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European Journal of Psychotraumatology logoLink to European Journal of Psychotraumatology
. 2026 Sep 28;17(1):2697563. doi: 10.1080/20008066.2026.2697563

Prevalence of exposure to lifetime and war-related traumas, PTSD and complex PTSD in a sample from the Ukrainian general population

Prevalencia de la exposición a traumas a lo largo de la vida y relacionados con la guerra, TEPT y TEPT complejo en una muestra de la población general ucraniana

Emma Facer-Irwin a,CONTACT, Roxanna Short a, Dominic Murphy b, Olga Onuch c, Henry E Hale d, Volodymyr Kulyk e, Natasha Biscoe b, Gwendolyn Sasse f,*, Deirdre MacManus a,*
PMCID: PMC13629818  PMID: 42805235

ABSTRACT

Background: PTSD is a common mental health difficulty in war-affected countries. Despite the ongoing nature of the full-scale Russian invasion of Ukraine, few previous studies have established rates of trauma exposure, PTSD, and CPTSD in representative population samples from across the country.

Objective: To explore both lifetime and war-related trauma experiences since the full-scale Russian invasion in 2022, to estimate the prevalence of ICD-11 PTSD and CPTSD in a representative general adult sample of Ukrainian civilians, and to examine associations of PTSD and CPTSD with sociodemographic and trauma characteristics.

Method: A large telephone survey of a randomized sample of adult residents in regions controlled by the Government of Ukraine (N = 2,504) was conducted. Trauma exposure, war stressors, and ICD-11 PTSD/CPTSD were assessed. Associations between type and number of lifetime and war trauma exposures and PTSD/CPTSD were examined using a series of logistic regression models, adjusted for age and gender.

Results: High levels of both lifetime and war-related traumas were reported. The national prevalence of ICD-11 PTSD was 25.2%, with 6% meeting further criteria for ICD-11 CPTSD, making a combined prevalence of 31.2%. Factors associated with combined PTSD/CPTSD status (compared to no diagnoses) included: female gender (aOR = 1.85, 95% CI 1.23–2.86), age in years (aOR = 1.01, 95% CI 1.01–1.02), past military service (aOR = 1.79, 95% CI 1.32–2.43), greater exposure to cumulative lifetime traumatic events (aOR = 1.16, 95% CI 1.11–1.21) and war stressors (aOR = 1.21, 95% CI 1.18–1.25).

Conclusions: Our estimates confirm that PTSD is a common difficulty among Ukrainian civilians exposed to an active and ongoing war. Lower rates of CPTSD found in our investigation compared to other population estimates may be reflective of the differing ways traumatic stress may manifest in the context of continuous trauma in war zones.

KEYWORDS: Trauma, PTSD, CPTSD, Ukraine, war

HIGHLIGHTS

  • The ongoing full-scale Russian invasion of Ukraine has had a significant psychological impact on civilians, but establishing rates of trauma exposure, PTSD and CPTSD in representative samples of the Ukrainian population has been methodologically challenging.

  • Most civilians reported high levels of exposure to lifetime and war-related traumas, and the estimated prevalence of combined PTSD and CPTSD was found to be high.

  • While findings are largely consistent with past research, lower rates of CPTSD may also indicate that traumatic stress manifests differently in active war contexts where threat is ongoing.

1. Introduction

Global Mental Health Surveys (e.g. WHO World Mental Health Surveys) consistently show that people living in conflict zones are at greater risk of experiencing trauma (e.g. physical violence, forced displacement, loss of loved ones) than populations not experiencing conflict (Benjet et al., 2016). Trauma exposure is associated with a range of mental and physical health disorders as well as substance use disorders (Bisson, 2022). The backdrop of historical trauma (Bezo & Maggi, 2015), the decade-long Russian aggression against Ukraine, and ongoing full-scale invasion since February 2022 have triggered a profound mental health crisis in Ukraine that is expected to worsen as the war continues (Dumchev & Klymchuk, 2024).

One condition commonly studied in war-affected countries and communities is Post-Traumatic Stress Disorder (PTSD). PTSD is a mental health condition that can develop after experiencing a traumatic event, characterized by symptoms like intrusive memories, avoidance of reminders, and heightened arousal (e.g. anxiety, irritability, and sleep difficulties) that last for more than a month and cause significant distress or functional impairment (World Health Organization 2022). The most recent edition of the International Classification of Mental and Behavioural Disorders (ICD 11) recognized the distinct but related disorder of Complex Post-Traumatic Stress Disorder (CPTSD) as a more severe form of PTSD resulting from prolonged or repeated trauma, such as chronic abuse or captivity. In addition to PTSD symptoms, it includes disturbances in emotional regulation, negative self-concept, and difficulties in interpersonal relationships (Cloitre et al., 2018). Known sociodemographic risk factors for the development of PTSD and CPTSD include female gender, younger age, lower educational attainment and socioeconomic status, and being single or having low levels of social support (Brewin et al., 2000; 2017; Kilpatrick et al., 2017) Trauma-related risk factors include younger age at the time of exposure to trauma and exposure to sexually and/or interpersonally violent traumatic events (Brewin et al., 2000; Ozer et al., 2003), with exposure to sexual violence or exposure to early chronic abuse increasing the risk of developing CPTSD over PTSD (Brewin et al., 2017).

As pressures on Ukraine’s health systems mount and uncertainties around the future of humanitarian support grow, understanding the relative prevalence rates of trauma exposure, PTSD, and CPTSD becomes imperative in informing how Ukraine can meet the immediate and long-term psychological needs of its population. The global point prevalence of PTSD in war affected adults is estimated at 26.5% (Hoppen et al., 2021), compared to estimates of 10% or less in general population samples (Frans et al., 2005; Kessler et al., 2017). Amongst Ukrainian samples, estimates of prevalence rates of PTSD have varied widely. An earlier study of internally displaced Ukrainians from before the full-scale Russian invasion found more than one-fifth (21%) to meet diagnostic criteria for PTSD or CPTSD (Shevlin et al., 2018). More recent estimates range from extremely high (50–76%) (Lushchak et al., 2024; Zasiekina et al., 2023) to low (approximately 10%) (Eshel et al., 2023; Lotzin et al., 2023).

