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. 2023 Jan 25;12:100487. doi: 10.1016/j.jadr.2023.100487

Depressive symptoms and psychological pain experienced by Polish adults in the context of both the war in Ukraine and the COVID-19 pandemic

Aleksandra Brągiel 1, Małgorzata Gambin 1,⁎
PMCID: PMC9873365  PMID: 36711256

Abstract

Background

This study sought to investigate the perceived influence of stressful events (i.e., the outbreak of the war in Ukraine, the political situation, and the COVID-19 pandemic) on the depressive symptoms and psychological pain experienced by Polish adults. The study also aimed to explore the association between experiential avoidance and emotional distress.

Method

110 Polish social media users aged 18–89 completed online the Patient Health Questionnaire-9, Psychache Scale and the Multidimensional Experiential Avoidance Questionnaire-30 and questions concerning perceived influence of stressful event on their emotional functioning.

Results

More than half of the participants (52.7%) reported experiencing a subjective increase in their depressive symptoms since the outbreak of the war in Ukraine. Interestingly, a larger percentage of participants associated their emotional distress with the outbreak of the war (44.6%) and the overall political situation (39.2%) than with the COVID-19 pandemic (27.2%). In addition, experiential avoidance was found to be associated with subjective increases in the participants’ depressive symptoms and emotional distress.

Limitations

Cross-sectional character of the study, small sample size, and exclusive use of online data are main limitation of the study.

Conclusions

Findings of our study can help planning preventive and therapeutic interventions for at-risk individuals to reduce negative long-term outcomes of the recent stressful life events in Poland.

Keywords: Depression, Psychache, Experiential avoidance, Pandemic, War

1. Introduction

As a result of the COVID-19 pandemic and the associated restrictions, individuals have had to deal with significant disruptions to their everyday life. They have also had to face multidimensional and enduring stressors throughout the pandemic, including changes in their daily routines, uncertainty, economic destabilization, loss of social support, social isolation, misinformation, health concerns, and the pain of both grief and loss (Chen and Bonanno, 2020). Previous studies have documented an increase in depressive and anxiety symptoms, and post-traumatic stress disorder in various countries worldwide, among others in Poland, in individuals during the COVID-19 pandemic when compared with the situation prior to the pandemic (e.g., Santomauro et al., 2021; Schafer et al., 2022, Wang et al., 2021a, 2021b, 2021c). Recent research also demonstrated heterogeneity among the general population in terms of their emotional responses over the course of the pandemic (Gambin et al., 2021; Shevlin et al., 2021). Additionally, some studies revealed differences in levels of emotional distress between populations from different countries during the COVID-19 pandemic (Wang et al., 2021a, 2021b, 2021c). Poland is one of the countries characterized by the highest levels of anxiety, depression, and stress among the other populations from Asia, Europe, and North America at the beginning of the pandemic (Wang et al., 2021a, 2021b, 2021c) possibly due to: relatively high number of COVID-19 cases and deaths, conflicting health information (e.g., concerning wearing face-masks), high distress and reluctance towards wearing face-masks, information in media that the healthcare system in Poland is not prepared to fight the pandemic, as well as limited access to public psychiatric and psychological care in Poland.

Furthermore, after two years of dealing with the stressors associated with the COVID-19 pandemic, the world witnessed the outbreak of war in Ukraine on February 24, 2022. During a period of only a month, over 2.23 million Ukrainian refugees crossed the border into Poland. Both the outbreak of the war and the resultant refugee crisis have resulted in multiple changes with regard to the functioning of Polish society, both from a global perspective (economic and political changes) and from an individual perspective (psychosocial consequences and differences in everyday functioning). Indeed, Poles have had to confront fears concerning Russian aggression spilling over into Poland as well as feelings of uncertainty, powerlessness, and distress in the face of images and information concerning the pain and suffering of the Ukrainians (Surzykiewicz et al., 2022). Moreover, many Poles have also committed their resources to providing aid and faced challenges when helping and supporting refugees.

It seems reasonable to predict that the outbreak of the war will have led to an increase in the levels of depressive symptoms and psychological pain––an aversive state that encompasses feelings of shame, guilt, humiliation, loneliness, fear, angst, dread, and anguish (Shneidman, 1999)––among Polish adults. In addition, it appears feasible that experiential avoidance could be an important risk factor for emotional distress, as numerous studies have reported its relation to mental health problems during the COVID-19 pandemic (e,g, McCracken et al., 2021).

In light of the above, the present study had two key aims:

  • 1)

    to investigate whether the participants perceived recent stressful events (i.e., the COVID-19 pandemic, the outbreak of the war in Ukraine, and the general political situation worldwide) to have had a significant influence on their well-being as well as whether they had observed a subjective change in their depressive symptoms since the outbreak of the war.

  • 2)

    to identify the factors (i.e., dimensions of experiential avoidance and demographic variables) most strongly associated with depressive symptoms, psychological pain, and perceived increase in sadness and depression in Polish adults following the outbreak of the war in Ukraine.

