Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138
Well-being of mental health workers during the
Russian-Ukrainian War
Hun Kang1, Ian C. Fischer2, 3, Viktor Vus4,5, Alla Kolyshkina6, Liudmyla Ponomarenko6, Anna
Chobanian6, Irina Esterlis2,3,7, Robert H. Pietrzak1,2,3
1Yale School of Public Health, New Haven, USA
2U.S. Department of Veterans Affairs National Center for PTSD, USA
3Yale School of Medicine, New Haven, USA
4Institute of Social and Political Psychology, Kyiv, Ukraine
5International Platform on Mental Health, Kyiv, Ukraine
6Sumy State Pedagogical University named after A.S. Makarenko, Sumy, Ukraine
7Department of Psychology, Yale University, New Haven, USA
Abstract
Introduction: While the detrimental impact of the Russian-Ukrainian War on mental health of
Ukrainian population has been well-documented, less attention has been given to mental health
workers (MHWs) providing mental health support services amid the war.
Purpose: To examine levels of domain-specific well-being in Ukrainian MHWs; identify and
quantify the relative importance of factors associated with well-being; and examine interactions of
risk and protective factors in relation to each well-being domain.
Methodology: A convenience sample of 178 MHWs completed a survey that assessed their well-
being, and sociodemographic, war-related, mental health, and psychosocial characteristics.
Results: Lower levels of mental health difficulties such as anxiety and posttraumatic stress
symptoms, and higher levels of psychosocial factors such as higher optimism, gratitude, and
presence and search for meaning were associated with higher well-being. MHWs with high levels
of protective psychosocial factors were more likely to report higher well-being even in the
presence of mental health difficulties.
Conclusion:. Results of this study provide insight into the levels and correlates of multiple well-
being domains among Ukrainian MHWs amid the ongoing war. They further suggest that
interventions to mitigate mental health difficulties and bolster protective psychosocial factors may
help promote well-being in this population.
Keywords
Well-being, mental health, war, epidemiology
Address for correspondence:
Robert H. Pietrzak, PhD, MPH. U.S. Department of Veterans Affairs National Center
for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell
Ave 151E, West Haven, CT 06516
E-mail: robert.pietrzak@yale.edu
This work is licensed under a Creative Commons Attribution-Non-Commercial 4.0 International
License (CC BY-NC 4.0).
©Copyright: Pietrzak, 2024
Publisher: Sciendo (De Gruyter)
DOI: https://doi.org/10.56508/mhgcj.v7i1.189
Submitted for publication:
12 September 2023
Revised: 03 February 2024
Accepted for publication: 18
March 2024
4
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Introduction
The most recent Russian-Ukrainian War has
been linked to adverse mental health in the
Ukrainian population (Ben-Ezra et al., 2023;
Lushchak et al., 2024; Osokina et al., 2023;
Pavlova et al., 2022). However, less attention has
been given to the mental health of mental health
workers (MHWs) who are providing services
during the ongoing conflict. Given that MHWs are
at risk for increased mental health problems amid
crises due to their professional responsibilities in
addition to conflict-related distress (Al Hariri et al.,
2022; Awan et al., 2021; Rosales Vaca et al.,
2022), identifying factors linked to well-being in
Ukrainian MHWs is crucial to identifying
intervention targets and resources to preserve
and improve functioning in this population.
To date, only two known studies have
examined mental health of Ukrainian MHWs since
the 2022 Russian invasion. One study assessed
the perceived mental health during the war using
a single-item question (Kang et al., 2023). The
other focused on negative mental health
outcomes such as depression, anxiety, and
burnout (Pinchuk et al., 2022). While these
studies contribute to understanding the
prevalence and burden of adverse mental health
outcomes in Ukrainian MHWs, further research is
needed to identify levels and correlates of well-
being and inform domains of well-being that may
benefit from targeted interventions and resource
allocation.
Purpose
Toward this end, we aimed to (1) examine
levels of domain-specific well-being in Ukrainian
MHWs; (2) identify and quantify the relative
importance of factors associated with well-being;
and (3) examine interactions of risk and protective
factors in relation to each well-being domain.
Methodology
Participants
In July and August 2023, a convenience
sample of 178 Ukrainian MHWs were invited to
complete a survey by a nongovernmental
organization in Ukraine, International Platform on
Mental Health, in collaboration with a local
university. Participants provided informed consent
before starting the survey. A sample size was not
predetermined given the uncertain conditions in
Ukraine; thus, the final sample size includes
MHWs who completed the survey over the two-
month period of data collection.
