The problem of the influence of wartime stress on the condition of patients with mental and behavioral disorders

Introduction

Any war leads to significant destruction, the decline of the country's economy, physical injury of people, hunger, and disease. In addition, combat activities lead to severe mental injuries, as their consequences later accompany the victims throughout their lives. The negative impact of the experienced stress often leads to the formation of pathological personality traits or the emergence of chronic mental illnesses. Various numerous studies conducted in Bosnia and Herzegovina, the Republic of the Congo, Uganda, the USA, and Germany revealed a significant increase in mental disorders of neurotic and psychotic levels during various wars [1-3]. A large number of cases of post-traumatic stress disorder were described in the study of civilians who were subjected to military operations in Chechnya; within three years, 90.8% of the studied patients underwent a transformation of this disease into affective, somatized disorders or chronic personality change [1]. Being in captivity and concentration camps has especially destructive effects on the human psyche. Most of the victims have symptoms of depressive, post-traumatic disorder, nightmares, phobias, chronic fatigue, aggressiveness, cognitive impairment, and suicidal tendencies [4].

According to a study on the impact of stress on the psycho-emotional sphere and cognitive functions of 7-9-year-old children who stayed in the military conflict zone in the Donbas region, the presence of chronic stress was noted in 100% of the cases. Children suffered from anxiety, fear, and cognitive impairment of a high frequency [5]. The severe stress experienced by the children of Iraq and Syria was caused not only by shelling and the death of loved ones but also by the subsequent stay in prisons with mothers convicted of relations with terrorist groups or of undergoing physical training in the “caliphate” with participation in violence acts [6][7].

However, the author has managed to find very few research results on the impact of wartime stress on the condition of patients with mental illness in the modern academic literature. Therefore, the conduction of such research work is considered to be really important.

The purpose of the study is to assess the impact of various wartime stresses on the condition of patients with mental illnesses, followed by the development of preventive measures.

Materials and methods

The research was conducted in the Luhansk People's Republic in the context of a difficult socio-political situation in the region. On voluntary terms, 510 patients suffering from mental and behavioral disorders (261 men, 249 women) were surveyed and interviewed. The survey of persons suffering from mental illnesses for the purpose of conducting scientific research or training met the requirements of Article 5 of the Law of the Russian Federation “About mental health services and guarantees of the rights of citizens in case of its rendering” No. 3185-1 dated July 2, 1992 (latest edition). Each patient who took part in the study gave voluntary informed consent to participate in it and had the opportunity to withdraw from the study without explanation. In the course of the questionnaire, performed in the presence of a psychiatrist, the doctor conducted an interview individually with each person with an explanation of the questions that arose. According to nosological units, patients were divided as follows: 88% of patients were diagnosed with “Chronic mental disorder (schizophrenia, recurrent depression, bipolar disorder, epilepsy, mental retardation, organic brain damage, personality disorders)”, and 12% of patients were observed for various neurotic disorders.

The questionnaire included a total of 67 questions and consisted of several sections, one of which (section VII) contained questions characterizing the impact of wartime stress on mental health. Then the subjects were divided into 2 groups: the 1^st group — people from zones of direct combat operations, and the 2^nd group — people from safer zones. As for experimental psychological methods, the Spielberger-Khanin scale was used in order to assess the level of situational anxiety. The author carried out the calculation of the proportion of persons depending on the appropriate answers to questions, the comparison of the anxiety levels in connection with the military situation in patients of the 1^st and 2^nd groups, as well as the analysis of the corresponding 510 outpatient charts studied in order to assess the impact of wartime stress on the nature of the course of mental illness.

Statistical processing of the research results was carried out on a software microcalculator and simultaneously on a personal computer by means of using the LibreOfficeCalc program of the freely distributed LibreOffice office suite (version 7.1). The results of data processing by both methods were considered to be completely identical. The specific weight of the subjects was calculated depending on the corresponding answers to the questions. For each data group, the values of the M indicator (in %) and the average error of the m indicator were calculated. The comparison of the obtained research results was carried out according to Student's criterion (STDEV) (t), followed by the calculation of the error value (p) depending on the number of observations (n) in the compared groups. To assess the effect of wartime stress on the mental health of the population, the nonparametric method c², developed by Pearson, was also used. The evaluation of the obtained values of c² was carried out using special tables and formulas.

Results

As a result of the conducted studies, it was found that the proportion of patients suffering from mental and behavioral disorders (men + women) who were staying in the zone of direct military operations was 77.65 ± 1.84% (54.54± 2.50% of men and 45.45± 2.50% of women). The proportion of patients (men + women) who were not staying in the zone of direct combat activities was significantly less and amounted to 22.35± 1.84% (42.98± 4.64% of men and 57.01± 4.64% of women).