Major methodological differences in prior studies, including measurement and sampling decisions, have made establishing rates of trauma exposure and PTSD challenging. Most studies exploring trauma and PTSD amongst Ukrainian samples have solely assessed for PTSD, not CPTSD, and have often focused exclusively on war-trauma exposure, failing to consider measures of other previous trauma exposure and how this might impact rates of PTSD or CPTSD. Furthermore, there have been few opportunities to access representative general population samples from across the entire country. One of the only nationwide studies to investigate PTSD and CPTSD as authoritatively catalogued in the ICD-11 (International Classification of Diseases) amongst war-exposed Ukrainian adults (Karatzias et al., 2023) used a non-generalizable sample of Ukrainian parents, most of whom were relatively young (mean 37 years) and living in an urban area. Younger age (Kongshøj & Berntsen, 2023; Wild et al., 2020) has been found to significantly increase the risk of PTSD development, including in Ukrainian war-exposed adult samples (Ben-Ezra et al., 2024), and parenting of a child during war-time is a significant stressor which may inflate the severity of PTSD symptoms (Eltanamly et al., 2021). This suggests that the prevalence rates for PTSD and CPTSD identified in this previous study (Karatzias et al., 2023) (25.9% and 14.6%, respectively) might be over-estimates and not generalizable to the wider population.

Addressing these gaps in our current understanding, the aims of the current study were to: (1) estimate the prevalence of PTSD and CPTSD as defined in the ICD-11 in a representative general adult sample of Ukrainian civilians; (2) to examine how this varies by sociodemographic characteristics; (3) to explore rates of lifetime trauma and war trauma exposure; and (4) to examine associations between type and number of lifetime and war trauma exposures and PTSD/CPTSD.

2. Method

2.1. Study design

Data were collected as part of a wider national telephone survey project ‘The effect of Russia’s war on attitudes, identities, and institutions in Ukraine’ (short title: KonKoop Trauma Study). The study was approved by a joint interinstitutional ethics committee set up by four German research institutes (Leibniz-Institute for Regional Geography; Leibniz-Institute for Agricultural Development in Transition Economies; Leibniz-Institute for the History and Culture of Eastern Europe; Centre for East European and International Studies), and followed the principles set out in the Helsinki Declaration. Wave one, analysed here, survey (CATI) fieldwork took place between 7 and 31 May 2024 and was carried out by the Kyiv International Institute of Sociology (KIIS) on behalf of the project team. The protocol included measures of lifetime trauma exposure, war-trauma exposure, and ICD-11 PTSD/CPTSD. All participants provided informed verbal consent.

2.2. Participants and recruitment

Potentially eligible to be surveyed were all adults (18 years and older) who owned a mobile phone (more than 96% of the adult population of Ukraine) and resided (at the time of data collection) in one of the country’s 24 regions (oblasts) and Kyiv City, excluding territory not controlled by the Government of Ukraine (i.e. controlled by Russian military forces). Sample eligibility thus extended to Ukraine’s large internally displaced population (people who fled their homes but remained inside government-controlled areas of Ukraine or escaped to such areas) and people in lands initially occupied by Russia and then liberated, but not to people outside Ukrainian borders or in Russian-occupied territories at the time of the survey. Eligibility also included people in government-controlled Ukraine who had left the military or were on leave at the time the survey was fielded. The actual sample was constructed by randomly generating phone numbers within each of Ukraine’s main service providers’ three-digit prefixes (sample strata), with the quantity of people called within each stratum proportional to known prefix distribution patterns. The final sample of respondents who completed a telephone interview was N = 2504, coming from all regions of Ukraine except for the Crimean Peninsula and Luhanska Oblast, reflecting a response rate of 11.3%, not untypical of survey research in Ukraine before 2022. Thus, the survey sample is nationally representative with respect to the 18 + population who at the time of the survey resided in government-controlled Ukrainian territory.

2.3. Procedures

Survey questionnaires were translated into Ukrainian and Russian, the country’s two main languages, in consultation with the research team. Questionnaires were pre-tested on a roughly representative sub-sample (n = 20) of the target population (namely adults living in urban and rural settlements in Kyiv and nine oblasts of Ukraine speaking Ukrainian and Russian), prior to survey fieldwork commencing. Surveys were administered by local interviewers who had been trained by the team. Prior to starting the interview, respondents were provided with a detailed explanation of the purpose of the survey and detailed clarification of the survey procedure, and informed verbal consent was obtained before proceeding with the questionnaires. As the focus of this survey was on traumatic experiences, a practicing psychologist with experience in trauma was involved in interviewer training, providing general guidelines for how to approach sensitive material. During data collection, interviewers had the opportunity to ask questions of the psychologist and consult with them about difficult cases. All interviewers had supervisors who carried out quality control of interviews through monitoring and verification of a selected subsample of respondents. A trauma informed approach was followed throughout, and procedures were in place to manage participants who experienced distress. Mental health resources and signposting locally and nationally were provided. The average length of interviews was 27 min.

3. Measures

3.1. Demographic information

A self-developed demographic questionnaire collected data on sociodemographic characteristics of participants in line with previous survey research carried out in Ukraine by some of the authors (https://ibifukraine.com; https:/mobiliseproject.com). Variables included in the analysis for this paper were: age (in years), gender (male vs female), relationship status (single vs married or in a relationship), education status (secondary or below vs incomplete or full higher education), macro region (West, Centre, South, East), survey language chosen by respondents (Ukrainian vs Russian), and nationality (Ukrainian, Russian, other).1

3.2. Exposure to traumatic events

The Life Events Checklist for DSM-5 (LEC-5; Weathers et al., 2013) includes descriptions of 16 events that cover a broad range of potentially traumatic experiences, including accidents, interpersonal violence, sexual violence, and natural disasters. Item 17 is an additional item for participants to endorse the experience of any other very stressful or traumatic event. Participants were asked to consider exposure at varying levels (e.g. directly experienced, witnessed, learned about, or experienced as part of the work) and across their lives (i.e. childhood and adulthood). Items were coded as present if they were reported to have been experienced at any exposure level. A cumulative LEC score was calculated by summing the number of endorsed items (out of 17). In the current study, the LEC-5 was adapted to include specific clarification as to whether each event occurred in (a) childhood and/or adulthood; (b) before and/or during the first phase of Russia’s war (i.e. between 2014 and 2022); or (c) before and/or during Russia’s all-out invasion of Ukraine (post-February 2022), with individuals permitted to endorse multiple time periods. Cumulative LEC scores were calculated for events that occurred in childhood, adulthood, and pre- or post-February 2022, respectively. LEC items were further grouped by type (according to Weis et al., 2022) into victimization, predominant death threat, and accidental/injury events, and the presence/absence of these types of events was recorded. We reported the prevalence of traumatic events in different time periods including lifetime, childhood, adulthood, pre-2022, and post-2022 traumatic events.

3.3. War trauma exposure

A person’s exposure to war trauma was assessed using a scale developed for the purpose of this study. It consisted of 20 items, adapted from a previous study (Karatzias et al., 2023). War traumas assessed amongst participants included: experiences of serving in armed forces; being captured or ill-treated by Russian forces; physical injury as a result of war; being displaced from home; witnessing ill-treatment, serious injury, suffering, or death; having loved ones who were injured or killed; and deprivation as a result of war (e.g. shelter, food, heating). For the first two items (‘Have you served in the Ukrainian Armed Forces or territorial defence?’, ‘Have any of your loved ones been serving with the Ukrainian Armed Forces or territorial defence?’), individuals were asked to clarify in which service they and/or their loved one(s) served, and whether or not they and/or their loved one(s) served on the front line. A cumulative war events score was calculated by summing the number of endorsed items (out of 20).

