Determining PTSD, Anxiety, and Depression Levels in Individuals Migrating From Ukraine to Türkiye due to the War
Abstract
The aim of this study is to determine the levels of post-traumatic stress disorder (PTSD), anxiety, and depression in individuals who migrated to Türkiye from Ukraine due to the ongoing conflict in their home country. In the study, 194 individuals were reached by using the Socio-Demographic Information Form, the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Impact of Event Scale-Revised (IES-R). It was determined that 38.1% of the participants were in the risk group for GAD, 21.6% were at risk for severe depression, and 7.2% were at risk for very severe depression. Being young and having a low level of education increases the risk of depression and PTSD. Overall, the participants were found to be at risk for PTSD.
1. Introductıon
In February 2022, the Russian army, with the support of the Belarusian government, began to invade Ukraine [1]. This meant that millions of Ukrainians had to flee their homes and communities to seek safety abroad [2], resulting in one of the largest refugee crises since the Second World War, with more than 5.7 million people fleeing Ukraine [3].
Leaving the country and settling in a new country and adjusting to an unfamiliar environment can be challenging for these individuals. Language and cultural barriers can be significant obstacles in this process, and the loss of social networks can cause refugees and asylum seekers to experience great mental distress [1]. War and/or violent armed conflict can also have acute and chronic effects on mental health [4]. Proximity to war events and duration of exposure have been associated with an increased risk of psychopathology [2]. Neuropsychiatric disorders, such as depression, post-traumatic stress disorder (PTSD), suicidal ideation, anxiety, acute stress reactions, cognitive impairment, and personality changes, frequently develop and are known to be common among civilians and military personnel living in conflict and war zones. This also applies to veterans and refugees, as these disorders can have the potential to leave long-term scars and significantly affect the lives of individuals [5, 6]. As a result of the multiple and repeated traumas they have experienced, many refugees may exhibit symptoms of PTSD, characterized by loss of confidence, inability to imagine a future, inappropriate risk-taking, and somatization [7]. Recent research suggests that major depression and PTSD are common and persistent among refugees and displaced persons. The highest rates of mental illness are found in postconflict countries where the general population has high levels of PTSD [8]. The emotional distress associated with war can arise not only from direct exposure but also from indirect sources viewing war scenes on television or social media. According to the indirect exposure theory, people who are affected by war but live outside the war zone may develop adverse mental health outcomes [9]. The literature suggests that approximately one third of refugees exceed the diagnostic threshold for PTSD, depression, and anxiety [10].
A study of war refugees in Albania found that 32.5% of individuals developed PTSD at a clinical level and 38.8% reached the threshold for psychiatric illness [11]. Mahmood et al. [12] found that the prevalence of probable PTSD among Syrian refugees in the Kurdish region of Northern Iraq was ~60%. Adıgüzel and Tanyaş [13] captured the experiences of Syrian women who migrated to Türkiye and found that the women experienced traumatic events such as violence, attacks, bombings, and loss of loved ones before and during their migration to Türkiye. They also continue to experience the settlement process after migration, language barriers, poverty, and distressing difficulties [13]. According to a meta-analysis evaluating individuals exposed to armed conflict prior to migration, the prevalence of PTSD, current major depressive disorder, and generalized anxiety disorder (GAD) was estimated to be 31%, 25%, and 14%, respectively [14]. It has been suggested that the Ukraine–Russia war and its impact on displacement may make Ukrainian youth more vulnerable to significant mental health problems [15].
The various effects of war, such as family displacement, lack of mental preparedness for disasters, insufficient social support, and inadequate coping skills, negatively affect individuals [16]. Individuals who migrate to another country after the war may additionally develop anxiety and other mental health disorders due to postmigration stressors such as separation anxiety and the added burden of resettlement in a new country [17]. One study highlighted the high prevalence of PTSD, depression, and anxiety among unaccompanied refugee minors [18]. In 2016, a survey was conducted among internally displaced Ukrainians following the Russian occupation of the south and east of the country. The results showed that 21.0% of participants met the diagnostic criteria for PTSD or complex PTSD (CPTSD), as defined by the 11th version of the International Classification of Diseases [19]. A meta-analytic study evaluating articles on the effects of war between 1989 and 2019 found a prevalence of 26.51% for PTSD and 23.31% for major depression was found [20]. Long-term adverse effects of war include a deterioration in occupational and social functioning, health problems, reduced quality of life, and psychiatric disorders [21].