Therefore, 71.17±2.00% of patients with mental and behavioral disorders noted that the military situation had a negative impact on their mental state, 14.90±1.58% of patients did not note the negative impact of the war on their psyche, and 13.92±1.53% of patients found it difficult to answer this question. During the survey of patients, while filling out the questionnaire, the degrees of anxiety they experienced in connection with the military situation were recorded as well (threat to life and health, concern for loved ones, possible loss of housing, disruption of public services, food and water delivery). Alarm levels were confirmed by means of using the Spielberger-Hanin situational alarm scale. Further, the patients were divided into 2 groups: those who were staying in the zone of direct combat activities (the first group) and those who were not in dangerous zones (the second group).

It was found out that the proportion of the 1^st group of patients experiencing severe anxiety due to the military situation was 50.00±2.51%, which is significantly higher than in the 2^nd group of patients (17.54±3.56%). Similar differences were also found among men (45.37±3.39% compared to 18.36±5.03%) and among women (55.55±3.07% compared to 16.92±4.16%) (p < 0.001). At the same time, the proportion of the 2^nd group of patients who did not experience anxiety due to the military situation was 36.84±4.51%, which is higher than in the 1^st group (8.58±1.41%). Similar differences were also found among men (51.02±7.14% compared to 8.33±1.88%) (p < 0.001) and among women (26.15±5.15% compared to 8.88±2.02%) (p=0.002).

The effect of wartime stress on the condition of patients with mental and behavioral disorders was also confirmed by means of the c² method in the general group (men + women) — c²= 57,201 (c²= 12,101 among men, c²= 28,764 women).

The data of the study are presented in the Table.

The strongest stress factors among the respondents were the threat to life and health (39.21%), concern for loved ones or separation from them due to departure (30.98%), possible loss of housing (16.67%), disruption of public services (3.92%), food and water delivery (9.21%).

According to the data of medical records of outpatient patients, exacerbations of mental illness were observed once every few months — in 58.00 ± 2.19% of patients, several times a month — in 9.00 ± 1.26% of patients, once a month — in 4.00± 0.87% of patients, once a year — in 20.00 ± 1.77% of patients, and once every few years — in 9.00 ± 1.26% of patients.

While comparing two groups of patients (who were directly in the combat zone and who were in safe territories), it was revealed that frequent exacerbations of mental illnesses (once every few months, several times a month, and once a month) were observed more often in the 1^st group of subjects and amounted to 61.86±2.44%, 9.09±1.44%, and 4.04±0.98% compared to similar indicators of the 2^nd group (44.74±4.65%, 8.77±2.65% and 3.51±2.65%). At the same time, the proportion of people whose exacerbations of diseases were rarely noted (once a year and once every few years) was higher in the 2^nd group of patients. The indicators were 30.70±4.32% and 12.28±3.07%, respectively, compared with the indicators of the 1^st group (16.9±1.88% and 12.28±3.07%).

As for the 1^st group of patients, they associated exacerbations of mental illness with the following factors:

• with wartime stresses (“attacks are to blame”, “I often watched news about the war”, “the war will be all my life”, “I was afraid I would die”, “I lost loved ones”) — 65.00±2.40%;
• conflicts with loved ones — 15.00±1.79%;
• refusal of maintenance treatment — 8.00±1.36 %;
• other reasons — 5.00±1.09 %;
• for no apparent reason — 7.00± 1.28%.

At the final stage of the study, the author carried out the analysis of patients receiving supportive treatment. A high percentage of maintenance therapy was detected in both groups. Full-fledged maintenance therapy was constantly taken by 69.94±2.30% of the 1^st group of patients and 65.78± 4.44% of the 2^nd group of patients, periodically by courses — 19.94± 2.00% of the 1^st group of patients and 25.44±4.07% of the 2^nd group of patients, not always regularly – 10.10±1.51% of the 1^st group of patients and 8.77±2.06% of the 2^nd group of patients.

Discussion

The authors found that the proportion of patients experiencing severe anxiety in connection with the military situation was significantly higher in the group of patients located directly in the zone of combat activity, compared with patients living in safer territories. Similar differences were found among both men and women of both groups. Frequent exacerbations of mental illnesses, despite the constant use of maintenance therapy by most patients of both groups, were observed in the 1^st group. Moreover, 65% of patients in dangerous zones associated exacerbations of diseases with wartime stresses.

Thus, wartime stresses affect the course of mental disorders, leading to a heavier clinical picture of the disease, an increase in the number of exacerbations, and resistance to therapy.

Conclusion

Therefore, patients suffering from mental and behavioral disorders and living in wartime conditions experience a high level of stress, which negatively affects the course of these disorders and complicates the tactics of treating such patients. So, one of the most urgent problems of mental hygiene is to increase the stress resistance of patients to the action of constantly present extremely strong psychotraumatic factors. The use of psychotherapeutic and rehabilitation techniques along with pharmacotherapy (various types of art therapy, such as fine art, film and music therapy, relaxation techniques, stress coping techniques, cognitive behavioral therapy, and others) is also of great importance.