For nearly three years Ukrainians have lived through war on a scale unseen in Europe since 1945, and they know it can find them anywhere at any moment, through a long-range strike by a Russian missile, word that a loved one has been killed or called up to fight, or news that a much-missed hometown in the east has fallen to the enemy.
Ukraine has had to rely on its widely admired resilience, but instead of inuring society to the stress suffered by people young and old, soldiers and civilians alike, the war has opened up its discussion on mental health and access to psychological support.
“I see there is much less stigma now. Everyone is experiencing difficulties and challenges to some degree, so I think this is normalising these problems and making it easier to seek and find help,” says Kristina Litvinova, a Kyiv-based psychologist and accredited cognitive behavioural therapist.
She has worked with adults at a centre called Kolo Simyi (Family Circle) in Kyiv since 2018 and stayed in the capital with her teenage son when Russian forces began their all-out invasion in February 2022 and soon reached the city’s outer suburbs.
“We tried to provide free consultations for all patients who needed them ... Some people felt alone, fearful, afraid of being outside, and it was a big challenge for them when they decided to leave the city. So we stayed in touch, even when they were actually fleeing and were then in temporary shelters for refugees.”
Those who stayed in Kyiv faced the eeriness of the empty, barricaded city, the wail of air raid sirens and the distant thud of artillery from places like Bucha and Irpin, leafy commuter-belt suburbs that were now cut by the front line.
Kyiv is now bustling again and much safer than cities such as Kharkiv, Dnipro, Zaporizhzhia and Odesa, which are far closer to Russian lines and have weaker air defences; but last year the capital still had to fend off 1,600 Russian attack drones and missiles, and endured 500 air raid alerts and nearly 100 days disrupted by blackouts.
My son doesn’t want to do it and neither does my partner. It’s hard for them to admit any kind of weakness. I also found it hard to admit I wasn’t coping ... but these services are available, so I use them
— Natalia Zakharchenko
“It’s very important to have a safe space for a consultation, to meet in a room that’s cosy and pleasant. Now, with some patients, we need to rearrange chairs so they are not close to windows or so they can be in a corner where the walls give more protection [from any air strike],” Litvinova says.
“Sometimes I start by asking the patient to imagine they are in a safe and calm space and state. I ask how they feel in their own safe space, and then the air raid siren goes off. When you hear that, how can you carry on with a session?”
[ Three in four Ukrainian refugees have depression, anxiety or PTSDOpens in new window ]
Litvinova does not work with the military, but some of her civilian patients have been traumatised while volunteering near the frontline or when their towns were occupied.
“The war can exacerbate existing problems by acting as a trigger that brings back past experiences,” she says.
“What is totally new here is the concept of undefined loss. It could be a family member who has disappeared and there’s no information, perhaps a civilian in an occupied area or a serviceman ... Should they bid farewell to this person or keep hoping for their return? This brings ambivalence – hope but also hopelessness and despair.”
Natalia Zakharchenko worked for 18 years in construction finance in Kyiv and was recovering from burnout and the death of her mother when the full-scale war began, and Russia quickly seized her hometown of Kherson in southeastern Ukraine.
“I stayed in Kyiv but it was horrible because of the silence. You’d hear suitcases being pulled along by people leaving and it sounded like gunfire. In our apartment building we have about 150 flats, but only 15 or 20 remained occupied at start of war,” she recalls.
“I no longer had my prestigious and well-paid job. I spent a lot of my savings and a property investment failed. I had always seen financial security as safety and then all that started to collapse, plus there were missile attacks and blackouts,” she says.
“I am a person who makes plans and I depend on my plans. But my plans basically collapsed. I was in shock and sometimes I couldn’t even make a coffee or prepare a meal when I wanted one because of the blackouts. And the occupation of Kherson was also a major trigger for me.”
If children feel that adults who they love are tense, then to them it means that everyone is in danger. This puts their nervous system into a state of stress. And when we are stressed, we have less energy for everything else
— Serhiy Mykhailik
Zakharchenko now attends some of the free support groups that have multiplied in Ukrainian communities and online since 2022, and pays for one-to-one sessions with a psychologist when necessary.
‘It’s still usually women who seek help,” she says. “My son doesn’t want to do it and neither does my partner. It’s hard for them to admit any kind of weakness. I also found it hard to admit I wasn’t coping ... but these services are available, so I use them.”
Posters offering mental health support for civilians and soldiers are common on the streets of Ukraine, on trains and in other public spaces, and perhaps the most prominent advertise the Ti Yak? (How are you?) programme launched in 2023 by the country’s first lady, Olena Zelenska.
Data shows that the number of people complaining of mental health problems in Ukraine doubled from 2023 to 2024 and that sales of antidepressants soared in recent years. Studies suggest levels of stress, anxiety and post-traumatic stress disorder are high and rising among Ukrainians, and the government recently announced plans to open at least 200 mental health centres nationwide.
“Hard times usually accelerate all processes in a society, and I see that people are becoming more understanding and there is less stigma than before about mental health. People are now less afraid of this field,” says Serhiy Mykhailik of Holosy Ditei (Children’s Voices), a foundation that helps children and families across Ukraine.
In 2022 he worked in de-occupied towns near Kyiv where stress and anxiety continued to affect children long after the Russians had been driven away.
“These children can struggle to memorise things and concentrate on their studies, and so they may seem to be less intelligent – but that is misleading, because anyone living with too little sleep and too much stress will have problems,” says Mykhailik, a psychologist from the now occupied southeastern city of Mariupol.
“The first way that war affects many children is through adults ... If children feel that adults who they love are tense, then to them it means that everyone is in danger,” he adds.
“This puts their nervous system into a state of stress. And when we are stressed, we have less energy for everything else. For children, the main thing is play, which is how they explore the world. So they have less chance to explore the world around them and their anxiety and worry becomes stronger.”
Early trauma can have a long-term impact on a child’s development and educational achievement.
“There is that tendency,” Mykhailik says. “But I don’t want to believe that this will be the case in Ukraine. I really want to think that people like us, and parents and doctors, will do everything possible to make sure this doesn’t happen.”
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