As the Russia–Ukraine war becomes increasingly violent, there is a need to study the psychological impact of the war not only on people in Ukraine but also on people who have migrated to other countries. Although research into the effects of the Russia–Ukraine war is still in its infancy, such studies may help authorities to develop more effective support systems or intervention programmes for people affected by the war. This study examines the mental health of people who migrated from Ukraine to Türkiye as a result of the war. It is vital to assess the levels of depression, anxiety, and PTSD experienced by people who have moved from Ukraine to Türkiye as a result of the conflict. This information is crucial for planning psychosocial interventions tailored to the needs of these individuals. Therefore, the aim of this study is to determine the rates of depression, anxiety, and PTSD experienced by people who have migrated from Ukraine to Türkiye as a result of the war.
2. Material and Methods
2.1. Participants
This descriptive cross-sectional survey was conducted among individuals displaced by the war in Ukraine and currently residing in Türkiye. The survey was available online between March and May 2023. The inclusion criteria for the study were as follows: being over 18 years of age, agreeing to participate in the study, having migrated from Ukraine to Türkiye due to the war, and knowing the Ukrainian language. In order to ensure that Ukrainian displaced persons have access to their rights and services and protection mechanisms, the Social Development and Counselling Association in Türkiye has established a helpline that has been providing services in Ukrainian and Russian since the Ukrainian war victims first arrived in Türkiye. The United Nations High Commissioner for Refugees has provided the Presidency of Migration Management for displaced people from Ukraine with basic resources such as materials, equipment, and human resources support, especially translators. We reached out to participants through Ukrainian online associations on Facebook, Instagram, WhatsApp, and Twitter. The link to the study was sent to Ukrainian associations on Instagram, WhatsApp, and Facebook. A questionnaire created using Google Forms was then sent to the participants. At the beginning of the online survey, we explained the purpose of the study, inclusion criteria, and procedures to potential participants. Participation in the study was voluntary. Participants who agreed to complete the survey started by selecting the “Agree” option, while those who wished to withdraw from the study did so by selecting the “Decline to Participate” option. Participants were then asked to answer all items in the survey. First and last names were not included in the survey. We emphasized the anonymity and confidentiality of the online survey. Those who completed the survey were not offered any incentive for their participation. Snowball sampling was used to reach individuals. All participants in the study were from Türkiye. In snowball sampling, the researcher collects data from a few members of the target population and then achieves the sample size by asking the respondents to identify others who might participate [22]. The sample size can be determined by considering the power of the study [23]. The G-Power analysis method was used to determine the sample size, and when the effect size was 0.49, α = 0.05 and the power value was 0.95, the sample size was found to be 180 [16]. Allowing for potential case attrition, 194 individuals were reached in the study.
Of the participants, 96.9% are women, and 88.4% are aged between 18 and 30. Regarding their marital status, 44.3% are married, 40.2% have never been married, and 15.5% are separated from their spouse. In terms of educational level, 75.3% had completed primary education, while 24.7% had completed secondary education (grades 7–9). In total, 176 people had no chronic illness, and 44.3% considered their health to be average.
2.2. Procedure
The online questionnaire was delivered through the association or Ukrainian acquaintances to participate in the study. Particular attention was paid to include individuals who had migrated due to the war and who agreed to participate in the study. After obtaining informed consent, participants were sent a survey questionnaire consisting of the GAD-7, Patient Health Questionnaire-9 (PHQ-9), the Impact of Event Scale-Revised (IES-R), and a sociodemographic information form. The survey took about 15 min to complete. The study was conducted between March and May 2023. Ethical approval was obtained from the research ethics committee of the university where the authors work.
2.3. Materials
Sociodemographic information form: The survey questionnaire consists of questions that determine individual characteristics such as age, gender, education level, marital status, and date of migration to Türkiye.