3.4. PTSD and complex PTSD

The International Trauma Questionnaire (ITQ; Cloitre et al., 2018) consists of 18 items, six each for the PTSD and DSO (Disturbances of Self Organization) symptom clusters, plus six functional impairment items (three for PTSD and three for DSO). As per administration of the ITQ, participants were asked to assess PTSD symptoms in relation to a self-reported index traumatic event. Items are rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely), with scores of 2 (Moderately) or more indicating the clinical threshold of each symptom. A probable diagnosis of PTSD requires endorsement of one symptom from each of the three symptom clusters (re-experiencing, avoidance, and threat) and functional impairment in at least one area. A probable diagnosis of CPTSD must first meet the criteria for PTSD, plus endorsement of at least one symptom from each of the three DSO symptom clusters and associated functional impairment. Missing data for approximately 1.5% of responses was identified, coded by interviewers as either ‘Hard to say’ (i.e. could not pick between two numerical items) or ‘refuse to answer’. Given that a response of ‘Hard to say’ suggested some level of symptom presence, we opted to treat this response as a substantively meaningful middle-range response rather than a ‘non-response’, so in the reported analysis we re-coded them as ‘Moderately’ for all PTSD and DSO items, in order to avoid risk of underestimation. Sensitivity analysis showed that the number of responses affected by this coding change were minimal, and primary associations remained unchanged if we simply dropped them. Respondents who did not identify or disclose an index trauma as outlined by the ITQ (n = 879, 35%) were also ‘screened out’ and not asked the six PTSD items; all respondents were asked the six DSO items, but were counted as ‘no disorder’.

3.5. Statistical analysis

When generalizing findings from our particular sample to Ukraine’s nationwide population, we weighted the sample to known population parameters on region, pre-war urban-rural settlement type, sex, and age. We used unweighted frequencies and weighted proportions (and their respective 95% confidence intervals [CI]) to describe categorical variables, stratified by ITQ diagnosis (PTSD, CPTSD, vs no diagnosis). Counts and other numerical variables were summarized using unweighted medians and inter-quartile ranges, again stratified by ITQ diagnosis.

We also estimated a series of binary logistic regression models (each adjusting for age and gender) to examine associations between socio-demographic variables (age, gender, language of survey, nationality, relationship status, education status, service status, and displaced from home due to war), cumulative lifetime traumatic events, the presence of any accidental/injury events, the presence of any victimization events, the presence of any predominant death threat events, cumulative war stressors, and: (a) PTSD and/or CPTSD vs no disorder; and (b) CPTSD vs PTSD. We report crude and adjusted odds ratios (aOR) for the binary logistic models, each with their respective 95% confidence intervals (CI) and p-values.

4. Results

4.1. Characteristics of sample

The final sample of 2,504 individuals was 54.1% female (N = 1,384), of primarily Ukrainian nationality (N = 2,316, 88.5%), with a median age of 54 years (IQR 39–65) (Table 1). Approximately a third of the sample (29.8%) were aged 60 + . The majority of participants were in a relationship (62.2%) and had completed some higher education (57.1%). Over a third of the sample resided in the centre of Ukraine (35.3%, N = 1,007). A quarter of the sample lived in the south of Ukraine (25.5%, N = 618), and a further 13% (N = 389) resided in the east; areas that have both generally been exposed to more war conflict. Approximately a third of the sample (33.3%) had been displaced from their home due to the war.

Table 1.

Descriptives of the sample, by PTSD/CPTSD status (N = 2,504).

    Total (N = 2,504) PTSD (N = 647) CPTSD (N = 146) No diagnosis (N = 1,711)
    N % (95% CI)* N % (95% CI)* N % (95% CI)* N % (95% CI)*
Sex                
  Female 1,384 54.1 (51.2–57.0) 435 66.1 (62.7–69.4) 102 62.5 (34.0–84.3) 847 49.0 (43.4–54.6)
  Male 1,120 45.9 (43.0–48.8) 212 33.9 (30.6–37.3) 44 37.5 (15.7–66.0) 864 51.0 (45.4–56.7)
Age group                
  18–29 209 14.5 (13.5–15.5) 26 7.7 (2.9–18.9) 12 17.3 (7.2–35.8) 171 16.8 (13.7–20.3)
  30–44 625 29.9 (28.4–31.4) 154 28.8 (20.6–38.6) 35 27.0 (17.5–39.3) 436 30.6 (26.4–35.1)
  45–59 714 25.8 (25.0–26.5) 183 27.3 (19.7–36.6) 44 27.8 (14.2–47.2) 487 25.0 (22.6–27.7)
  60+ 956 29.8 (27.9–31.8) 284 36.2 (28.8–44.3) 55 28.0 (17.7–41.2) 617 27.7 (25.4–30.1)
Language of Survey                
  Ukrainian 2,153 88.5 (58.7–97.7) 557 88.0 (52.9–97.9) 118 84.6 (27.9–98.7) 1478 89.0 (63.2–97.5)
  Russian 351 11.5 (2.4–41.3) 90 12.0 (2.1–47.1) 28 15.4 (1.3–72.2) 233 11.0 (2.5–36.8)
Native language                
  Ukrainian 1,906 80.5 (50.7–94.3) 512 83.1 (54.6–95.3) 113 83.0 (38.6–97.4) 1281 79.2 (48.4–94.0)
  Russian 350 11.9 (3.6–32.8) 77 9.9 (2.7–30.5) 17 9.1 (0.9–53.5) 256 13.0 (3.9–35.6)
  Both 195 6.9 (2.1–20.4) 49 6.3 (2.2–16.9) 13 7.9 (2.0–26.2) 133 7.0 (2.0–21.6)
  Other 20 0.7 (0.2–2.2) 5 0.7 (0.1–8.8) 0 0.0 (0.0–0.0) 15 0.8 (0.3–2.5)
  Missing 33   4   3   26  
Nationality                
  Ukrainian 2,316 95.8 (92.7–97.7) 611 96.0 (93.4–97.6) 136 96.1 (49.8–99.8) 1569 95.8 (92.9–97.5)
  Russian 63 2.0 (0.6–6.3) 18 2.5 (0.7–8.9) 4 2.0 (0.1–43.5) 41 1.8 (0.6–5.1)
  Other 57 2.2 (2.0–2.4) 11 1.6 (0.7–3.7) 3 1.9 (0.1–23.0) 43 2.5 (2.1–2.9)
  Missing 68   7   3   58  
Relationship status                
  Single 944 37.8 (30.2–46.0) 238 34.6 (27.5–42.6) 79 56.2 (50.0–62.1) 627 37.3 (29.5–46.0)
  In relationship 1,545 62.2 (54.0–69.8) 408 65.4 (57.4–72.6) 66 43.9 (37.9–50.0) 1071 62.7 (54.0–70.6)
  Missing 15   1   1   13  
Education status                
  Secondary or below 1,077 42.9 (36.7–49.3) 307 48.4 (42.9–54.0) 78 48.7 (26.5–71.4) 692 40.4 (34.2–46.9)
  Incomplete or full higher 1,425 57.1 (50.7–63.3) 340 51.6 (46.1–57.1) 68 51.3 (28.6–73.5) 1017 59.6 (53.1–65.8)
  Missing 2   0   0   2  
Macro region                
  West 490 26.4 (0.5–96.4) 122 26.7 (0.5–96.3) 15 13.4 (0.2–92.3) 353 27.4 (0.5–96.6)
  Centre 1,007 35.3 (0.8–97.5) 231 30.7 (0.6–96.9) 63 47.4 (1.3–98.5) 713 36.0 (0.8–97.6)
  South 618 25.3 (0.5–96.2) 171 26.9 (0.5–96.4) 31 19.1 (0.3–95.0) 416 25.2 (0.4–96.2)
  East 389 13.0 (0.2–91.3) 123 15.7 (0.3–92.9) 37 20.1 (0.3–95.4) 229 11.4 (0.2–90.1)
Service                
  Did not serve 2359 92.5 (89.4–94.8) 616 93.8 (88.6–96.8) 136 85.2 (64.0–94.9) 1607 92.7 (89.1–95.2)
  Armed forces 89 4.1 (3.1–5.3) 15 2.9 (1.6–5.2) 7 5.5 (0.8–30.0) 67 4.4 (3.3–5.9)
  Territorial defence 56 3.4 (1.6–7.0) 16 3.3 (1.2–8.6) 3 9.3 (0.9–54.7) 37 2.9 (1.6–5.2)
Displaced from home due to war                
  No 1646 66.7 (37.9–86.8) 403 62.5 (31.5–85.8) 86 56.5 (27.2–81.9) 1157 69.2 (41.1–87.8)
  Yes 858 33.3 (13.2–62.1) 244 37.5 (14.2–68.5) 60 43.5 (18.2–72.8) 554 30.8 (12.2–58.9)
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Note: * weighted percentage and 95% confidence intervals (CI). Weights are based on pre-war macro-region, city/village, gender, and age group.

