Outcomes of addressing war-related trauma in an active war context: a Médecins Sans Frontières-led model of care in Vinnytsia, Ukraine

War-related trauma (WRT) can lead to various mental health (MH) disorders, including post-traumatic stress disorder (PTSD) and complex PTSD (C-PTSD). The prevalence of PTSD among individuals exposed to war exceeds 15.3%, which is more than three times higher than that of the general population. This has become a public health issue in Ukraine since Russia’s annexation of Crimea and starting of the land war in the east of Ukraine in 2014, following a further full-scale invasion of Ukraine’s territory in 2022 that created a frontline exceeding 3000km with more than 1000km of intense fighting. The prevalence rates of PTSD and C-PTSD in an active war context of current Ukraine are estimated to range between 9.06%-62.2%, and 12-5-14.6%, respectively. They’re expected to only increase with time becoming a major burden on public health as the number of active and ex-combatants, war prisoners, IDP and refugees increase. Due central location and relative safety of Vinnytsia oblast, the region served as an evacuation location for war-wounded military personnel and civilians, orphans, the elderly, disabled individuals, and psychiatric patients which made it suitable site for MSF to provide war-related care since 2022. Continuous exposure to traumatic events in an active war context is generally considered a contraindication to provision of a specialized WRT care, with MH care being limited to psychological first aid (PFA). 

MSF has firsthand witnessed PFA being insufficient to satisfy the ever-increasing need for MH care in the population, especially in the sub-groups on IDPs and military personnel (active combatants and veterans). 

MSF Recovery Centre for a specialized WRT care has been established in September 2023 as a response to the said needs. It is relevant to provide evidence on the outcomes of the WRT model of care in Vinnytsia. Evidence, provided under the frame of operations research, can help answer the knowledge gaps, provide guidance to the holistic integration of basic mental health care approaches and of specialized mental health care to WRT patients in active war contexts in humanitarian context, improve WRT care model in Vinnytsia, inform MH care policies and approaches of Ukraine, other humanitarian actors, as well as MSF in other war contexts.  

Aim 

The research aims to determine patient outcomes of applying a model of specialized WRT care in an active war context in central Ukraine, find how retention in WRT care leads to achievement of clinical recovery for PTSD and C-PTSD patients, and find what enabling factors lead to the said recovery.  

objectives

Primary objectives: 

P1. To describe uptake, and retention in WRT care for MSF Recovery Centre’s clients diagnosed as probable or confirmed PTSD or C-PTSD (including IDP, and military personnel and relatives). 

P2. To describe the MSF Recovery Centre’s clients’ outcomes, from diagnosis to discharge, alongside their participation in the Centre’s model of WRT care. 

Secondary objectives: 

S1. To describe the socio-demographics of the WRT clients, by precipitating factors (including forced displacement, engagement in the military, being an ex-war prisoner or a relative of military personnel.) 

S2. To calculate the proportion of different conditions in the WRT spectrum (e.g., probable and confirmed PTSD, C-PTSD, anxiety, depression) alongside the research implementation period. 

S3. To describe the clinical characteristics – including signs and symptoms – of WRT clients at baseline and throughout their engagement in WRT care. 

S4. To describe the outcomes of the application of trauma-focused techniques to WRT patients, as per clinician-rated (CGI-I, CGI-S) and client-rated (MHGS) functioning scales and trauma scales (ITQ), at baseline and throughout their engagement in WRT care. 

S5. To identify risk and protection factors determining differences in clinical characteristics and outcomes between different sub-groups of WRT clients (e.g., military personnel and IDP.) 

S6. To calculate rates of recurrent probable and/or confirmed PTSD and C-PTSD after initial clinical recovery.