GAD-7: The scale developed by Spitzer et al. [24] in 2006. It is a test that helps to assess GAD and focuses on the last 15 days for the assessment, relying on self-reported information provided by the individual. It consists of a total of seven items and each item is scored 0-1-2-3 based on the answer given. Individuals with a total score of 10 or more should undergo further assessment and confirmation of the diagnosis of GAD using other methods [24]. Those with a total score of 10 or more should be diagnosed with GAD using other methods. Scores of 10 or more may indicate a high-risk group. This scale has been used previously in similar studies with Syrian refugees living in Germany [25], Ukrainian refugees living in the Republic of Korea (ROK) [26], and university students living in the Czech Republic [16].
The PHQ-9: This is a nine-item depression module. According to the developers of the PHQ-9, a score of 0–4 indicates no or minimal depression, 5–9 mild depression, 10–14 moderate depression, 15–19 moderate depression, and 20–27 severe depression [27]. Both instruments (GAD-7 and PHQ-9) were translated from English into Ukrainian by Kroenke, Spitzer, and Williams [27]. The Ukrainian versions of the GAD-7 and PHQ-9 were translated using a standard translation methodology including conceptual analysis, forward and backward translation, cognitive debriefing, proofreading, and finalization can be found at the following website (https://www.phqscreeners.com/select-screener). This scale has been similarly used as a measurement tool in some studies evaluating the mental health of refugees [16, 28–30].
The IES-R: This is a 22-item five-point Likert scale developed by Sundind and Horowitz [31] and later revised by Weiss and Marmar [32] based on the DSM-IV criteria for PTSD. It consists of three subscales: Intrusion (eight items), Avoidance (eight items), and Hyperarousal (six items). The IES-R scale is designed to measure distress in cases that have experienced a trauma at the time the scale is administered. The IES-R is a validated and reliable scale that is widely used in both daily clinical practice and clinical trials to assess the severity of PTSD [33]. Higher IES-R total scores indicate that participants experienced more severe psychological distress and PTSD symptoms during the study period. The three-factor structure of the IES-R scale has been reported to have high reliability and validity [33, 34]. The Cronbach’s alpha values for the intrusion, avoidance, and hyperarousal scales for the Ukrainian participants were 0.88, 0.79, and 0.84, respectively [19]. The IES-R provides a total score (ranging from 0 to 88), and a cutoff point of 33 and above is considered to be the best cutoff point for a diagnosis of PTSD [33]. The Ukrainian version of the screening scale was obtained from IAPT guidance (The Improving Access to Psychological Therapies, NICE, 2018) (https://k-s.org.ua/ptsd/). The IES-R total score is divided into 0–23 (normal), 24–32 (mild psychological impact), 33–36 (moderate psychological impact), and >37 (severe psychological impact). An IES-R total score >24 indicates the presence of PTSD symptoms [35]. Some examples of studies conducted with refugees and using this scale are as follows: Afghan refugees living in Australia [36], in a study of North Korean refugees [37], in a study conducted with Syrian refugees in Türkiye [38], individuals living in Polonya, Taiwan, Ukraine, and affected by the Ukraine–Russia war [9].
2.4. Analysis Strategy
Data were analyzed using the SPSS 25 software package (IBM Corp., Armonk, NY, USA). Comparison of normally distributed variables according to the Kolmogorov–Smirnov test [39] was performed using the t-test [40] and one-way analysis of variance [41]. Scale means were calculated using mean and standard deviation. Mean scale scores by gender were evaluated using the Mann–Whitney U test [42]. Spearman correlation analysis [43] was used to examine the relationship between participants’ GAD-7, PHQ-9, and IES-R scores. Multivariate linear regression analysis [44] was used to determine the variables that predicted individuals’ PTSD. The results were interpreted with a 95% confidence interval, and p < 0.05 was considered statistically significant.
3. Results
3.1. Scale Score Averages of the Participants
Table 1 shows the mean scores of the participants on the GAD-7, PHQ-9, and IES-R scales. The mean score of the participants on the GAD-7 scale was 11.21 ± 5.39, on the PHQ-9 scale was 10.97 ± 6.14, and on the IES-R scale was 45.85 ± 9.82.