4.2. Estimated prevalence of PTSD/CPTSD

The combined national estimated prevalence of PTSD and CPTSD across the full sample, we find, was 31.2% (95% CI 26.37–36.46). The estimated prevalence of PTSD was 25.2% (95% CI 20.4–30.7, including 647 of our respondents). Substantially fewer participants met the diagnostic threshold for CPTSD, whose national prevalence we estimate to be 6.0% (95% CI 2.8–12.3; 146 respondents). The probable prevalence of PTSD was higher among women, 30.8% (95% CI 25.5–36.7; N = 435), than among men, 18.6% (95% CI 14.0-24.2; N = 212).

4.3. Prevalence of trauma exposure(s), war stressors

The overall estimated prevalence of trauma exposure across the sample was high. The presence of at least one traumatic event in adulthood was endorsed by 92.9% of the sample (95% CI 88.7–95.7). Childhood traumas were less commonly reported, but still highly prevalent – 45.2% (95%CI 41.8–48.6) indicated the presence of any childhood trauma. The estimated prevalence of individuals who reported experiencing traumatic events after the full-scale Russian invasion (post-2022) was found to be only slightly higher than those who reported experiencing events pre-2022 (79% compared to 77%).

The most common type of lifetime traumatic experience was a fire or explosion, endorsed by over half the sample (54.7%, 95% CI 17.0–34.1) (Table 2). Other frequently reported traumatic exposures were: severe human suffering (51.7%, 95% CI 47.7–55.8), transportation accident (43.3%, 95% CI 37.3–49), life threatening illness or injury (40.8%, 95% CI 35.5–46.3), and combat/warzone exposure (39.0%, 95% CI 19.8–62.3). Thirty percent endorsed exposure to a physical assault. Approximately a quarter of the same reported exposure to a sudden violent or accidental death (witnessing, or occurring to someone close to them). Conversely, the prevalence of sexual traumas was relatively low – only 6.4% (95% CI 4.8–8.5, N = 170) reported experiences of sexual assault and 4.7 (95% CI 3.8–5.9, N = 103) reported any other unwanted or uncomfortable sexual experience.

Table 2.

Lifetime trauma events prevalence by PTSD and CPTSD.

  None (N = 1,711) PTSD (N = 647) CPTSD (N = 146) Total (N = 2,504)
  N % (95% CI) N % (95% CI) N % (95% CI) N % (95% CI)
Natural disaster 391 23.9 (14.1–37.6) 155 24.8 (18.7–32.2) 37 30.8 (18.1–47.2) 583 24.5 (17.0–34.1)
Fire or explosion 887 52.2 (37.5–66.5) 398 59.6 (32.9–81.6) 88 61.9 (44.2–76.9) 1373 54.7 (36.8–71.4)
Transportation accident 732 44.0 (38.1–50.0) 245 39.9 (32.8–47.5) 68 50.0 (25.3–74.7) 1045 43.3 (37.3–49.5)
Serious accident 417 23.9 (18.4–30.3) 170 25.6 (23.0–28.3) 51 31.7 (17.9–49.8) 638 24.8 (21.1–28.8)
Exposure to toxic substance 306 16.2 (10.5–24.2) 152 22.6 (13.3–35.6) 36 22.6 (8.2–48.8) 494 18.2 (11.3–28.1)
Physical assault 462 27.2 (24.1–30.4) 229 37.3 (30.1–45.0) 55 36.6 (32.8–40.6) 746 30.3 (28.1–32.6)
Assault with weapon 264 15.3 (12.6–18.5) 120 19.2 (17.0–21.6) 30 19.8 (10.5–34.2) 414 16.6 (13.4–20.3)
Sexual assault 101 5.5 (4.6–6.6) 48 7.1 (3.1–15.3) 21 13.8 (6.5–27.1) 170 6.4 (4.8–8.5)
Other unwanted or uncomfortable sexual experience 56 3.3 (2.6–4.3) 33 5.4 (2.9–10.0) 14 17.9 (5.8–43.5) 103 4.7 (3.8–5.9)
Combat Exposure to a warzone 628 36.1 (19.2–57.4) 285 44.2 (20.4–71.1) 69 49.4 (26.5–72.5) 982 39.0 (19.8–62.3)
Captivity 130 8.1 (6.4–10.2) 64 10.0 (5.4–17.8) 18 18.1 (5.5–45.8) 212 9.2 (7.4–11.3)
Life–threatening illness or injury 645 37.0 (32.2–42.0) 306 48.6 (33.8–63.6) 74 51.5 (29.2–73.3) 1025 40.8 (35.5–46.3)
Severe human suffering 810 44.8 (42.2–47.5) 442 66.9 (61.7–71.7) 98 67.2 (48.9–81.5) 1350 51.7 (47.7–55.8)
Sudden violent death 436 24.0 (19.6–29.1) 226 34.8 (31.3–38.5) 57 45.4 (31.2–60.4) 719 28.0 (24.5–31.8)
Sudden accidental death 398 24.4 (18.5–31.3) 172 26.6 (25.0–28.2) 40 27.6 (17.5–40.7) 610 25.1 (21.2–29.5)
Serious injury, harm, or death you caused to someone else 46 2.6 (2.5–2.8) 16 2.5 (0.7–8.0) 8 6.9 (2.6–17.2) 70 2.8 (1.8–4.4)
Bullying 319 21.2 (19.2–23.3) 135 23.0 (19.5–26.9) 50 40.1 (19.3–65.1) 504 22.8 (20.7–24.9)
Any other very stressful event 712 41.1 (37.1–45.3) 385 57.8 (54.4–61.1) 91 63.5 (45.0–78.8) 1188 46.7 (41.9–51.5)
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Participants were almost all Ukrainian civilians, with only a small proportion reporting having served in the armed forces (4.1%, n = 89) or territorial defence (3.4%, n = 56). Despite this, war stressors were overwhelmingly endorsed (Table 3). Half reported having a loved one serving on the front line (51.1%, n = 1224). Over 70% had experienced shelling in their neighbourhoods, and 65% reported having witnessed physical destruction caused by the war. Participants reported multiple war stressors related to their family and loved ones, including them being displaced/missing (48%, n = 1260), injured or killed in the war (45.3%, n = 1099), or living under Russian occupation (34.7%, n = 912).

