Anxiety
Tracking Ukrainians' Mental Health Through 5 Years of War
Ukraine's health system is adapting as 70% of citizens report anxiety or stress.
Posted September 20, 2026 Reviewed by Jessica Schrader
Key points
- First Lady Olena Zelenska's "How Are You?" campaign addresses Ukrainians’ wartime mental health.
- The initiative is rolling out a program to track how patients progress during the duration of treatment.
- Psychological therapy has historically been stigmatized in Ukraine, but the war is shifting cultural views.
Before Russia invaded his country, Vladyslav Sentiakov envisioned building a family and being a steady provider.
To further that ambition, the florist from the eastern Ukrainian city of Kharkiv volunteered to join the military.
The day he signed his contract “felt like a breath of freedom,” he said. “It was the start of a new chapter in my life.” He began in a patrol battalion and went on to serve in several other roles as the war progressed.
Yet service in the war left Sentiakov with clinical-level anxiety. He sought help with the Heart of Azovstal, an NGO that provides veterans with medical assistance, retraining, and education, as well as physical and mental rehabilitation.
As he began working with his psychologist, he also took part in a pilot study for a new patient tracking system called Healthy Mind, which is being tested ahead of a national rollout.
At the beginning and end of therapy, Sentiakov filled out surveys tracking his symptom scores. He is one of more than 4,500 patients who have participated in the program, which aims to bolster psychological diagnostics and systemic mental health work.
It is one of the partner platforms contributing to the rollout of Ukrainian First Lady Olena Zelenska’s nationwide mental health program “How Are You?” That campaign launched in March 2023 as an all-Ukrainian mental health initiative with partnership from the WHO and USAID. It coordinates a range of programs across the Ukrainian government, which include making psychological support accessible for everyone in the country.
Zelenska, who worked as a television writer prior to her husband Volodymyr Zelensky’s election to the presidency, has used her public profile to champion a range of issues including accessibility (barrier-free environments), the introduction of healthy and nutritious meals, the promotion of Ukrainian culture abroad, and mental health education.
"How Are You?" aims to "promote the formation of a culture of caring for mental health in society," according to the official website of the President of Ukraine. Mental health is essential to the population's ability to adapt, function, and develop during the war. And Ukrainian citizens' emotional solidarity is equally crucial to Ukraine's prospects for its eventual post-war recovery.
Some 70% of Ukrainian adults report symptoms of mental health distress, according to a 2025 survey by the World Health Organization. Just 1 in 5 said they had sought professional help.
“Despite everything that’s happened,” Sentiakov says, “I’m still working toward those same goals.”
Digital technology paints a distinct picture
“The war has simultaneously increased the need for psychological help and made it harder to provide,” says psychologist Daryna Romanovska, who leads the psychological department of Healthy Mind.
A 2026 WHO study found that Ukraine experienced more than 3,000 attacks on health facilities during more than 1,534 days of war.
Given four and a half years of conflict, the strains on the healthcare system are palpable. Time with a qualified specialist can be scarce. That has prompted Ukraine's Ministry of Health to explore ways to minimize the burden of intake questionnaires and data collection that are typical of initial consults.
By freeing up clinicians from these initial bureaucratic hurdles, the program empowers providers to focus on the critical aspects of therapy: clinical judgment, building a therapeutic relationship, developing a care plan, and providing the actual therapy.
Prior to a consultation, clients complete the digital assessment on their own—answering questions across 55 validated psychodiagnostic scales.
This data forms a baseline for assessment through the duration of therapy, with future follow-up assessments to track progress with quantitative measures. Healthy Mind complements information from the clinical interview, including the person’s history, life context, and the clinician’s own judgment.
The program is slated for recommendation by Ukraine’s Ministry of Health and aligns with a broader buildout of certification and professional development to bolster the system in addressing mounting needs.
The team recently completed a pilot study with 533 veterans through the Heart of Azovstal. After diagnostics, 256 of them retested, showing measurable improvement over the course of the program.
Among them, 34% of respondents reported PTSD symptoms, a figure that is 10 times higher than peacetime norms. It showed 47% reporting high stress levels, with clinical-level anxiety in 23% of users.
The war has catalyzed technological innovation as a core facet of Ukraine’s defense. The government's Diia Digital State initiative, which offers digital portals for government services and education, was launched in 2019. Such advances catapulted Ukraine from 122nd in the world to third on UN rankings of digital services by national governments.
Romanovska notes that bolstering Ukraine's mental health system with individual-level progress tracking “fits the broader direction of Ukraine’s digital transformation: using digital tools to scale access to services, standardize processes, collect and analyze data, and support decision-making.”
Focus on individuals’ direct experience
In Ukraine, there isn’t a hard line between the PTSD civilians experience versus what soldiers face after the battlefield.
“The core of the disorder is the same: reliving the traumatic experience, avoiding reminders of it, a sense of ongoing threat, disrupted sleep, and emotional and cognitive changes,” Romanovska says.
The critical characteristics are the nature, duration, and repetition of the traumatic experience, says Natalia Shevchenko, a Project Manager at the NGO “The Heart of Azovstal.”
In Ukraine, many civilians are exposed directly to the war, often through Russia’s near-constant attacks on cities and civilian areas.
They endure repeated, prolonged traumatic events: shelling, occupation, captivity, the loss of loved ones, the destruction of their homes, forced displacement, separation from family, and constant uncertainty.
The emerging psychological literature from Ukraine paints a different picture from recent wars.
For instance, about 1 in 5 American service members returning home from Afghanistan had symptoms of PTSD or major depression. The strongest predictor of symptoms was whether an individual had been exposed to combat directly.
A more apt comparison to the Ukrainian experience is that of the Israeli population following the Hamas terrorist attack on October 7, 2023, and the subsequent war.
Those shocks led to 30,000 new PTSD cases among the most heavily traumatized, with some 500,000 Israelis considered at risk for the disorder. Sampling and study criteria make direct comparisons across recent conflicts difficult.
The specifics of Ukraine’s situation—a prolonged full-scale war, internal displacement, and strikes on civilian infrastructure—don’t lend themselves to a direct extrapolation with Iraq, Afghanistan, or Israel either.
“Prolonged, repeated traumatic experience—regardless of a person’s status—significantly raises the risk of PTSD, and healthcare systems in the post-conflict period consistently run short of the resources needed to cover it,” Shevchenko said.
Despite the strain on resources, Ukraine’s status as a global leader in digital technology is charting its own story in how civilians and veterans reckon with the psychic toll of war.
“I really do believe the healthcare system really can help—the main thing is to reach out for the support you need,” the veteran Sentiakov said. After completing therapy with his psychologist, his symptoms are more manageable and he feels empowered to move forward.
“My core life goals remain just as important to me as they always were,” he said.