| Scales | Mean ± standart deviation |
|---|---|
| The Generalized Anxiety Disorder-7 | 11.21 ± 5.39 |
| The Patient Health Questionnaire-9 | 10.97 ± 6.14 |
| Impact of Event Scale-Revised | 45.85 ± 9.82 |
| Intrusion subscale | 16.10 ± 4.15 |
| Avoidance subscale | 16.93 ± 4.28 |
| Hyperarousal subscale | 12.81 ± 3.10 |
Table 2 shows the risk status of the participants according to the GAD-7 scale, the PHQ-9 scale, and the IES-R scale. According to the GAD, 38.1% of the participants are at risk. According to the PHQ-9 scale, 21.6% are at a severe level and 7.2% at a very severe level of depression. According to the IES-R scale, 94.8% of the participants were at risk for PTSD.
| Scales | n | Percentage |
|---|---|---|
| The Generalized Anxiety Disorder-7 | ||
| Risk present | 74 | 38.1 |
| No risk | 120 | 61.9 |
| The Patient Health Questionnaire-9 | ||
| Minimal | 32 | 16.5 |
| Mild | 56 | 28.9 |
| Moderate | 50 | 25.8 |
| Moderately severe | 42 | 21.6 |
| Severe | 14 | 7.2 |
| IES-R score | ||
| Risk present | 184 | 94.8 |
| No risk | 10 | 5.2 |
3.2. Comparison of GAD-7, PHQ-9, and IES-R Scores According to the Sociodemographic Characteristics of the Participants
Table 3 displays the comparison of scale scores based on the participants’ sociodemographic characteristics. In terms of age group, there was no statistically significant difference in GAD-7 scale scores between participants aged 18–30 and those aged 31 and over. However, participants aged 18–30 (with a mean score of 11.60 ± 5.66) had a significantly higher mean PHQ-9 score than those aged 31 and over (with a mean score of 8.71 ± 7.26) (p = 0.007). In addition, individuals aged 18–30 years had a higher mean score on the IES-R scale (46.73 ± 9.56) than those aged 31 years and older (42.66 ± 10.21), and this difference was statistically significant (p = 0.017). Furthermore, the mean scores of the Intrusion subscale (p = 0.028) and the Hyperarousal subscale (p = 0.032), which are subdimensions of the IES-R scale, were significantly higher in the 18–30 age group compared to those aged 31 and over (Table 3).
| Characteristics | GAD-7 | PHQ-9 | IES-R | Intrusion subscale | Avoidance subscale | Hyperarousal subscale |
|---|---|---|---|---|---|---|
| Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | |
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| Gender | Median (min.–max.)/Mean range | Median (min.–max.)/Mean range | Median (min.–max.)/Mean range | Median (min.–max.)/Mean range | Median (min.–max.)/Mean range | Median (min.–max.)/Mean range |
| Female | 12.00 (0–21)/98.73 | 10 (2–27)/97.77 | 44.5 (24–74)/96.74 | 15.5 (8–28)/96.65- | 16 (10–28)/96.57 | 12 (6–23)96.84 |
| Male | 7.00 (0–14)/58.83 | 10 (80–18)/89.17 | 45 (24–74)/121.17 | 16 (15–24)/124.14 | 17 (16–23)126.5 | 12 (12–18)118.17 |
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According to the mean scores of the scales based on marital status, there were no statistically significant differences in the total scores of the GAD-7, PHQ-9, and IES-R scales between single, married, and divorced individuals. However, there was a statistically significant difference in the Hyperarousal subscale of the IES-R scale, where single individuals (mean score: 13.82 ± 3.25) scored higher than married individuals (mean score: 12.23 ± 2.98) and divorced individuals (mean score: 11.86 ± 2.28) (p = 0.001).
There is no significant difference in the GAD-7 scores of the participants according to their educational status. However, the PHQ-9 score was found to be significantly higher in secondary school graduates compared to primary school graduates (p = 0.016). The total score of the IES-R scale was determined to be significantly higher in secondary school graduates (48.45 ± 10.95) than in primary school graduates (45.0 ± 9.30) (p = 0.034). This difference was also observed on the Hyperarousal subscale of the scale (p < 0.001).
It was found that the presence of chronic conditions in the participants did not have a statistically significant effect on the GAD-7, PHQ-9, and IES-R scale scores (Table 3).
Among the study participants, those who rated their own health as poor had higher GAD-7 scores (12.75 ± 5.04) than those who rated their health as good (9.44 ± 5.27) (p < 0.001). Regarding the PHQ-9 score, those who rated their own health as poor (12.51 ± 6.24) had significantly higher scores than those who rated their health as good (9.20 ± 5.53) (p < 0.001). No significant difference was found in the total score of the IES-R for people who rated their health as poor. However, the subscales of the IES-R, specifically the Intrusion subscale (p = 0.040) and the Hyperarousal subscale (p = 0.028), were higher in people who rated their health as poor than in those who rated their health as good.