Table 3.

Prevalence of war stressors by PTSD and CPTSD (N = 2,504).

      No diagnosis PTSD CPTSD Total
Item Description N % (95% CI)* N % (95% CI)* N % (95% CI)* N % (95% CI)*
1 Service                  
   Did not serve 1,607 92.7 (89.1–95.2) 616 93.8 (88.6–96.8) 136 85.2 (64.0–94.9) 2,359 92.5 (89.4–94.8)
   Armed Forces 67 4.4 (3.3–5.9) 15 2.9 (1.6–5.2) 7 5.5 (0.8–30.0) 89 4.1 (3.1–5.3)
   Territorial Defence 37 2.9 (1.6–5.2) 16 3.3 (1.2–8.6) 3 9.3 (0.9–54.7) 56 3.4 (1.6–7.0)
  Served on front line 51 3.4 (2.0–5.7) 16 3.6 (1.2–10.2) 6 4.9 (0.6–29.4) 73 3.5 (2.1–6.0)
2 Loved one served 1,003 60.8 (52.4–68.6) 417 65.8 (57.1–73.6) 85 65.4 (42.4–82.9) 1,505 62.4 (54.0–70.0)
  Loved one served on front line 795 48.6 (38.3–59.0) 356 56.5 (48.6–64.0) 73 57.0 (40.2–72.4) 1,224 51.1 (42.2–59.8)
3 Lived under Russian occupation 160 9.2 (2.8–25.8) 95 14.4 (4.6–36.8) 25 13.9 (4.6–35.1) 280 10.8 (3.5–28.9)
4 Loved ones lived under Russian occupation 570 31.9 (15.5–54.3) 277 41.1 (21.9–63.5) 65 40.1 (23.3–59.7) 912 34.7 (17.5–57.0)
5 Captured/ill–treated by Russian Forces 32 1.8 (0.6–5.2) 36 5.6 (2.1–14.1) 7 3.5 (1.2–9.9) 75 2.9 (1.0–7.9)
6 Loved ones captured/ill–treated by Russian Forces 302 19.1 (16.6–21.9) 180 27.6 (20.4–36.2) 38 30.9 (14.2–54.8) 520 22.0 (18.6–25.7)
7 Neighbourhood hit by shelling 1,265 70.1 (40.5–89.0) 519 75.8 (35.3–94.7) 113 70.1 (31.3–92.4) 1,897 71.5 (40.4–90.3)
8 Witnessed physical destruction caused by the war 1,125 62.9 (32.9–85.4) 475 70.8 (33.7–92.1) 105 64.1 (25.0–90.5) 1,705 65.0 (34.1–86.9)
9 Physically injured in the war 48 2.7 (1.2–6.2) 35 5.3 (2.4–11.1) 7 5.2 (0.5–35.8) 90 3.5 (1.7–7.2)
10 Loved ones injured/killed in war 694 41.5 (38.6–44.5) 329 52.8 (43.1–62.3) 76 58.0 (45.6–69.5) 1,099 45.3 (41.1–49.7)
11 Displaced from home/loved ones 554 30.8 (12.2–58.9) 244 37.5 (14.2–68.5) 60 43.5 (18.2–72.8) 858 33.3 (13.2–62.1)
12 Loved ones displaced/gone missing 802 44.0 (25.7–64.1) 368 55.4 (32.4–76.2) 90 66.1 (49.0–79.8) 1,260 48.2 (28.5–68.4)
13 Witnessed ill–treatment, serious injury and suffering of civilians 419 24.2 (13.8–39.0) 237 37.0 (22.5–54.4) 61 36.6 (21.3–55.1) 717 28.2 (16.4–44.0)
14 Witnessed or touched dead bodies/body parts as a result of war 182 10.8 (8.8–13.1) 124 20.9 (13.9–30.3) 25 17.5 (6.0–41.2) 331 13.7 (9.8–18.9)
15 Suffered significant deprivation due to war 834 47.5 (34.6–60.7) 416 64.4 (42.5–81.6) 98 70.4 (53.5–83.1) 1,348 53.1 (37.5–68.2)
16 Done harm to someone/killed someone in the war 46 2.8 (2.4–3.4) 17 4.4 (1.5–12.3) 3 1.8 (0.5–6.6) 66 3.2 (2.2–4.5)
17 Experienced negative attitudes from people because of nationality/language/residence 268 15.5 (9.1–25.0) 149 24.5 (18.0–32.4) 44 35.0 (23.8–48.1) 461 18.9 (12.5–27.6)
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Note: * weighted percentage and 95% confidence intervals (CI). Weights are based on pre-war macro-region, city/village, gender, and age group Cumulative war stressors (items 1–17) median (IQR): No diagnosis 5 (3–7); PTSD 6 (4–8) CPTSD 6 (4–8) PTSD/CPTSD vs none: OR = 1.16, 95%CI 1.12–1.20, p < .001; aOR = 1.21, 95%CI 1.18–1.25, p < .001 CPTSD vs PTSD: OR = 1.03, 95%CI 1.04, 95%CI 0.94–1.13, p = .392; aOR = 1.01, 95%CI 0.86–1.18, p = .905.