Assessments
Well-being was assessed using a modified
version of the Secure Flourishing Index
(VanderWeele, 2017). Participants rated ten items
on a scale of 0-10, and scores were computed
into six domains: happiness and life satisfaction
(2-item; Cronbach’s =0.89), physical health
(single-item), meaning and purpose (2-item;
Cronbach’s =0.83), character and virtue (2-item;
Cronbach’s =0.73), close social relationships (2-
item; Cronbach’s =0.90), and financial stability
(single-item); see Table 1 for detailed description
of well-being assessments.
Furthermore, as summarized in detail in Table
1, a broad range of sociodemographic, war-
related, mental health, and psychosocial variables
was assessed. Sociodemographic variables
included age, sex, length of work experience, and
occupation. War-related variables included
distress from displacement, witnessing destruction
of Ukraine, witnessing death, and uncertainty.
Mental health variables included anxiety,
depressive, and posttraumatic stress disorder
(PTSD) symptoms, as well as burnout and current
suicidal ideation. Psychosocial variables included
optimism, gratitude, and presence of and search
for meaning in life.
Statistical Analysis
Data were analyzed in five steps. First,
descriptive statistics were computed to summarize
levels of well-being in each domain. Second,
bivariate correlations were conducted between six
domains of well-being, and a broad range of
sociodemographic, war-related, mental health,
and psychosocial variables. Third, a series of
multivariable linear regressions were conducted to
identify independent correlates of well-being
domains; only significant variables in bivariate
correlations (p<0.05) were included in these
models. Fourth, interaction terms of significant
correlates were then incorporated into these
models to explore interactions of risk and
protective factors in relation to each well-being
domain. Fifth, relative importance analyses were
conducted to quantify the relative variance in
scores on each well-being domain explained by
each statistically significant correlate, accounting
for intercorrelations between independent
variables (Tonidandel & LeBreton, 2011).
Ethical considerations
This study was based on a de-identified,
secondary data. No approval from an ethics
committee was required. Informed consent was
obtained during the data collection
Results
Table 2 summarizes sample characteristics
and results of multivariable regressions. Lower
anxiety symptoms (=-0.44, p<0.01), absence of
suicidal ideation (=-0.18, p<0.01), and higher
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presence of meaning scores (=0.28, p<0.01)
were independently associated with greater
happiness and life satisfaction scores. Lower
anxiety (=-0.29, p<0.01) and PTSD symptoms
(=-0.25, p<0.05) were independently associated
with greater physical health scores. Lower anxiety
symptoms (=-0.36, p<0.01) and higher presence
of meaning scores (=0.41, p<0.01) were
independently associated with greater meaning
and purpose scores. Absence of suicidal ideation
(=-0.26, p<0.01) and higher optimism scores
(=0.35, p<0.01) were independently associated
with greater character and virtue scores. Lower
anxiety symptoms (=-0.41, p<0.01) and higher
gratitude scores (=0.19, p<0.01) were
independently associated with greater close social
relationships scores. Higher gratitude (=0.29,
p<0.01) and search for meaning scores (=0.24,
p<0.01) were independently associated with
greater financial security scores.
Figure 1. Interactions of risk and protective factors in relation to well-being domains
Note. We used median split to operationalize low and high levels of anxiety symptoms, presence of
meaning, optimism, and gratitude. Error bars indicate 95% confidence intervals.
Relative importance analyses revealed that
lower anxiety symptoms (43.7% relative variance
explained), higher presence of meaning scores
(35.0%), and absence of suicidal ideation (21.3%)
explained the variance in happiness and life
satisfaction scores; lower PTSD (50.4%) and
anxiety symptoms (49.6%) explained the variance
in physical health scores; higher presence of
meaning scores (57.7%) and lower anxiety
symptoms (42.3%) explained the variance in
meaning and purpose scores; higher optimism
scores (59.2%) and absence of suicidal ideation
(40.8%) explained the variance in character and
virtue scores; lower anxiety symptoms (83.8%)
and higher gratitude scores (16.2%) explained the
variance in close social relationships scores; and
higher gratitude (59.5%) and search for meaning
(40.5%) scores explained the variance in financial
stability scores.
