Serious psychological distress and disability among older persons living in conflict affected areas in eastern Ukraine: a cluster-randomized cross-sectional household survey

Abstract

Background Older persons are often unable to leave conflict areas; however, little is known about the mental and physical health among this population. Our objective was to determine the prevalence of and whether there was an association between psychological distress and disability among older persons affected by conflict in eastern Ukraine. Methods We conducted a cluster-randomized cross-sectional household survey of persons aged ≥60 years in government and non-government controlled areas (GCA and NGCA) of Donetsk and Luhansk regions in January–March 2016. Psychological distress and dependency (degree of disability) were measured using the Kessler K6 Psychological Distress Scale and Katz Index of Independence in Activities of Daily Living, respectively. Association between psychological distress and dependency was assessed using logistic regression adjusting for demographic and socioeconomic characteristics. Results Final sample included 758 and 418 persons in GCA and NGCA, respectively. Prevalence of serious psychological distress was 33.6% (95% Confidence Interval (CI), 28.0 – 39.7%) in GCA and 42.5% (95%CI, 36.1 – 49.2%) in NGCA. Overall, 32.2% (95%CI, 27.9 – 36.7%) of independent persons and 74.0% (95%CI, 65.2 – 81.2%) of moderately/severely dependent persons reported serious psychological distress ( P < .0001). Being dependent, a woman, and having a chronic disease were all significantly associated with psychological distress in a logistic regression model. Conclusions Prevalence of serious psychological distress was very high compared with rates reported from developed countries and was highly associated with disability. Health services for the disabled, including psychological as well as physical support, could help in reducing the proportion of people needing mental health services not normally identified. Electronic supplementary material The online version of this article (10.1186/s13031-019-0194-0) contains supplementary material, which is available to authorized users.

Noncommunicable disease burden among conflict-affected adults in Ukraine: A cross-sectional study of prevalence, risk factors, and effect of conflict on severity of disease and access to care

“…older adults diagnosed with at least one NCD (78% Donbas and 95% IDPs) compared with those found in the 2016 study of older persons in eastern Ukraine (68% and 74% in the government controlled and non-government controlled areas respectively) [15]. The variance in findings may be driven by the difference in study populations and the higher prevalence of NCDs among displaced adults outside of Donbas.…”

“…The survey included questions about the individual: age, sex, education, self-reported height and weight, and the household: current location, living situation, residence before displacement, length and number of displacements, number of people in household, income, access to non-governmental assistance. These questions, while not validated, were drawn from a previous study conducted in Ukraine to allow for comparability [15].…”

“…While we used registration lists for IDPs, these were non-exhaustive and did not include households who were unregistered, without a working phone number, or were unavailable during the survey period. However, these lists were the best available at the time and used in previous studies [15]. Unregistered IDPs may be less likely to receive benefits and assistance and may have a lower socio-economic status, factors which may increase their risk of NCDs [4,33].…”

“…To date, only a few studies have examined the effect of conflict and displacement on the health status and care seeking behaviors of Ukrainians [15][16][17]. An assessment of older persons (>60 years) conducted in the Donbas regions of Ukraine (an area that includes Donetsk and Luhansk regions) in early 2016 showed that approximately 70% of individuals suffered from at least one chronic disease, with hypertension and cardiovascular disease being the most prevalent.…”

“…An assessment of older persons (>60 years) conducted in the Donbas regions of Ukraine (an area that includes Donetsk and Luhansk regions) in early 2016 showed that approximately 70% of individuals suffered from at least one chronic disease, with hypertension and cardiovascular disease being the most prevalent. Additionally, the survey results showed a high prevalence of serious psychological distress ranging from 33% to 42% [15]. A cross-sectional study conducted between March and May 2016 found high prevalence of post-traumatic stress disorder (PTSD) (32%), depression (22%), and anxiety (17%) among adult (�18 years) IDPs in Ukraine [16].…”