The war in Ukraine: psychiatry on the frontline

2 June 2022

Oleg Chaban, M.D., Ph.D., is professor of Psychosomatic Medicine and Psychotherapy at Bogomolets National Medical University in Kyiv, Ukraine. Since the outbreak of hostilities, he has been working with displaced persons and with people directly affected by the war. Here he is interviewed by Iryna Frankova, chair of the ECNP Traumatic Stress Network, who is temporarily living in the Netherlands while on leave from Bogomolets National Medical University.

IF: Professor Chaban, where are you now? What is a ‘normal’ day like?
OC: I haven't left Kyiv since the beginning of the war. My day is all about work and family. Work has changed considerably: there’s lots of remote work with university students, face-to-face consultations at the clinic, and online patients in Ukraine, Europe and North America, although one of my patients has already reappeared in Argentina! The great resettlement of Ukrainians due to the war.

How has the situation changed since the start of the invasion? Are you seeing different mental health problems? Has the mood of the people changed over the last couple of months?
The situation has changed greatly, and not in a good way. The number of psychotraumas and their consequences, including psychotic and paranoid symptoms, has significantly increased. But there are more stress disorders, anxiety and phobia as well. A new problem has also emerged: comorbid disorders. These are both psychiatric and psychosomatic, mainly with cardiovascular pathology – arterial hypertension. There is an increase of anxiety and panic disorder. There are more and more patients with complex PTSD and delayed stress disorders. There’s an increase in addictive behaviour. We’re seeing more anxiety, panic disorders and depression, more aggression within families. We can see correlation between stress and personality disorders and increasing rates of criminality and suicide.

We’re also seeing many delusions or obsessions, based on the social upheavals or traumatic experiences which people are undergoing. There has also been an increase in psychosomatic disorders in women, for example more reproductive problems.

Of course, we are also seeing mental disorders as comorbidities with typical military traumas, such as traumatic brain traumatic, wounds, phantom pain. We are seeing sleep disorders, emotional instability, exhaustion, general anxiety. There’s burnout of health workers. We see families separated by war – with the mental health consequences for children in the future.

There are huge amounts of displaced persons, how can you cope with this?
We are trying to quickly train those who will be in contact with displaced people. Mental and physical health and social wellbeing should be equally important, rather than one of them being predominant.

We have been asked to prioritise how we give help, and so perhaps simpler and faster screening tools are needed. We are facing these problems with untrained volunteers, who are eager to provide psychosocial support. They have a lot of enthusiasm, but they do not know psychopathology, neuropsychology (especially in children), and the basics of preventative psychiatry.

Many families are divided, with men staying in Ukraine and women and children elsewhere. What stresses are you seeing, on men, women, and children?
Separated families are definitely under stress. Here the situation is difficult. On the one hand children close themselves down to protect themselves, but on the other they are rapidly ‘growing up’. There’s a desire to re-establish familial connections, and this is important. They can do a little of this digitally, families can reconnect online.

What are you able to do to help people cope with these stresses?
We can do several things. We teach general practitioners to screen emotional and stress disorders, and we can try to build multidisciplinary teams with doctors.

We’re working with the mass media on coverage of mental health, to try to ensure that media coverage isn’t just headlines, for example to warn against the dangers of linking already existing PTSD to the war.

We’re trying to educate psychiatrists and clinical psychologists, especially to alert doctors to guidelines with evidence-based treatment approaches. We also need to be on the lookout for burnout among medical workers.

In Europe we’re not used to dealing with wars – what has surprised you?
The unexpectedness, the ‘disbelief’’ that this is possible in the centre of Europe in our time; the horror of the experience when you see a field burning from a fallen missile and the fire being driven by the wind toward your home. The site of a large number of confused people, just on the move.

It was almost impossible to leave the city in the first days of war – roads were overflowing with refugees’ cars, and then there were the daily explosions and running to the bomb shelter. You can’t be prepared for war if you’re not in the military, and all the things you see and hear, including from the stories people tell you, drive you into despair and anger. But there is work, and it saves you to some extent.

There has been tension between Russia and Ukraine for the last eight years: were you able to prepare for the situation deteriorating? If so, how? Would you do anything differently now?
I really wish I had a magic wand and a time machine. I was totally unprepared for things to get worse, and neither was I prepared for this influx of work. I didn’t think about how I could have prepared for it. Perhaps I would have tried to convince the kids to stay out of the war. But they wouldn’t have listened to me.

I imagine that in many areas the existing mental healthcare structure has fallen apart. How do you deal with your normal work in this emergency situation?
Unfortunately, yes, this is true. But we will rebuild one day, perhaps even better than it was. We are starting to begin to do this now. Hospitals for psychiatric patients have been bombed – some patients were moved to other hospitals. Humanitarian aid arrives, but we still have to constantly look for this neuroleptic or that anticonvulsant. Pharmacies, unfortunately, are often unable to help, not all of them have reopened yet.

I was recently approached for help by a colleague of ours, a child neurologist. The Russian military shot up the bus on which her daughter, a musician and violinist, a very talented child, was travelling. Only her daughter and the driver were killed. I worked with her grief. It was very difficult. I thought about my own daughter, who is also somewhere driving a car through Ukraine. I felt a lump in my throat, but I knew that I had to help her and not just cry at her story. I could barely contain myself. I also feel sometimes I should just give up. I am tired. And there are a lot of stories like that.

The next day I was ‘cheered up’ by a patient with schizophrenia who had to be given olanzapine – he said he had figured out how to end the war in one day. One should land a spacecraft at the moon and when the Earth turns the right way, shoot the enemy with a laser blast. Even our psychotics are at war!