Furthermore, results of interaction analyses
revealed significant interactions between anxiety
symptoms and presence of meaning scores in
predicting happiness and life satisfaction
(R2=0.073, F(1,174)=26.27, =0.32, p<0.001;
Figure 1A) and meaning and purpose (R2=0.057,
F(1,174)=23.24, =0.28, p<0.001; Figure 1B)
scores; suicidal ideation and optimism scores in
predicting character and virtue scores (R2=0.18,
F(1,174)=54.19, =0.55, p<0.001; Figure 1C);
and anxiety symptoms and gratitude scores in
predicting close social relationships scores
(R2=0.065, F(1,174)=20.42, =0.27, p<0.001;
Figure 1D).
Discussion
To our knowledge, this study is the first to
examine levels and key correlates of domain-
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specific well-being among Ukrainian MHWs amid
the ongoing war. Results of this study revealed
that Ukrainian MHWs reported moderate levels
(average 6.0 to 7.4/10) of well-being during the
ongoing conflict. Lower levels of mental health
symptoms (i.e., anxiety and PTSD symptoms,
current suicidal ideation) and higher levels of
protective psychosocial factors (i.e., dispositional
optimism, meaning in life, gratitude) were
associated with higher well-being. Interestingly,
none of the war-related stressors were associated
with well-being. This may in part reflect functional
resilience, with MHWs able to function relatively
normally even when experiencing distress (Litz,
2014). Indeed, bivariate correlations showed that
while war-related stressors were associated with
adverse mental health outcomes (burnout, anxiety
and PTSD symptoms), they were largely
unrelated to well-being scores.
MHWs with high levels of protective
psychosocial factors such as meaning in life were
more likely to report better well-being even in the
presence of mental health difficulties. Higher
levels of meaning in life may help individuals to
disengage from ruminative and anxiety-provoking
thoughts (Ostafin & Proulx, 2020), which could in
turn help to maintain well-being in the presence of
distress. Thus, interventions to help promote such
protective psychosocial factors (Czyzowska &
Gurba, 2021; van Agteren et al., 2021) may help
enhance the well-being of MHWs. Further
research is warranted to develop and evaluate
such interventions in this population.
This study has three notable limitations. First,
the data are from a convenience sample of
Ukrainian MHWs, which may limit generalizability
to other MHWs or trauma-exposed populations.
Second, use of self-report measures might have
been susceptible to social desirability bias. Third,
use of cross-sectional data limits causal
interpretation between well-being and its
correlates.
Conclusions
Notwithstanding these limitations, results of
this study provide insight into the levels and key
correlates of multiple well-being domains among
Ukrainian MHWs amid the ongoing war. They
further suggest that interventions to mitigate
mental health difficulties and bolster protective
psychosocial factors may help promote well-being
in this population.
Acknowledgements:
The authors thank the MHPSS workers who
participated in this study.
Conflict of interest
The authors declare that they have not
conflicts of interest.
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Table 1. Assessments of well-being and sociodemographic, war-related, mental health, and psychosocial variables
Measure
Assessment
Well-being
Happiness and life satisfaction
Mean score on the two-item (domain 1) from the Secure Flourishing Index (VanderWeele, 2017): “Overall, how
satisfied are you with life as a whole these days?” (0=Not satisfied at all to 10=Completely satisfied) and “In general,
how happy or unhappy do you usually feel?” (0=Extremely unhappy to 10=Extremely happy). Cronbach’s =0.89.
Physical health
Score on the single-item (domain 2) from the Secure Flourishing Index (VanderWeele, 2017): “In general, how
would you rate your physical health?” (0=Poor to 10=Excellent).
Meaning and purpose
Mean score on the two-item (domain 3) from the Secure Flourishing Index (VanderWeele, 2017): “Overall, to what
extent do you feel the things you do in your life are worthwhile?” (0=Not at all worthwhile to 10=Completely worthwhile)
and “I understand my purpose in life” (0=Strongly disagree to 10=Strongly agree). Cronbach’s =0.83.
Character and virtue
Mean score on the two-item (domain 4) from the Secure Flourishing Index (VanderWeele, 2017): “I always act to
promote good in all circumstances, even in difficult and challenging situations.” (0=Not true of me to 10=Completely
true of me) and “I am always able to give up some happiness now for greater happiness later.” (0=Not true of me to
10=Completely true of me). Cronbach’s =0.73.
Close social relationships
Mean score on the two-item (domain 5) from the Secure Flourishing Index (VanderWeele, 2017): “I am content with
my friendships and relationships.” (0=Strongly disagree to 10=Strongly agree) and “My relationships are as satisfying
as I would want them to be.” (0=Strongly disagree to 10=Strongly agree). Cronbach’s =0.90.
Financial security
Score on the single-item (domain 6) from the Secure Flourishing Index (VanderWeele, 2017): “How often do you
worry about being able to meet normal monthly expenses?” (0=Worry all the time to 10=Do not every worry).
