginekol Pol. 2017;88(1):36-42. doi:10.5603/GP.a2017.0007 PubMed DOI

Fear NT, Jones M, Murphy D, et al.. What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. Lancet. 2010;375(9728):1783-1797. doi:10.1016/S0140-6736(10)60672-1 PubMed DOI

Summers A, Leidman E, Pereira Figueira Periquito IM, Bilukha OO. Serious psychological distress and disability among older persons living in conflict affected areas in eastern Ukraine: a cluster-randomized cross-sectional household survey. Confl Health. 2019;13:10. doi:10.1186/s13031-019-0194-0 PubMed DOI PMC

National Institutes on Drug Abuse. Common Comorbidities With Substance Use Disorders Research Report. National Institutes on Drug Abuse; 2020. PubMed

Silver RC, Holman EA, Andersen JP, Poulin M, McIntosh DN, Gil-Rivas V. Mental- and physical-health effects of acute exposure to media images of the September 11, 2001, attacks and the Iraq war. Psychol Sci. 2013;24(9):1623-1634. doi:10.1177/0956797612460406 PubMed DOI

Holman EA, Garfin DR, Silver RC. Media’s role in broadcasting acute stress following the Boston Marathon bombings. Proc Natl Acad Sci USA. 2014;111(1):93-98. doi:10.1073/pnas.1316265110 PubMed DOI PMC

Boers E, Afzali MH, Conrod P. Temporal associations of screen time and anxiety symptoms among adolescents. J Psychiatry. 2020;65(3):206-208. doi:10.1177/0706743719885486 PubMed DOI PMC

Reed P, Romano M, Re F, et al.. Differential physiological changes following internet exposure in higher and lower problematic internet users. PLoS One. 2017;12(5):e0178480. doi:10.1371/journal.pone.0178480 PubMed DOI PMC

Riehm KE, Holingue C, Kalb LG, et al.. Associations between media exposure and mental distress among U.S. adults at the beginning of the COVID-19 pandemic. Am J Prev Med. 2020;59(5):630-638. doi:10.1016/j.amepre.2020.06.008 PubMed DOI PMC

Vermani M, Marcus M, Katzman MA. Rates of detection of mood and anxiety disorders in primary care: a descriptive, cross-sectional study. Prim Care Companion CNS Disord. 2011;13(2):PCC.10m01013. doi:10.4088/PCC.10m01013 PubMed DOI PMC

Ayano G, Demelash S, Yohannes Z, et al.. Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia. Ann Gen Psychiatry. 2021;20(1):10. doi:10.1186/s12991-021-00333-7 PubMed DOI PMC

Henderson C, Evans-Lacko S, Thornicroft G. Mental illness stigma, help seeking, and public health programs. Am J Public Health. 2013;103(5):777-780. doi:10.2105/AJPH.2012.301056 PubMed DOI PMC

Jansen S, White R, Hogwood J, et al.. The “treatment gap” in global mental health reconsidered: sociotherapy for collective trauma in Rwanda. Eur J Psychotraumatol. 2015;6:28706. doi:10.3402/ejpt.v6.28706 PubMed DOI PMC

Carbonell Á, Navarro-Pérez JJ, Mestre MV. Challenges and barriers in mental healthcare systems and their impact on the family: a systematic integrative review. Health Soc Care Community. 2020;28(5):1366-1379. doi:10.1111/hsc.12968 PubMed DOI

World Health Organization (WHO) and Global Mental Health, University of Washington. Ukraine WHO special initiative for mental health situational assessment. 2020. Accessed March 31, 2022. https://cdn.who.int/media/docs/default-source/mental-health/who-special-initiative-country-report—ukraine—2020.pdf?sfvrsn=ad137e9_4

Quirke E, Klymchuk V, Suvalo O, Bakolis I, Thornicroft G. Mental health stigma in Ukraine: cross-sectional survey. Glob Ment Health. 2021;8:e11. doi:10.1017/gmh.2021.9 PubMed DOI PMC

Alexéyeff S. Abuse of psychiatry as a tool for political repression in the Soviet Union. Med J Aust. 1976;1(5):122-123. doi:10.5694/j.1326-5377.1976.tb109281.x PubMed DOI

van Voren R. (ed.). Directorate-General for External Policies of the Union (Directorate B, Policy Department Study): Psychiatry as a Tool for Coercion in Post-Soviet Countries, 1st ed. European Union and European Parliament’s Subcommittee on Human Rights; 2013. Accessed May 22, 2022. https://www.europarl.europa.eu/RegData/etudes/etudes/join/2013/433723/EXPO-DROI_T(2013)433723_EN.pdf

Dolberg P, Goldfracht M, Karkabi K, Bleichman I, Fleischmann S, Ayalon L. Knowledge and attitudes about mental health among older immigrants from the former Soviet Union to Israel and their primary care physicians. Transcult Psychiatry. 2019;56(1):123-145. doi:10.1177/1363461518794233 PubMed DOI

Barghadouch A, Kristiansen M, Jervelund SS, Hjern A, Montgomery E, Norredam M. Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers. Soc Psychiatry Psychiatr Epidemiol. 2016;51(8):1125-1136. doi:10.1007/s00127-016-1260-1 PubMed DOI

Wainberg ML, Scorza P, Shultz JM, et al.. Challenges and opportunities in global mental health: a research-to-practice perspective. Curr Psychiatry Rep. 2017;19(5):28. doi:10.1007/s11920-017-0780-z PubMed DOI PMC

Thornicroft G. Evidence-based mental health care and implementation science in low- and middle-income countries. Epidemiol Psychiatr Sci. 2012;21(3):241-244. doi:10.1017/S2045796012000261 PubMed DOI

Engel CC, Hyams KC, Scott K. Managing future Gulf war syndromes: international lessons and new models of care. Philos Trans R Soc Lond B Biol Sci. 2006;361(1468):707-720. doi:10.1098/rstb.2006.1829 PubMed DOI PMC

Committee on the Science of Changing Behavioral Health Social Norms, Committee on the Science of Changing Behavioral Health Social Norms. Ending Discrimination Against People With Mental and Substance Use Disorders: The Evidence for Stigma Change. National Academies Press; 2016. PubMed

Nott E. Ukraine invasion: why I fear for Ukraine’s healthcare workers. BMJ. 2022;376:o605. doi:10.1136/bmj.o605 PubMed DOI

Gates S, Mokleiv Nygård H, Bahgat K. (eds.). Patterns of attacks on medical personnel and facilities: SDG 3 meets SDG 16. 2017. Accessed March 10, 2022. https://www.prio.org/Publications/Publication/?x=10785

Baker A. Syria’s health crisis spirals as doctors flee. Time. 2014:4.

Mollica RF, Cardozo BL, Osofsky HJ, Raphael B, Ager A, Salama P. Mental health in complex emergencies. Lancet. 2004;364(9450):2058-2067. doi:10.1016/S0140-6736(04)17519-3 PubMed DOI

van Ommeren M, Saxena S, Saraceno B. Mental and social health during and after acute emergencies: emerging consensus? Bull World Health Organ. 2005;83(1):71-75. PubMed PMC

Eisenman D, Weine S, Green B, et al.. The ISTSS/Rand guidelines on mental health training of primary healthcare providers for trauma-exposed populations in conflict-affected countries. J Trauma Stress. 2006;19(1):5-17. doi:10.1002/jts.20094 PubMed DOI