Abstract
Effective evidence-based mental health support is most crucial during times of crisis. However, conducting research to establish an evidence base in such settings is highly challenging. This session examines how mental health trials in Ukraine have adapted to the ongoing armed conflict and detail strategies and lessons for conducting rigorous research in unstable environments. The speakers will provide insight into methodological, operational, and recruitment adaptations required for research in crisis settings, with relevance beyond Ukraine. The session brings together studies focusing on diverse populations and settings, including school children, war-affected men, internally displaced people and users of secondary mental health services. These populations differ in mental health needs, recruitment barriers and contextual constraints, requiring tailored and flexible research approaches. The session opens with SAFE SPACE, a multi-layered school-based intervention training teachers to support resilience, equipping school psychologists to deliver group therapy and establishing referral pathways. A key contribution of this study is demonstrating large-scale implementation under chronic insecurity, reaching over 3000 teachers from 500 schools. Building on this, the SHAWL and SUPRA studies investigate interventions targeting substance use among displaced adults through two randomized controlled trials and one observational study. By meeting their research goals despite funding insecurity in addition to the challenges of the Ukrainian context, these studies demonstrate the importance of adaptability and responsiveness to participant needs in making research resilient. Focusing on a high-risk subgroup, the CHANGE study evaluates a transdiagnostic intervention addressing alcohol misuse and psychological distress in war-affected men. This study illustrates how stigma, mistrust, competing demands such as participant conscription must be considered when developing and adapting recruitment and retention strategies. Finally, a prospective cohort study examining Ukraine’s transition towards community-based mental health care centers describes the importance of iterative design and stakeholder engagement when evaluating system level reforms. In this case, recruitment strategies needed to be adapted separately for different stakeholder groups. Together, these studies provide a multi-level perspective on conducting mental health research under instability. By synthesizing lessons across populations and designs, the session offers experience and guidance for building resilient research designs in crisis-affected settings. These insights carry implications for future public health emergencies and fragile contexts globally.
Key messages
• Mental health trials in Ukraine face and address harsh challenges. The lessons learned carry implications for resilient public health across disciplines.
• Adaptability in all respects and close listening to local stakeholders are crucial in insecure contexts. Recruitment and retention strategies need to evolve continuously.