Alcohol use among conflict-affected persons in Ukraine: risk factors, coping and access to mental health services

Abstract

Background There are approximately 1.5 million internally displaced persons (IDPs) in Ukraine as a result of the conflict in eastern Ukraine. Exposure to violence, forced displacement and increased mental disorders are potential risk-factors for alcohol use disorder (AUD). The aim of this study was to estimate the prevalence of and risk factors for AUD among Ukrainian IDPs and investigate the relationship between AUD, mental health service utilization and coping behaviours. Methods A nation-wide cross-sectional survey of 2203 IDPs was conducted. Data were collected on AUD [using alcohol use disorder identification test (AUDIT)], mental health disorders, utilization of health services and coping behaviours. Multivariable logistic regression was used to identify risk factors for AUD, and to estimate the odds ratios for the association between alcohol use and utilization of health services and coping behaviours. Results Of 2203 IDPs surveyed, 8.4% of men and 0.7% of women screened positive for AUD (AUDIT >7). Among current drinkers, AUD was present in 14.9% of men and 1.8% of women. Age, cumulative trauma exposure and anxiety were significantly associated with AUD in multivariable analysis. Alcohol users were 43% less likely to access health services for mental health compared with non-users. AUD was associated with more negative coping behaviours. Conclusions AUD is present within the male Ukrainian IDP population. Alcohol use was significantly associated with lower utilization of mental health services and more negative coping behaviours. AUD screening and low-intensity treatment services should be expanded for IDPs in Ukraine, particularly if integrated into mental health and psychosocial support programmes.

Noncommunicable disease burden among conflict-affected adults in Ukraine: A cross-sectional study of prevalence, risk factors, and effect of conflict on severity of disease and access to care

“…Lastly, our study only captured previously diagnosed disease, it is likely an underestimate of the true prevalence of NCDs because it did not capture undiagnosed disease. Lastly, we did not collect information on substance use and any changes in use behavior following the conflict, which is a limitation given their link with accessing health services found in Ramachandran et al [17].…”

“…This may suggest that exposure to trauma does not always result in the same level of psychological distress among the respondents, and therefore also lead to different associations and perceptions of NCD severity. The growing body of literature looking at NCD and mental illness comorbidities has shown that mental distress may lead to unhealthy coping behaviors, such as drinking, smoking, and sedentary behavior, that are known risk factors for NCDs [17,31]. While further research is needed to understand this relationship in conflict-affected and displaced populations, the association between psychological distress and perceived worsening of NCDs also highlights the need to train general practitioners to identify and address comorbid mental illnesses or strengthen referral chains in settings where populations may experience trauma, particularly when displaced from familiar surroundings and care providers.…”

“…To date, only a few studies have examined the effect of conflict and displacement on the health status and care seeking behaviors of Ukrainians [15][16][17]. An assessment of older persons (>60 years) conducted in the Donbas regions of Ukraine (an area that includes Donetsk and Luhansk regions) in early 2016 showed that approximately 70% of individuals suffered from at least one chronic disease, with hypertension and cardiovascular disease being the most prevalent.…”

“…A high proportion of respondents likely needing mental health and psychosocial support reported not seeking it for reasons including inability to pay and not knowing where to find health services. A third study examined the prevalence of alcohol use disorder (AUD) among Ukrainian IDPs and found that AUD was present among men and alcohol users were significantly less likely to access mental health services than non-users [17].…”

A randomized-controlled trial of community-based transdiagnostic psychotherapy for veterans and internally displaced persons in Ukraine

“…Since 2014 military conflict with Russia-backed separatists has left 13 000 casualties and 3.4 million people requiring humanitarian assistance (United Nations Office for the Coordination of Humanitarian Affairs, 2020 ). Conflict affected populations in Ukraine have high prevalence rates for post-traumatic stress disorder (PTSD; 32%), depression (22%), anxiety (17%) and alcohol use disorders (8.4% in men and 0.7% in women) (Weissbecker et al ., 2017 ; Ramachandran et al ., 2019 ; Roberts et al ., 2019 ). 74% of adult internally displaced persons (IDPs) who likely required mental health services reported not receiving them due to lack of trust in the health system, lack of awareness of where to seek care, poor quality of services, stigma and embarrassment, and/or logistical barriers (e.g.…”