Sociodemographic variables
Age
Reported in years.
Sex
Male; Female; Other.
Work experience
Reported in months. Recoded into quartiles.
Occupation
Psychologist (25.3%); Psychiatrist (5.6%); Medical doctor (9.0%); Nurse (3.4%); Social worker (17.4%); Volunteer
worker (39.3%). Based on the Inter-Agency Standing Committee (IASC) guidelines on mental health and psychosocial
support in emergency settings (Inter-Agency Standing Committee, 2007), volunteer workers are those who address
“basic services and security,” “community and family support,” and “focused, non-specialized supports,” while other
health professionals are those in charge of “specialized services.” Thus, occupation was recoded into health
professionals (psychologist, psychiatrist, medical doctor, nurse, social worker) versus volunteer worker.
War-related variables
Distress from displacement
“The evacuation of relatives/friends/colleagues to other regions of Ukraine or other countries due to the Russian
invasion affects my mental health.” Ratings ranged from 0=no impact to 10=a significant impact.
Distress from witnessing destruction
“The destruction of Ukraine due to the Russian invasion, witnessed by my own experience and through media
sources, affects my mental health.” Ratings ranged from 0=no impact to 10=a significant impact.
Distress from witnessing death
“The information—from social networks and mass media—about the death of Ukrainian civilians and military
personnel due to the Russian invasion affects my mental health.” Ratings ranged from 0=no impact to 10=a significant
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impact.
Distress from uncertainty
“The uncertain conditions due to the Russian invasion affect my mental health. (For example: what will happen
next? When will the war end? Can new territories be occupied? Will a man-made disaster repeat itself?)” Ratings
ranged from 0=no impact to 10=a significant impact.
Mental health variables
Anxiety symptoms
Score on the 2-item measure of anxiety disorders from the Generalized Anxiety Disorder-2 (Sapra et al., 2020):
Since the most recent Russian invasion, how often have you been bothered by the following problems in the past two
weeks? “Feeling nervous, anxious, or on edge,” and “Not being able to stop or control worrying.”; Ratings ranged from
1=Not at all to 4=Nearly every day. Cronbach’s =0.70.
Depressive symptoms
Score on the 2-item measure of depression from the Patient Health Questionnaire-2 (Kroenke et al., 2003): Since
the most recent Russian invasion, how often have you been bothered by the following problems in the past two weeks?
“Feeling down, depressed, or hopeless,” and “Little interest or pleasure in doing things.”; Ratings ranged from 1=Not at
all to 4=Nearly every day. Cronbach’s =0.51.
PTSD symptoms
Score on the abbreviated four-item version of the PTSD Checklist for DSM-5 (Geier et al., 2020): Since the most
recent Russian invasion, how often have you been bothered by the following symptoms in the past month? “Repeated,
disturbing, and unwanted memories of the invasion/war,” “Avoiding external reminders of the invasion/war,” “Having
strong negative beliefs about yourself, other people, or the world,” and “Feeling jumpy or easily startled”; Ratings
ranged from 1=Not at all to 5=Extremely. Cronbach’s =0.79.
Burnout
Score on the single-item measure of burnout from the Maslach Burnout Inventory (West et al., 2012): “Since the
most recent Russian invasion, I have felt burnt out (e.g., emotionally exhausted) from my work.”; Ratings ranged from
0=Never to 5=Every day.
Current suicidal ideation
Score of 1 or higher on the single-item measure of suicidal ideation (item 9) from the Patient Health Questionnaire-9
(Altura et al., 2016): “Over the last 2 weeks, how often have you been bothered by: Thoughts that you would be better
off dead or of hurting yourself in some way.”; Ratings ranged from 0=Not at all to 3=Nearly every day.
Psychosocial variables
Optimism
Score on the single-item measure of optimism from the Life Orientation Test-Revised (Scheier et al., 1994): “In
uncertain times, I usually expect the best”; Ratings ranged from 1=strongly disagree to 6=strongly agree.
Gratitude
Score on the single-item measure of gratitude from the the Gratitude Questionnaire (McCullough et al., 2002): “I
have so much in life to be thankful for”; Ratings ranged from 1=strongly disagree to 6=strongly agree.
Presence of meaning in life
Score on the single-item measure of presence of meaning in life from the Meaning in Life Questionnaire (Steger et
al., 2006): “I understand my life’s meaning”; Ratings ranged from 1=absolutely untrue to 6=absolutely true.