4.4. Factors associated with PTSD and CPTSD

Several factors were associated with probable PTSD/CPTSD (i.e. combined status vs no diagnosis). Individuals meeting the criteria for PTSD/CPTSD tended to be female (vs male: aOR = 1.85, 95% CI 1.23–2.86), older (aOR =   1.01, 95% CI 1.01–1.02), with a lower level of educational attainment (up to secondary education vs higher: aOR = 1.28, 95% CI 1.06–1.54) (Table 4). These individuals were also more likely to have reported having served in the military (vs not: aOR = 1.79, 95% CI 1.32–2.43), or to have been displaced as a result of the war (vs not: aOR =   1.51, 95% CI 1.28–1.78). There were no significant associations with variables such as language or nationality and combined PTSD/CPTSD.

Table 4.

Associations between socio-demographic factors and: PTSD/CPTSD vs no disorder (N = 2,504); and CPTSD vs PTSD (N = 793).

    PTSD/CPTSD vs none (N = 2,504) CPTSD vs PTSD (N = 793)
    OR (95%CI) p aOR (95%CI)* p OR (95%CI) p aOR (95%CI)* p
Sex                
  Female Ref — Ref — Ref — Ref —
  Male 0.51 (0.33–0.77) .014 0.54 (0.35–0.81) .018 1.17 (0.33–4.12) .713 1.10 (0.35–3.43) .816
Age 1.01 (1.01–1.02) <.001 1.01 (1.01–1.02) .002 0.99 (0.95–1.03) .368 0.99 (0.96–1.02) .348
Language of Survey                
  Ukrainian Ref – Ref – Ref – Ref –
  Russian 1.18 (0.55–2.55) .544 1.13 (0.47–2.70) .694 1.33 (0.42–4.27) .489 1.40 (0.45–4.34) .414
Nationality                
  Ukrainian Ref – Ref – Ref – Ref –
  Russian 1.34 (0.56–3.21) .361 1.12 (0.49–2.54) .688 0.81 (0.03–19.25) .845 0.91 (0.03–23.76) .932
  Other 0.65 (0.37–1.17) .104 0.73 (0.40–1.32) .191 1.19 (0.04–39.04) .885 1.17 (0.03–41.50) .895
Relationship status                
  Single 1.06 (0.89–1.26) .350 0.99 (0.82–1.19) .860 2.42 (1.35–4.34) .017 2.63 (1.76–3.94) .005
  In relationship Ref – Ref – Ref – Ref –
Education status                
  Secondary or below Ref – Ref – Ref – Ref –
  Incomplete or full higher 0.72 (0.62–0.84) .007 0.78 (0.65–0.94) .024 0.99 (0.36–2.70) .971 0.89 (0.34–2.32) .731
Served                
  No Ref – Ref – Ref – Ref –
  Yes 1.07 (0.76–1.52) .556 1.79 (1.32–2.43) .009 2.63 (0.48–14.54) .170 2.55 (0.91–7.14) .062
Displaced                
  No Ref – Ref – Ref – Ref –
  Yes 1.41 (1.15–1.73) .013 1.51 (1.28–1.78) .004 1.31 (0.50–3.43) .435 1.22 (0.52–2.87) .513
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*Odds Ratio (OR) adjusted for age and gender; standard errors are adjusted for participant weights and macro-region.

Individuals with PTSD/CPTSD (vs those with no disorder) tended to have experienced a greater number of lifetime trauma events (aOR =   1.16, 95% CI 1.11–1.21) (Table 5). These individuals had greater odds of having experienced victimization (vs not: aOR = 1.99, 95%CI 1.69–2.34), or predominant death threats (vs not: aOR = 2.35, 95% CI 1.49–3.71), but not events involving accidents or injuries (Table 5). Greater exposure to cumulative lifetime war stressors significantly increased the odds of having PTSD/CPTSD (aOR = 1.21, 95% CI 1.18–1.25) (Table 3).

Table 5.

Associations between lifetime trauma events and: PTSD/CPTSD vs no disorder (N = 2,504); and CPTSD vs PTSD (N = 793).

    No disorder (N = 1,711) PTSD/CPTSD (N = 793) PTSD/CPTSD vs none PTSD (N = 647) CPTSD (N = 146) CPTSD vs PTSD
    Mdn (IQR) Mdn (IQR) OR aOR† Mdn (IQR) Mdn (IQR) OR aOR†
Total traumas 4 (2–6) 5 (3–8) 1.12 (1.07–1.18)** 1.16 (1.11–1.21)** 5 (3–8) 6 (3–8) 1.09 (0.96–1.23) 1.08 (0.98–1.19)
                   
    N (%) N (%) N (%) N (%)
Trauma types (endorsed)                
  Accident/injury 1395 (81.5) 692 (87.3) 1.40 (0.74–2.67) 1.62 (0.92–2.87) 562 (86.9) 130 (89.0) 1.18 (0.57–2.43) 1.11 (0.58–2.11)
  Victimization 510 (29.8) 311 (39.2) 1.68 (1.40–2.01)** 1.99 (1.69–2.34)** 244 (37.7) 67 (45.9) 1.71 (0.66–4.49) 1.60 (0.79–3.25)
  Predominant death threat 1279 (74.8) 695 (87.6) 2.40 (1.46–3.94)* 2.35 (1.49–3.71)** 565 (87.3) 130 (89.0) 1.33 (0.85–2.06) 1.37 (0.90–2.09)
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†

Adjusted odds ratio (OR), adjusted for age (in years) and gender (male vs female).

*p < .05; ** < .01.

Note: Mdn = median; IQR = interquartile range.

Compared to those with PTSD, those with CPTSD had increased odds of being single (vs in a relationship: aOR =   2.63, 95% CI 1.76–3.94). There was a positive association between military service and CPTSD (aOR = 2.55, 95% CI 0.91–7.14), but this was not significant (Table 4). No other sociodemographic variable (sex, education, language, nationality, displacement) was found to be differentially associated with CPTSD compared to PTSD. Traumas that were more likely to be reported by those with CPTSD compared to PTSD were: sexual assault (13.6% vs 7.1%), other unwanted sexual experience (17.9% vs 5.4%), and bullying (40.1% vs 23%) (Table 2). There was less discrepancy in the likelihood of reporting of all other types of trauma between PTSD and CPTSD. When adjusted regression analyses were carried out to examine differences in trauma types between PTSD and CPTSD groups, however, no differences were identified.