There is no statistically significant difference in the mean GAD-7 (p = 0.086), PHQ-9 (p = 0.711), and IES-R (p = 0.294) scale scores according to gender.
3.3. Correlation Among GAD-7, PHQ-9, and IES-R Scores
The correlations between the scales are shown in Table 4. A statistically significant and positive relationship was found between the GAD-7 and the PHQ-9. However, no statistically significant relationship was found between the IES-R and either the GAD-7 or the PHQ-9.
| Scales | GAD-7 | PHQ-9 | IES-R | |
|---|---|---|---|---|
| 1. GAD-7 | r | 1 | 0.665 ∗∗ | 0.053 |
| 2. PHQ-9 | r | 0.665 ∗∗ | 1 | 0.053 |
| 3. IES-R | r | — | — | 1 |
- ∗∗p < 0.01.
3.4. Predictive Factors of Participants’ IES-R
The results of the regression analyses explaining the factors influencing individuals’ PTSD are presented in Table 5. Factors that showed a statistically significant relationship through t-test, ANOVA, or correlation tests were included in multivariate regression analyses. The predictive power of the linear regression model calculated using the enter method was 4%.
| Variables | Unstandardized B (95% CI) | SE | Standardized β | t | p | |
|---|---|---|---|---|---|---|
| Constant | 56.139 (49.365–62.914) | 3.435 | — | 16.346 | 0.000 | |
| Age | −3.837 (−2.280 to 0.024) | 1.683 | −0.161 | −2.280 | 0.024 | |
| Education level | −3.204 (−1.995 to 0.047) | 1.606 | −0.141 | −1.995 | 0.047 | |
- Note: R = 0.22, adj. R2 = 0.04, F = 4.928, p = 0.008. β, standard partial regression coefficient; B, partial regression coefficient.
- Abbreviations: 95% CI, 95% confidence interval; adj. R2, adjusted R square.
The relationship showing the prediction of IES-R scores according to regression analysis is as follows: IES-R = 56.139 − age × 1.683 − educational level × 1.606
It was found that the variable affecting IES-R scores was age. For a one-unit increase in the age variable, the IES-R score decreases by 1.683 units. For a one-unit increase in education, the IES-R score decreases by 1.606 units. In the model, having a chronic disease, health rating, GAD-7, and PHQ-9 were found to be statistically insignificant.
4. Discussion
For many people who have been forced to leave their country because of war, the consequences of trauma, if not addressed, can continue to affect their brain and mental health and exacerbate a range of physical illnesses [10]. For this reason, it is thought to be important to evaluate the psychosocial conditions of individuals who migrated due to war and to provide support to at-risk groups. In this study, which examined the levels of general anxiety, depression, and PTSD among individuals migrating from Ukraine to Türkiye due to the war, the average GAD-7 scale score of the participants was 11.21 ± 5.39. In addition, 38.1% of them were found to be at risk for an anxiety disorder according to the cutoff score of the GAD-7 scale (scores of 10 or more can be considered as an indication of a high-risk group). This finding is consistent with studies of Ukrainian refugees conducted by others in Germany (5.62 ± 4.05) [45] and Central Europe (7.86 ± 5.32) [16]. However, this is not consistent across studies. Hyland et al. [46] looked at the psychological effects of the war in Ukraine and found that 71% of people in the study experienced an increase in anxiety symptoms, while 62.1% experienced an increase in depression symptoms. Borho et al. [28] also found that 7.8% of Syrian refugees living in Germany are at risk according to the GAD-7 score. It is thought that the differences in the results of this research may be due to a number of reasons. The fact that the studies were conducted in different countries suggests that individuals may experience different difficulties. The ongoing nature of the war, the first-hand experience of those who came to Türkiye, the ongoing risk faced by their relatives in Ukraine, and various other factors may have contributed to the differences in these findings compared to other studies. In addition, the majority of study participants were women, which may have influenced the results. Further research would be needed to determine the reasons for this. Differences in the sample population could also affect the results. It is believed that people who have been displaced from their countries due to war should receive psychological support. It was found that a single session of art therapy applied to individuals who remained in the ROK as a result of the Russian–Ukrainian war effectively reduced participants’ anxiety and distress [47]. It is considered necessary to implement such intervention programmes regularly for the psychosocial empowerment of war-affected individuals.