Search for meaning in life
Score on the single-item measure of search for meaning in life from the Meaning in Life Questionnaire (Steger et al.,
2006): “I am searching for meaning in life”; Ratings ranged from 1=absolutely untrue to 6=absolutely true.
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Table 2. Sample characteristics and results from bivariate analyses and multivariable linear regression analyses.
Sample
characteristics
Domain 1:
Happiness
and life
satisfaction
Domain 2:
Physical
health
Domain 3:
Meaning and
purpose
Domain 4:
Character and
virtue
Domain 5:
Close social
relationships
Domain 6:
Financial
stability
Mean (SD) or
n (%)
r
r
r
r
r
r
Sociodemographic
variables
Age
34.8 (9.9)
0.07
-
-0.09
-
0.10
-
0.11
-
0.03
-
0.04
-
Female sex1
155 (87.1%)
-
0.02
-
-0.09
-
0.12
-
0.10
-
0.07
-
0.07
-
Work experience (in months)2
94.9 (88.0)
0.00
-
-0.08
-
0.00
-
0.09
-
-
0.04
-
0.01
-
Volunteer status3
70 (39.3%)
0.03
-
-0.07
-
0.06
-
-
0.08
-
-
0.07
-
-0.15*
-0.08
War-related variables
Distress from displacement
5.1 (2.8)
-
0.06
-
0.06
-
-0.10
-
0.04
-
-
0.03
-
0.02
-
Distress from witnessing
destruction
7.7 (2.1)
-
0.05
-
-0.03
-
-0.08
-
0.11
-
0.00
-
0.06
-
Distress from witnessing death
7.9 (2.1)
-
0.17*
-0.06
-0.04
-
-0.11
-
0.06
-
-
0.07
-
-
0.01
-
Distress from uncertainty
7.6 (2.1)
-
0.08
-
0.00
-
-0.04
-
0.07
-
0.04
-
0.05
-
Psychiatric variables
Depressive symptoms
2.5 (1.6)
-0.22**
0.04
0.00
-
-0.22**
0.10
-
0.03
-
-0.15*
-0.07
0.13
-
Anxiety symptoms
2.4 (1.6)
-0.41**
-0.44**
-0.40**
-0.29**
-0.46**
-0.36**
0.02
-
-0.35**
-0.41**
-0.01
-
PTSD symptoms
7.0 (3.3)
-0.30**
0.04
-0.28**
-0.25*
-0.45**
-0.12
-0.06
-
-0.18*
-0.12
-0.04
-
Burnout
2.8 (1.4)
-0.09
-
-0.09
-
-0.28**
0.02
-0.09
-
-0.07
-
0.12
-
Suicidal ideation
19 (10.7%)
-0.34**
-0.18**
-0.09
-
-0.36**
-0.12
-0.17*
-
0.26**
-0.04
-
-0.18**
-0.09
Psychosocial variables
Optimism
4.8 (1.2)
-0.06
-
0.03
-
0.06
-
0.19*
0.35**
0.06
-
0.09
-
Gratitude
4.8 (1.2)
0.18*
0.12
0.01
-
0.18*
0.03
0.06
-
0.19*
0.1
9**
0.27**
0.29**
Presence of meaning in life
4.7 (1.4)
0.32**
0.28**
0.06
-
0.44**
0.41**
0.08
-
0.02
-
0.27**
-
48
https://www.sciendo.com/journal/MHGCJ ISSN 2612-2138
0.02
Search for meaning in life
4.6 (1.4)
0.02
-
0.15
-
-
0.01
-
0.03
-
0.07
-
0.28**
0.24**
R2
0.50
0.27
0.54
0.23
0.39
0.24
Mean (SD)
6.3 (1.9)
6.7 (2.0)
7.1 (2.1)
7.4 (1.9)
7.1 (2.3)
6.0 (2.4)
1 Two participants who chose “Other” were excluded from bivariate and regression analyses.
2 Work experience was recoded into quartiles in bivariate and regression analyses. Means and standard deviations of each quartile are as follows: Q1: 14.7 (6.2);
Q2: 40.9 (7.3); Q3: 99.4 (22.3); Q4: 229.9 (48.9).
3 Non-volunteer psychosocial support workers include psychologists (25.3%), social workers (17.4%), medical doctors (9.0%), psychiatrists (5.6%), and nurses
(3.4%).
Note. PTSD, posttraumatic stress disorder. r, Spearman correlation coefficient. , standardized coefficient. R2, total variance explained.
*p < 0.05, ** p < 0.01.
49