5. Discussion

In our study, the combined estimated prevalence of PTSD and CPTSD in Ukraine is estimated at 31.2%, with 25% meeting criteria for PTSD but not CPTSD. As may be expected, high estimated prevalence rates of PTSD were observed within a sample of civilians with a long history of transgenerational trauma now exposed to an active and ongoing war. This was in keeping with other recent Ukrainian-based studies, including those which have also utilized the ITQ to establish ICD-11 PTSD caseness but with samples that are nongeneralizable to the population as a whole (Karatzias et al., 2023). The variation in prevalence of PTSD by sociodemographic characteristics such as age, gender, and relationship or education status is also consistent with extant worldwide research (Brewin et al., 2000; 2017; Kilpatrick et al., 2017), further validating the use of this measurement tool for Ukrainian populations. Such rates are likely to be underestimations, given that we could not survey respondents in Russian-controlled areas of Ukraine where exposure to war-related atrocities is likely to be even higher.

Previously highlighted variations in rates of PTSD across studies may be explained by differences in measurement of PTSD, variation in sample sociodemographic characteristics, and/or differences in proportions of highly vulnerable individuals such as displaced persons (Johnson et al., 2022; Karatzias et al., 2023; Lotzin et al., 2023; Lushchak et al., 2024; Ressler et al., 2024). Unsurprisingly, our sample reported high rates of exposure to lifetime traumas and war-related stressors/traumas, and differences in rates of trauma exposure before and after the 2022 invasion differed by only two percentage points. Such a finding adds to the growing literature documenting the cumulative trauma experienced by the people of Ukraine prior to 2022, as well as the impact of Russia’s full-scale invasion on Ukrainian civilians (Karatzias et al., 2023; Lotzin et al., 2023). Associations between combined PTSD/CPTSD status and trauma exposure(s) found in our study corroborate previous research on the dose–response relationship between cumulative trauma exposure and risk of PTSD/CPTSD, as well as findings suggesting that traumas involving interpersonal victimization or actual/threatened death may be more pathogenic in the development of PTSD/CPTSD compared to other forms of trauma (Frost et al., 2019; Hecker et al., 2018; Karatzias et al., 2019). An association between military service and PTSD/CPTSD was observed; however, the proportion of our sample who reported military service was modest. This may have been because individuals who were currently serving may have been unavailable to take part in the study.

The estimated prevalence of CPTSD was found to be considerably lower than PTSD in our study, at 6%. This contrasts with some previous studies, which have reported the prevalence of probable CPTSD in Ukrainian civilian samples to be as high as 42.6% (Levin et al., 2023), as well as previous studies with other war-exposed samples which have reported higher rates of CPTSD than PTSD (Kira et al., 2013; Nickerson et al., 2016; Vallières et al., 2018). However, several other recent studies have similarly found CPTSD to be less common than PTSD across Ukrainian civilian samples (Ho et al., 2023; Karatzias et al., 2023; Lotzin et al., 2023; McGinty et al., 2023). One of these studies found considerably higher rates of CPTSD, 14.6%, compared to 6% in our study, but a non-representative sample comprised of parents of younger children was utilized, resulting in over-representation of younger, female participants (Karatzias et al., 2023). Similarly, a previous study of Ukrainian students, the overwhelming majority of whom were female, reported a probable prevalence rate of 11.2% for CPTSD (Lotzin et al., 2023). As younger age, gender, and being a parent are all factors that have been found to increase the odds of CPTSD (Brewin et al., 2017; Karatzias et al., 2019), it is possible that such findings were over-estimations, and that our estimate is based on a more representative sample of the current Ukrainian general population. Furthermore, while lower than some previously reported prevalence rates, our CPTSD estimate is comparable to that of a large sample of internally displaced persons in Ukraine which reported a CPTSD rate of 7.8% (McGinty et al., 2023).

One possible explanation for the lower rate of CPTSD estimated across our sample may be the nature of the conflict and associated war stressors in Ukraine, which, while severe, for many civilians might involve less prolonged or repeated traumatic exposure compared to war-exposed populations that experience traumas such as frequent/persistent artillery attacks. CPTSD is more likely to develop in response to prolonged, chronic exposure to trauma such as direct experience of violence, displacement, and sexual violence (Kira et al., 2022), trauma types which were less frequently reported by our sample and which may not be as widespread or continuous in all areas of Ukraine. Childhood traumatic experiences, which have been repeatedly identified as a strong risk factor for CPTSD development (Karatzias et al., 2019), were also less commonly identified in our sample than in the sample recruited by Karatzias et al. While there is undoubtedly significant exposure to the sorts of violent, complex, and interpersonal traumatic events which increase the risk of CPTSD development, some areas of Ukraine may have more intermittent exposure (e.g. periods of intense fighting followed by lulls). Exposure to these sorts of events, and consequently rates of PTSD, have been found to be significantly higher amongst Ukrainians who have been internally displaced, compared to those living in urban areas less directly affected by the war (Johnson et al., 2022; McGinty et al., 2023). Thus, rates of CPTSD may be higher in war zone areas where populations are exposed to more prolonged and chronic violence, perhaps explaining the slightly higher prevalence of CPTSD in Eastern Ukraine found in our study. However, this warrants further investigation.

Sociocultural differences in Ukraine, such as a strong sense of national identity and/or stronger community bonds and social support networks may also increase resilience and defend against the development of the more chronic manifestations of CPTSD. One study of internally displaced persons (IDPs) in Ukraine found that, on average, Ukrainian IDPs had high levels of positive coping styles and low levels of negative coping styles (McGinty et al., 2023) – consistent with previous research in Ukrainian samples that have revealed high levels of positive coping in the face of adversity (Bohucharova, 2017). The lower rates of CPTSD found in our investigation compared to other population estimates may therefore be reflective of the resilience and adaptive coping of Ukrainian civilians enduring ongoing war and warrants further investigation.

The fact that the war in Ukraine is ongoing may also mean that the full psychological impact is not yet visible, as many if not all war-related stressors are continuing with no anticipated end. A conceptualization of traumatic stress that assumes traumatic exposure to be fixed and have occurred in the past may have limited applicability in contexts when the threat is active, prolonged, and unending (Eagle & Kaminer, 2013). For instance, in the current Ukrainian context, persistent symptoms of traumatic stress, like hyperarousal, should not be viewed as maladaptive ‘false alarms’ shaped by past experiences. Instead, they represent accurate indicators of present and ongoing threats (Stevens et al., 2013). Research indicates that using posttraumatic stress models for individuals experiencing continuous trauma in high-risk settings, such as wars and armed conflicts, is often ineffective (Kaminer et al., 2018).

