Mental health in Ukraine – a bit of background

A few facts about mental health in Ukraine, by way of a quick point-form backgrounder:

– Suicide is a big problem in Ukraine. Figures from 2007 show that Ukraine has one the highest suicide rates in the world, and that the suicide rate has been increasing since independence. The risk of dying from suicide in Ukraine is about twice as high as dying in a car accident. I haven’t come across any more recent statistics on suicide (and the situation in the country now makes it even tougher to do any sort of large-scale public health research, period) but nothing suggests these statistics have changed.

– People who have mental health issues in Ukraine, like depression or anxiety, rarely seek help. There are a lot of complex reasons for this, some of which I touch on here, but the fact that 75% of people with major depression who admitted to suicidal thoughts never talked to a professional about their problems is pretty worrying.

– In the 2012 European Social Survey, respondents in 28 countries, including Ukraine, were asked a series of questions about their self-rated mental health. Ukrainians scored at or near the bottom of almost every measure.* They were the most likely to have felt anxious in the past week (29% compared to 11% on average), most likely to have felt sad in the past week (23% compared to 9% on average) and most likely to have felt lonely in the past week (21% compared to 8% on average). When it came to feeling depressed over the past week, only Hungarians and Albanians were more depressed than Ukrainians.

The papers I’ve linked to above are well worth a read, by the way.

*As a former stats man, I ran this analysis in SPSS using the 2012 data, which you can download for free. For anyone so inclined, I saved my SPSS syntax so if you happen to have SPSS or its open-source alternative, you can run it yourself. 

Mental health and war in Ukraine

A piece I wrote about (as the title a bit obviously suggests) mental health and war in Ukraine. Published in the Winnipeg Free Press print edition April 27, 2015 A11 (http://www.winnipegfreepress.com/opinion/analysis/mental-health-and-war-in-ukraine-301392321.html)

Maidan Nezalezhnosti, Kiev

The hallway of the mental health department at the Railway Clinic Hospital No 1 in Kyiv is empty except for me and two middle-aged women. They sit over by the window at the end of the bench, their heads together in the sunlight, whispering.

After a few minutes of waiting, Dr. Svitlana Polshkova calls me in to meet with her and the chairman of the mental health department at the hospital, Prof. Oleh Chaban.

Polshkova, in jeans and a Minnesota Twins jacket, is a psychiatrist who studied in Donetsk and has worked at the University of Michigan. Chaban, a towering figure with a grey moustache, looks as much like a retired defenceman as a Soviet-educated psychiatrist. Both Polshkova and Chaban are keen to talk about how the war in eastern Ukraine has hurt people far from the front lines. It all started in the Maidan — Kyiv’s central square where the current bloody turmoil started.

“The Maidan situation was very strong, and had a lot of emotional power,” Polshkova says. “When people tried to help, they got into a specific state, a state of elevated mood. It went up, and it came down.”

Later in 2014, Polshkova and Chaban started seeing more patients with post-traumatic stress disorder, and this doesn’t surprise them. But a sense of disillusionment with the current situation in the country hasn’t helped matters. “People have not been able to believe in things,” Polshkova says bluntly.

The trauma extends far beyond the Maidan. “There has been no time since the Maidan without war,” Chaban reminds me. More than a million refugees, he estimates, have fled the war in the east, and an unknown number of these have come to Kyiv. Most of these refugees live with relatives in the city, mostly in small Soviet-era apartments, but some live on the streets, a sight immediately obvious in the city centre.

“They are emotionally exhausted,” Polshkova says of the relatives of refugees in Kyiv. “At first, people were happy and helpful.” Time though has taken its toll on those supporting their refugee relatives and on people in the city in general. “They have become exhausted,” she says again.

Mental health professionals in Ukraine have felt this personally. Olena Zhabenko, a psychiatrist originally from Lugansk in separatist-occupied eastern Ukraine, is candid about her own story.

“Unfortunately, my parents became refugees because of the situation,” she tells me from Singapore, where she is now a research fellow at Nanyang Technological University. “They lost everything.” Her grandmother is still in Lugansk and has refused to leave the war-torn city.

And it isn’t just her, she stresses. Even in such a big country, the connections to the east run deep. “I know even in Kyiv,” she says, “almost everyone has either a neighbour or relatives who are living in the east or are somehow connected.”

Richard Styles echoes Zhabenko’s story. He is the chief medical director at the American Medical Centre in Kyiv. Originally from Britain, he has spent more than 15 years working in Ukraine.

“A lot of people have had their social networks and their support networks, both their family and friends, shattered,” Styles says. “A lot of those relationships have been broken.”

Styles says the war has had a noticeable impact on people’s mental health in Kyiv. “What people here live with, although they’re not involved in the actual conflict in a physical sense or in a visual sense,” he says, “They are very much involved in a mental sense, in that there is a sort of daily anxiety about what is happening.” People constantly follow the latest news from the war zone on their phones or on TV, where images of fatigues and fighters dominate newscasts.

He sees examples of this daily anxiety more often now in Kyiv than ever before. “In Kyiv, there are regular bomb scares, and that adds to people’s anxiety.” Fears of petty crime in the city centre have increased, thanks in part — justifiable or not — to the new transient population made up largely of refugees. This anxiety is changing the city, he says. “Kyiv used to be a golden, light-hearted city. Now it’s taken on a slightly dour sort of mood.”

But back at the Railway Clinical Hospital No 1, both Polshkova and Chaban reflect a ray of hope. The stigma around mental health may be strong in Canada, but it is much stronger in Ukraine, where rates of seeking help for mental health problems are much lower than in Canada and suicide rates are some of the highest in the world.

“The stigma around mental health in Ukraine is decreasing,” Polshkova says. “Because of this catastrophic situation, people are talking more about mental health. People who need help don’t have as much fear of talking about it.”

Republished from the Winnipeg Free Press print edition April 27, 2015 A11

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