On February 24, 2022, the Russian military, with support from the Belarusian government, began invading the country of Ukraine. Countries around the world are taking various measures to stop the Russian government, including wide-scale economic sanctions on the Russian and Belarusian governments. This conflict has caused the worst humanitarian crisis since World War II-millions of Ukrainian people are evacuating from Ukraine and becoming refugees. While a large majority of them are fleeing to neighboring European countries, some refugees are heading to other countries around the globe, including Japan.The Japanese government has been criticized for restricting the acceptance of refugees and asylum seekers compared with other developed countries. 1 In 2019, Japan accepted merely 44 refugees from 15 422 cases (acceptance rate: 0.29%). On the other hand, the acceptance rates for Canada, Australia, and Germany were 51.2% (27 168/53 081), 17.3% (5 002/29 109), and 16.1% (53 973/336 380), respectively. 2 Therefore, Japanese mental health professionals generally have fewer experiences in supporting refugees. There are very few Japanese psychiatry-related studies on this topic-PubMed searches ("Japanese refugees mental health" or "Japanese refugees depression" or "Japanese refugees posttraumatic stress disorder [PTSD]") yielded only two original manuscripts. 3,4 With the evolving Ukrainian situation, however, it is an urgent matter for Japanese mental health professionals to better understand the mental health effect of this war on the affected people. Mental health topics are broad-they range from direct trauma exposure (e.g., refugees, deployed responders, and journalists) to the indirect effects of media exposure on mental health to the public, especially in vulnerable populations (e.g., children, those with preexisting mental health conditions). 5 Among them, we are particularly concerned about the three groups of adverse mental health:
the Russian military initiated armed attacks on Ukraine. The Japanese government has advised Japanese residents in Russia to evacuate, and many Japanese companies have downsized/withdrawn their business in Russia. People who continued to stay in Russia have been distressed (e.g. air/monetary service discontinuations, family separations). 1 Foreign nationals experience extensive stress even in peacetime (e.g. racial/ethnic minority status, safety/health concerns, language/cultural barriers). 2 In armed conflicts, affected civilians potentially develop anxiety, depression, and posttraumatic stress disorder (PTSD). 3 However, mental health studies of foreign nationals in situations of political uncertainty are limited. To elucidate this research gap, we studied Japanese nationals half a year after the start of the 2022 conflict in Ukraine.We distributed an online, anonymous self-report survey among the Japanese community organizations in Russia (11 August-4 September 2022). This timing was before the Russian government's "partial mobilization" announcement to their people (21 September 2022). Complete methods are shown in Table S1. Briefly, the two study inclusion criteria were (i) either a current Russian resident or post-conflict evacuee/returnee from Russia and (ii) ≥18 years. We obtained informed consent electronically. The Ethics Committees of Mejiro University and Teikyo Heisei University approved this study's protocol.
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