Findings from a recent network analysis of ICD-11 PTSD and CPTSD symptoms support the idea that both PTSD and DSO symptoms may manifest differently in a context of continuous traumatic stress (Levin et al., 2023). This study found that, in contrast to previous literature which has supported the six-symptom cluster model, a merging of PTSD and DSO symptoms was observed, with symptoms of re-experiencing/avoidance and negative self-concept/relationship difficulties merging to form a four-factor model. Research on continuous traumatic stress, particularly in the Ukrainian context, remains limited, suggesting important avenues for future studies.

5.1. Strengths and limitations

This study had several strengths. We used a large, randomized sample of Ukrainian civilians recruited from across the whole country and designed to be representative of the adult population of Ukraine (Paniotto, 2024). By including a measure of lifetime exposure to traumatic events in addition to war stressors, we were able to investigate the prevalence of childhood and adulthood traumatic events across a Ukrainian sample and examine their associations with PTSD and CPTSD development.

Nonetheless, findings from the current study must be considered in light of several methodological limitations. As our study is based on self-reported data, the prevalence rates reported throughout are estimations, and subject to potential bias associated with self-report tools. Despite our large sample, low reported rates of CPTSD found in our study resulted in limited power to investigate comparisons between PTSD and CPTSD in terms of sociodemographic or traumatic exposure risk factors. Insufficient power also prevented us from examining whether rates of PTSD and CPTSD differed by region. The development and administration of the translated adaptation of the ITQ used in our study may have impacted estimations of prevalence rates, possibly accounting for the low rates of CPTSD found in our study. The decision to conduct assessments of trauma and PTSD via telephone surveys, as opposed to anonymous online or paper survey questionnaires, may have resulted in a possible underreporting of trauma exposure(s) or posttraumatic symptoms, due to experiences of shame or stigma. Conducting trauma surveys by telephone is a relatively novel practice, employed primarily because of its potential to reach a nationally representative sample. Further research, therefore, will be needed into the advantages and disadvantages of this method relative to other common techniques. As is acknowledged with all self-report tools, we were only able to measure symptoms in those who disclosed an index traumatic event; given the nature of trauma, it is likely that within our sample were respondents who had experienced traumas but did not disclose these to interviewers. Reliance on self-report questionnaires also introduces the potential for error through subjective interpretation of question items by participants – as illustrated by the relatively low frequency of exposure to war-zone reported by sample (39%) despite the active and ongoing conflict across the country.

Trauma, PTSD and CPTSD were measured using questionnaires developed and validated for use in developed Westernized countries, which were translated into Ukrainian for the purposes of our investigation. A previous psychometric evaluation of the ITQ in a Ukrainian sample during the war found that it had good psychometric properties (Ho et al., 2023). Nonetheless, it’s possible that this diagnostic tool does not fully account for Ukrainian cultural expressions and linguistic idioms which may vary across cultural contexts. It is also possible that our coding and interpretation of ‘hard to say’ recorded responses in a small proportion of the overall sample may have introduced potential bias.

Data for this study were collected during a single time interval in an ongoing war. As the temporal development of symptoms was not taken into account, using the ITQ, a screening instrument designed for the posttraumatic context, with a population experiencing ongoing peritraumatic responses could result in an overestimation of PTSD or CPTSD rates (Levin et al., 2023). Continued assessments at future timepoints are needed to explore whether and how PTSD/CPTSD symptoms develop and are sustained over time.

5.2. Implications and conclusions

Findings from this study further highlight the significant psychological impact of the ongoing war in Ukraine. The high baseline of trauma exposure prior to 2022 reported by our sample highlight the cumulative impact of trauma experienced by residents of Ukraine following over a decade of conflict, and that the full-scale Russian invasion represents an escalation of pre-existing trauma exposure experienced nationwide. This has important implications for understanding the mental health needs of the Ukrainian population and the long-term impacts of sustained, long-term population-level threat. Our findings provide further corroborative evidence to suggest that in the general population of war-affected persons in Ukraine, PTSD might be the more common response (compared to CPTSD). Early interventions targeting the core symptoms of PTSD (threat, avoidance, hyperarousal) might therefore be most critical in reducing the severity or chronicity of posttraumatic stress within a Ukrainian context.

Given the high probable prevalence of PTSD and likely even higher prevalence of subthreshold posttraumatic symptomatology, the development of accessible support for traumatized communities is vital. Despite international efforts to train Ukrainian therapists to deliver trauma therapies (Pfeiffer et al., 2023; Redlener et al., 2025; Yavna et al., 2024), and given the shortage of resources on the ground, priority must also be given to community and group level support. Research suggests that providing early psychological interventions to those exposed to recent trauma, regardless of symptomatology, is not clinically effective, and that social support (and interventions that bolster this) are often central to the prevention of later mental health difficulties (Roberts et al., 2019; Wessely, 2005). As increasing evidence, including our paper, suggests that a significant proportion of Ukrainian civilians exposed to trauma may not go on to meet the threshold for PTSD/CPTSD diagnoses, community-based social support interventions may be more appropriate at a population level. There is increasing research support for community-based approaches to improving and managing conflict-related trauma, particularly those which train lay mental health workers and apply a broader, transdiagnostic approach to working with trauma and war stressors (Al-Tamimi & Leavey, 2022). Creative group-based interventions can be delivered without a need for intensive or high-level training for providers and have been found to be effective in reducing the transdiagnostic impact of war-related stressors amongst refugee samples (Acarturk et al., 2024; Grasser & Javanbakht, 2019). While some similar psychosocial interventions have been introduced to support those affected by the war in Ukraine with promising preliminary results (Hillis et al., 2024), this evidence base remains in its infancy.

The results of this study also highlight other important avenues for research. Future investigations of experiences of moral injury and continuous traumatic stress responses feel especially pertinent given the enduring nature of the war in Ukraine. One recent study demonstrated successful cross-cultural adaptation and psychometric validation of the Continuous Traumatic Stress Response Scale for war-affected Ukraine, highlighting that this tool may be worth considering for future investigations in Ukrainian samples (Zasiekina et al., 2024). As the Russo-Ukrainian war persists, further studies that examine the active, ongoing and prolonged suffering caused by this conflict on civilians are greatly needed to provide a sound basis for a better understanding of the policy challenges and prioritization of mental health issues as part of Ukraine’s recovery process.

Funding Statement

The research study was conducted within the Research Network ‘Conflict and Cooperation in Eastern Europe’ (KonKoop), supported by the German Federal Ministry of Research, Technology and Space (BMFTR) [grant number 01UG2209 A].

Note

1

Identity-related variables, such as language, ethnicity and civic identity, are complex in the Ukrainian context (also prior to 2022). Language preferences and practices can vary (see Onuch and Hale 2018 suggesting a composite measure) and the broad variable ‘nationality’ captures a mixture of ethnic and civic criteria (see Kulyk 2018). For the purposes of this paper, we have used the language in which respondents completed the survey as a rough binary measure and ‘nationality’ as a broad identity marker.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

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Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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