2. Methods

110 Polish social media users aged 18–89 (M = 35.17, SD=13.89) completed online the following questionnaires: the Patient Health Questionnaire-9 (PHQ-9; Kroenke et al., 2001; Kokoszka et al., 2016), Polish adaptation of the Psychache Scale by Ronald Holden (Chodkiewicz et al., 2017) and Polish adaptation of the Multidimensional Experiential Avoidance Questionnaire-30 (MEAQ-30; Baran et al., 2019). Each of the questionnaires used in the study has good psychometric properties (Kroenke et al., 2001; Chodkiewicz et al., 2017; Baran et al., 2019). In addition, we included questions about the perceived relationship of symptoms listed in the PHQ-9 with current events – in particular, whether the participants’ experienced difficulties are related to: the pandemic situation, the political situation in the world, and the outbreak and consequences of the war in Ukraine, and whether the respondents experienced a greater intensity of sadness and depression during the war in Ukraine compared to the time before the outbreak of the war. The data were collected between the 12th and the 30th of March 2022. This study was approved by the institutional review board of the Faculty of Psychology, University of Warsaw.

3. Results

At the time of filling the questionnaires, 34,5% of participants reported clinically significant symptoms of depression, with 12 cut-off points on the PHQ-9 questionnaire. 52.7% of respondents declared that they experienced higher levels of sadness and depression since the outbreak of the War in Ukraine. In addition, 44.6% of the participants admitted that their depressive symptoms were associated with the war in Ukraine and its consequences, whereas 39.2% of the participants considered their symptoms to be associated with the overall political situation. Finally, 27.2% of the participants declared that their depressive symptoms were associated with the COVID-19 pandemic (Supplementary Table S4).

An analysis of the Spearman's rho correlation revealed that the current financial situation, as well as current level of education, were negatively correlated with the intensity of the participants’ depression and psychache (Supplementary Table S5). Moreover, Pearson's r correlation analysis demonstrated that age is negatively correlated with both the intensity of depression symptoms and psychache (Supplementary Table S6).

Two dimensions of experiential avoidance were found to be positively related to the participants’ perception of the increase in the intensity of their sadness and depression since the outbreak of the war in Ukraine, namely the distress aversion and the procrastination (Supplementary Table S5). Depressive symptoms and psychache were positively related to three dimensions of experiential avoidance: distress aversion, procrastination, and repression/denial, as well as negatively to distress endurance (Table 1 ).

Table 1.

Correlation of depressive symptoms, psychache and experiential avoidance subscales.

Experiential avoidance subscales Depressive symptoms Psychache
Behavioral avoidance 0.032 0.048
Distress aversion 0.504⁎⁎ 0.585⁎⁎
Procrastination 0.415⁎⁎ 0.434⁎⁎
Repression/denial 0.503⁎⁎ 0.612⁎⁎
Distraction and suppression 0.001 0.006
Distress endurance −0.262⁎⁎ −0.230*
Open in a new tab
⁎

p<0,05.

⁎⁎

p<0,01.

4. Discussion

The results of this study revealed that over half of the participants reported an increase in the intensity of their depressive symptoms since the outbreak of the war in Ukraine. A larger percentage of the participants considered their depressive symptoms to be related to the outbreak of the war (44.6%) and the overall political situation (39.2%) than to the COVID-19 pandemic (27.2%). Based on the obtained results, we suggest experiential avoidance (especially distress aversion, procrastination, and repression/denial) to be an important target for therapeutic and preventive interventions conducted during stressful periods and in the context of threatening events. As there exists an urgent need to support refugees from Ukraine, who are facing significant mental health and psychosocial challenges, as well as to provide support for at-risk individuals from Poland (of a younger age and with lower socioeconomic status), it is crucial to propose systemic solutions and prepare for the huge demand for mental health specialists that will manifest in Poland in the very near future (Kardas et al., 2022; Patel, Erickson, 2022). To mitigate negative consequences of the current social crises (COVID-19 pandemic and war in Ukraine) for mental health, it is necessary to identify high-risk groups, improve psychiatric morbidities screening, accurately disseminate health information and public opinions, and implement evidence-based treatment, such as cognitive behavioral therapy, including Internet CBT (Ho et al., 2020; Zhang and Ho, 2017), that could be particularly helpful during the epidemiological or war-related crises that may limit possibilities to conduct face-to-face therapy.

The main limitations of the present study were the relatively small number of participants and the exclusive use of online data. As the study used self-reported questionnaires to measure psychiatric symptoms and did not make clinical diagnosis, it is important to include structured clinical interview or functional neuroimaging in face-to-face research, conducted after COVID-19 restrictions are removed, to guarantee the gold standard for establishing psychiatric diagnosis (Husain et al., 2020). In the future, larger-scale and longitudinal studies will be required to investigate the influence of the ongoing conflict and its consequences for the mental health of individuals from Ukraine, Poland, and other countries.

Declaration of Competing Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Footnotes

Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.jadr.2023.100487.

Appendix. Supplementary materials

mmc1.docx (29KB, docx)

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