ANALYSIS OF THE STRUCTURE OF STRESS- ASSOCIATED MENTAL AND BEHAVIORAL DISORDERS AND THE FEATURES OF MEDICAL CARE FOR INTERNALLY DISPLACED PERSONS IN LUHANSK REGION IN 2022–2025

Abstract

Relevance. The war has led to an unprecedented level of chronic psycho-emotional distress, which, according to WHO estimates, will result in mental disorders in 22% of the affected population. Chronic stress, through the hyperactivity of the Hypothalamic–pituitary–adre- nal (HPA) axis, causes significant structural changes in the brain (hippocampal atrophy, amygdala hypertrophy, and prefrontal cortex dysfunction), worsening cognitive functions and contributing to the development of Post-Traumatic Stress Disorder (PTSD) and depression. A consequence is also the increase in somatic pathology and accelerated “aging” of the pop- ulation. Internally Displaced Persons (IDPs) from the Luhansk region, numbering 320 thou- sand (as of 01.04.2025), constitute one of the most vulnerable groups, as their traumatic war experience is compounded by the consequences of forced migration. Aim. To determine the mental health status of internally displaced persons from the Luhansk region under wartime conditions and to analyze the specifics of providing medical care for this category of individuals. Methods. The analysis was conducted on official reports of IDP consultations for special- ized care at the relocated psychiatric facilities of the Luhansk Regional Council for the period 2022–2025. Statistical, analytical, graphical, and bibliosemantic methods were used to pro- cess data regarding the structure of consultations and diagnosed pathology. Results. IDPs from the Luhansk region are characterized by a high level of loneliness, a passively defensive adaptation style, and low stress resistance, which are manifestations of specific distress (losses, uncertainty, broken ties). Over the period 2022–2025, ambulatory psychiatric care was provided to 4,782 individuals, with a steady trend of increasing con- sultation numbers each year. The most common complaints recorded by primary care phy- sicians were anxiety, sleep disturbances, and sadness/depression. The structure of disorders diagnosed by psychiatrists is dominated by stress-associated disorders (adjustment disorders, mixed anxiety-depressive disorders, PTSD). Key barriers to specialized care were identified: stigmatization (up to 70% of individuals do not receive assistance), centralization of services, and fear of psychiatry. Conclusions. The psychopathological consequences of the war among IDPs from the Luhansk region are most frequently characterized by adjustment disorders, mixed anxiety-depressive disorders, and PTSD. Effective treatment requires a comprehensive approach, including phar- macotherapy, psychoeducation, and psychotherapy (forming adaptive coping strategies). To overcome barriers to access, it is necessary to strengthen the human resources of primary care (particularly through supervision and the implementation of the WHO mhGAP program) and develop community-based, non-institutional forms of specialized psychiatric care (Mental Health Centers, deinstitutionalization).