In this study, participants had an average score of 10.97 ± 6.14 on the PHQ-9 scale, indicating a moderate level of depression. In addition, 21.6% were identified as being at risk for severe depression (scoring between 15 and 19 on the PHQ-9 scale) and 7.2% were identified as being at risk for very severe depression (scoring between 20 and 27 on the PHQ-9 scale). While similar findings have been reported in studies of Syrian war refugees in the literature [25, 28, 29], our results showed lower prevalence rates among Ukrainian war refugees [16, 45]. Our research findings are consistent with those of other studies conducted with refugees, indicating that the challenges faced by individuals displaced from their countries due to war are similar and that common policies are needed to protect their mental well-being.
In our study, the IES-R score was determined to be 45.85 ± 9.82. In addition, 94.8% of the participants are in the risk group for PTSD, defined as those with an IES-R scale score of 33 and above. While similar findings were reported in a study of Syrian individuals in Türkiye [48], our scores were lower than a study conducted with North Korean refugees [49]. In this study, 94.8% of participants were found to be at risk for PTSD according to the cutoff score of the IES-R scale. Cengiz, Ergün, and Çakici [38] found that 80% of Syrian refugee participants were classified in the PTSD group. Individuals who leave their country due to war are not only dependent on the process of adaptation to the place to which they migrate but also worry about their relatives living in their country, are negatively affected by news about their country, and experience psychological tension. Our findings may be related to these factors.
In this study, younger participants (aged 18–30) had higher scores on the PHQ-9 and the IES-R than those aged 31 and over. Regression analysis showed that age was the only variable that predicted the impact of events on the scale. In addition, mean scores on the Intrusion and Hyperarousal subscales of the IES-R were also higher in the younger age group. Acarturk et al. [50] identified a statistically significant negative correlation between age and depression in Syrian refugees [50]. Kim et al. [49] found a negative significant relationship between the IES-R and age in North Korean refugees. Higher levels of social dysfunction and severe depression among older people were found among Rwandan refugees living in Zambia [51]. With increasing age, the degree to which people are affected by events decreases, which may be due to the fact that people have gained experience in problem solving over the years. The studies mentioned in the literature also found similar results to our findings.
In this study, the Hyperarousal subscale of the IES-R scale showed a statistically significant higher mean score in single individuals (13.82 ± 3.25) compared to married (12.23 ± 2.98) and divorced (11.86 ± 2.28) individuals. However, studies have found no significant relationship between the IES-R scale and marital status [36, 38, 50, 51]. The finding in our study that unmarried people were disadvantaged suggests the need to provide adequate social support for these people.
In the study, individuals with a low level of education (primary school graduates) had statistically significantly higher PHQ-9 scores than those with higher education levels (secondary school graduates). In contrast to our study, it was found that the level of depression was higher in Syrian refugees living in Germany with higher education levels [25]. The total score of the IES-R scale was 48.45 ± 10.95 in individuals with a low level of education (primary school graduates) and 45.0 ± 9.30 in individuals with a high level of education (secondary school graduates), which was statistically significantly higher. In addition, this difference was observed in the Hyperarousal subscale, one of the subdimensions of the IES-R scale. Kim et al. [49] found a statistically significant positive correlation between the IES-R and educational attainment among North Korean refugees. Acarturk et al. [50] found no statistically significant association between education level and depression and PTSD among Syrian refugees. A study of Rwandan refugees living in Zambia found that those with lower levels of education had higher levels of general health problems, anxiety, insomnia, and depression [51]. The low level of education may have affected the inability of individuals to use coping skills. In addition, the work and financial situation of people with a high level of education may be better. This also seems to be a positive factor in preventing depression. However, some studies have found a different relationship between education and depression. It is thought that many sociodemographic variables other than education may have played a role in the different results. It is therefore important that studies control for other variables that affect depression.
