When talking about wars , the press headlines tend to pay attention to military advances , the declarations of political leaders and the reactions of the international community . The catastrophic effects of an armed confrontation such as the one experienced in Ukraine, especially since the beginning of the Russian invasion on February 20, 2022 , dominate the media .
The deaths and the destruction of infrastructure are obvious. Rising prices of food and basic necessities , shortages of medical supplies, collapse of the education system, migrations and chaos quickly appear as a consequence of the conflict .
But there is one aspect that usually receives less media attention: the psychological and psychiatric impact on people who experience the war in the first person, and whose mental health will be seriously affected .
With war comes the fear of dying, uncertainty, chaos. It is not only about the impacts of the bombs or the forced exile , but rather that an entire life plan is truncated. Nothing will ever be the same again. Without schools , without health centers , without food , the population is forced to abandon their family, their country, their cultural origin.
Armed conflicts can blow up the projects of an entire generation . At first, the population is subjected to initial stress ; in clinical terms: reactive anxiety . But, over time, and depending on personal experiences and how long the stress lasts, psychiatric disorders can arise that prevent people from remaking their world.
According to a study by the World Health Organization ( WHO ), published in 2019 in the British medical journal The Lancet , one in five people in conflict zones lives with some type of mental disorder , from mild depression to severe depression. psychosis . In the case of Ukraine , we would be talking about eight million people with different mental problems caused by the war .
Thirty- nine countries were represented in the WHO systematic review . Studies published since 1980 were taken into account, all of them agreeing on a harsh reality: 10% of people who live in war situations will have serious mental health problems , while at least another 10% will develop behaviors that make it difficult to day to day, including psychosomatic problems such as insomnia or back and stomach pain .
The study identified five conflict- recurring disorders, present in more than 22% of people who have lived through war : depression , anxiety , post-traumatic stress disorder , bipolar disorder and schizophrenia .
Low spirits and anxiety are two of the most common and natural manifestations in a situation of armed conflict . Family separation , loss of property and employment, interruption of access to basic services and the feeling of anguish due to the anticipation of what is to come are threatening situations .
Reacting with fear , sadness , anguish and worry is completely normal in such a case, and we would not be talking about disorders yet . But if the causes that cause these reactions are prolonged over time, or are intense enough , they can lead to psychiatric disorders that continue to affect people when they are no longer in danger .
Depression and bipolar disorder are part of the group of mood disorders (sometimes called mood disorders ). Its main characteristic is that the person manifests an abnormal mood , which can be very low (as in major depression), excessively high (mania) or different combinations of episodes of high mood with depressed mood (bipolar spectrum disorders).
Major depressive disorder is the most common mood disorder and can be very dangerous . The individual falls into a state of deep sadness , being unable to enjoy , disconnected from any interest, and whose feelings of guilt or uselessness can lead to suicidal behavior .
Anxiety disorders , meanwhile, are characterized by excessive anxiety , heightened worry, and irritability. As with mood disorders, these anxiety conditions cause sleep problems , poor concentration , and fatigue , among other things.
A type of disorder that is very common in wars is post-traumatic stress disorder (PTSD) , which affects both civilians and, frequently, soldiers. The transitory fear that we would all feel after hearing a nearby explosion , for example, lasts for many months, in such a way that the person re-experiences the traumatic event again, suffering nightmares and frights , and developing avoidance behaviors that make their day-to-day difficult. The reminders of the traumatic event can be constant, a real nightmare for those who suffer from them.
Schizophrenia is the fifth most frequent disorder in conflict zones. It is the most common psychotic disorder . It is characterized by the presence, at some point in its development, of delusions and hallucinations that alter the perception of reality . The most frequent delusions are of a persecutory type : the person feels that someone is persecuting him to harm him , whether they are people or institutions. But, on this occasion, such enemies are only “ in his mind ”. Despite their irrationality , delusions are experienced with great anguish , with those who suffer from them unable to distinguish what is real from what is imagined . Disorganized speech and behavior are also often symptoms of schizophrenia.
Unfortunately, in Ukraine it is raining on wet. According to Amnesty International , before the war the situation was already a humanitarian emergency , with an estimated 430,000 children in the Donetsk and Luhansk areas with serious psychological trauma resulting from the conflict between Russia and Ukraine , since 2014. And these are figures prior to the invasion ordered by Putin . The number of minors affected today is much higher.
Some Ukrainian children have known bombing since they were born. And together with the minors, their mothers make up the bulk of those who escape, in a painful exile . Women , often the only ones in charge of children , bear the responsibility of saving the lives of their little ones, and providing them with a minimum of stability outside their borders, while their fathers join the ranks to fight .
And it is that the misfortune has been primed with the Ukraine . The COVID-19 pandemic , together with the lack of access to basic services such as access to water, health or transport, made psychiatric patients especially vulnerable , who fell far down the list of priorities. Those who were already fighting against a mental disorder will now see their illnesses greatly aggravated .
We know more and more about the fatal psychological repercussions of wars . Given the incontestable evidence available , it is urgent that international institutions prioritize the development of mental health services in war contexts , aimed both at those who remain within their borders and at displaced persons who flee from terror in search of a little hope ; who yearn to one day stop surviving, to start living again.
References:
American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders (5th ed.). DOI: 10.1176/appi.books.9780890425596
Charlson, F. 2019. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. The Lancet, 394(10194), 240-248. DOI: 10.1016/S0140-6736(19)30934-1
Garry, S. 2020. Armed conflict and public health: into the 21st century. Journal of Public Health, 42(3), e287-e298. DOI: 10.1093/pubmed/fdz095
Rozanov, V. 2019. Mental health consequences of war conflicts. In Advances in psychiatry (pp. 281-304). Springer, Cham. DOI: 10.1007/978-3-319-70554-5_17
