What is the prevalence of depression and anxiety in externally and internally displaced Ukrainian refugees? A European mixed-methods study

Background: Refugees are more likely to experience higher rates of depression and anxiety. Since the start of the full-scale invasion of Ukraine in 2022, large numbers of Ukrainians have been forced to leave their country or become internally displaced. This study investigated the levels of depression and anxiety symptoms in Ukrainian refugees, both outside and inside Ukraine. Methods: A descriptive, mixed-methods study of Ukrainians aged > 18 who became refugees during or following February 2022, currently living in Belgium, Greece, Israel, Latvia, North Macedonia, Slovenia, Spain, Türkiye and Ukraine. We asked about previous episodes of depression and/or anxiety and used the PHQ-9 and GAD-7 questionnaires to assess current prevalence of depression and anxiety symptoms (score ≥ 15, categorised as moderate-severe symptoms of depression, and ≥ 10 categorised as moderate-severe symptoms of anxiety, respectively). Participants’ current place of residence was categorised as ‘Outside Ukraine’ or ‘Inside Ukraine’. An open-ended question asked: “What life events/circumstances have affected your psychological state now?” Participant recruitment was through convenience sampling during 2023–2024. We used descriptive statistics, with bivariate, logistic regression of quantitative variables, and thematic analysis of the free-text answers. Results: Four hundred sixty two respondents met the inclusion criteria, mean age 41 (SD:12.5); 422 (91.7%) were women. Before 2022, 64 (13.9%) had been diagnosed with depression and/or anxiety, and 36 (7.8%) had received treatment for these conditions. The current prevalence of moderate-severe symptoms of depression was 37.0% (95% CI: 32.6–41.6) and of moderate-severe symptoms of anxiety was 51.5% (95% CI: 46.9–56.2). After adjusting for age, the odds ratio for refugees outside Ukraine compared with those remaining in Ukraine was 1.86 (95% CI:1.18–2.93) for moderate-severe symptoms of depression, and 1.70 (1.11–2.58) for moderate-severe symptoms of anxiety. Thematic analysis revealed six themes: impact of war, disrupted networks, economic burdens, health-related problems, barriers to local integration, using tools, and resources for a better adaptation. Conclusions: The prevalence of moderate-severe symptoms of depression and anxiety in Ukrainian war refugees was high, with those in Europe being more likely to have symptoms than those internally displaced. We found a wide range of circumstances that had affected respondents’ psychological states.