The study found that people who rated their own health as poor had significantly higher levels of anxiety, depression, and scores on the intrusion and hyperarousal subscales. This is an expected result, as the subjective perceptions of individuals who rate their own health as poor are consistent with their mental well-being. It is thought that people who do not feel well should seek professional help. This study found a statistically significant and positive relationship between depression and anxiety scores. A study conducted among adolescents in Gaza found a positive, statistically significant relationship between depression and anxiety [52]. People with severe anxiety and depression should be referred for professional support. Some studies have shown that patients benefit from the use of digital technology in healthcare [53]. It is believed that online therapy or counseling applications may be beneficial for individuals.
The study found a positive, statistically significant relationship between GAD-7 and PHQ-9. The GAD-7 and PHQ-9 should be used for mental health screening, especially in populations facing severe psychological stress, such as refugees or displaced persons, and the necessary interventions should be made for those at risk (referral to clinic, provision of psychosocial support, teaching breathing exercises to reduce anxiety, etc.).
Other variables that predict PTSD include education and age. Starting or continuing education increases resilience and resistance to external factors, supports social and emotional development, and provides hope for a better future [54]. In a study of North Korean refugees, education and age variables were found to be similarly associated with PTSD [37]. One study identified low levels of education as a risk factor for PTSD [51]. A systematic meta-analysis by Mesa-Vieira et al. [14] reported a higher prevalence of PTSD in adolescents and young adults compared with adults. A study of refugees living in Greece found that age and education were not associated with PTSD [30]. The reason for the differences in the results of this study may be due to the difference in the sample. Based on the results of our study, it is recommended that those with lower levels of education and younger ages should be screened more frequently for PTSD risk. It is also recommended that all individuals receive regular psychosocial support.
4.1. Strengths, Limitations, and Future Directions
There are few studies on people who have migrated from Ukraine due to war. Therefore, this study is of great importance in terms of protecting and maintaining the health of individuals who have been forced to migrate due to war. It is hoped that the findings will provide guidance for future intervention studies. The age difference between the participants and the fact that the majority of them were women limits the generalisability of the study. The fact that the study was conducted with people reached through social media is also a limitation of the study. Participants who engage with the survey through social media platforms may have specific characteristics, experiences, or motivations that differ from the wider population. In addition, the voluntary nature of participating in a self-administered survey on social media introduces a self-selection bias, as individuals who choose to participate may have a personal interest or connection to the topic, which may influence the results. These limitations significantly reduce the generalisability of the findings. Similarly, the study lacks information on participants’ income and employment status, which is another limitation. It is recommended that these variables be included in future studies. Another limitation of the study was that participants were not asked about their exposure to trauma. It may be beneficial to include this question in other new studies.
5. Conclusion
This study, conducted among people who had migrated from Ukraine to Türkiye as a result of the war, assessed their levels of PTSD, anxiety, and depression. The results showed that 38.1% of the participants were at risk for anxiety disorder, 21.6% had severe depression, 7.2% had very severe depression, and 94.8% were at risk for PTSD. The fact that individuals scored above the moderate level on the IES-R scale suggests that they can be considered at risk for PTSD. It was observed that younger people, those with a lower levels of education, and those who rated their health as poor had higher levels of depression. It can be said that people who are younger and have a lower levels of education are in the risk group for PTSD. The Hyperarousal score, one of the subdimensions of the IES-R scale, was found to be higher in single people compared to married and divorced people. The implementation of psychological screening for at-risk groups and the provision of psychological support to this population is considered essential in future studies. A meta-analytic study found that psychosocial interventions were effective for PTSD in asylum seekers and refugees [55]. Programmes need to be designed to reduce the impact of maladaptive coping strategies in the aftermath of war [56]. Several nongovernmental organizations in Türkiye offer psychological support to refugees [57]. However, it is noted that this support is very limited and not regular. It is thought that appropriate strategies and policies should be implemented to detect the psychological problems of these individuals at an early stage and to provide individual support. This service should be provided on a systematic basis.
Ethics Statement
Ethical approval was obtained from the Research Ethics Committee of Izmir Demokrasi University (Number: 2023/03-18, Date: January 3, 2023).
Consent
All participants provided informed consent before their participation.
Conflicts of Interest
The author declares no conflicts of interest.
Funding
The author received no specific funding for this work.
Open Research
Data Availability Statement
The author has nothing to report.
