Comparative analysis of the incidence of mental and behavioral disorders over a long period of time in the Luhansk region

Introduction

The health of the population is a vital indicator of the social, spiritual, and economic well-being of any state, and serves as a criterion for its sustainable development [1][2]. Mental health is an essential and inseparable component of overall health, underpinning our capacity to make decisions, build relationships, and shape the world we live in [3][4]. Mental and behavioral disorders are currently classified among the diseases of modern civilization. A depressive living environment is a key factor contributing to the development of mental disorders.

A depressive social environment emerges during periods of sharp economic decline and acquires distinct features of social depression, such as a deterioration in the standard (economic factors), quality (social factors), style (socio-psychological factors), and structure (socio-economic factors) of life [5]. Since 2014, residents of the Luhansk People’s Republic have been living under conditions of a depressive environment characterized by extreme wartime stress. This type of stress response overwhelms the adaptive capacities of the human psyche due to the total disruption of normal life, the constant presence of death as a theme, and the sense of an impending and inescapable catastrophe. As a result, high levels of chronic anxiety and fear are formed [6].

In light of the above, it is highly relevant to undertake a scientific study focused on the analysis of morbidity rates for mental disorders in the Luhansk region over an extended period.

The study aims to conduct a comparative analysis of various indicators of mental and behavioral disorders among the Luhansk region population over a long-term period, and to develop scientifically grounded recommendations.

Materials and Methods

The study was conducted in the Luhansk region in 2004–2023, encompassing three distinct historical phases: the first phase (2004-2013), during which Luhansk Oblast was part of Ukraine; the second phase (2014-2021) corresponding to the establishment and functioning of the Luhansk People’s Republic (LPR) as a separate entity; and the third phase (2022–2023), when the LPR operated as part of the Russian Federation.

The overall 20-year interval was divided into two equal decades: a peaceful period (2004–2013) and a wartime period (2014–2023).

This study used official data from the annual reports of the Statistical Department of the State Budgetary Healthcare Institution “Luhansk Clinical Psychoneurological Hospital” of the LPR, as well as data from the Luhansk Coordinating Health Protection Center, including “Population Health Indicators and Medical Organizations’ Activities in Luhansk Oblast” and “Population Health Indicators and Medical Organizations’ Activities in the Luhansk People’s Republic”. These sources provide annual data for 2004–2023 on the mental health status of populations in the settlements of the former Luhansk Oblast that became part of the LPR in 2014 (including the cities of Luhansk, Alchevsk, Antratsyt, Bryanka, Kirovsk, Krasnodon, Krasnyi Luch, Pervomaisk, Rovenky, Sverdlovsk, Stakhanov, as well as Lutuhyne, Perevalsk, and Slavyanoserbsk districts).

The following mental health indicators were analyzed:

• Detection and registration rates (per 100,000 population) of mental and behavioral disorders among the total population, adults, adolescents, and children;
• Detection and registration rates (per 100,000 population) of mental and behavioral disorders in the total population according to the following ICD-10 nosological groups: F00-F09 (organic, including symptomatic, mental disorders), F20-F29 (schizophrenia, schizotypal, and delusional disorders), F30-F39 (mood [affective] disorders), F40-F69 (neurotic, stress-related and somatoform disorders; personality and behavioral disorders in adulthood), F80-F99 (psychological [mental] development disorders), and F70-F79 (intellectual disabilities)
• Disability and initial disability incidence among patients diagnosed with mental and behavioral disorders (per 100,000 population);
• Duration of inpatient treatment for patients with mental and behavioral disorders across the nosological categories F00-F09, F20-F29, F30-F39, F40-F69, F80-F99, and F70-F79.

“Detection” refers to incidence, i.e., all newly identified cases of mental and behavioral disorders (ICD-10 Class V F) during the current year, standardized per 100,000 population. “Registration” refers to prevalence, encompassing newly identified cases during the current year plus patients with previously established diagnoses who remain under medical supervision, also expressed per 100,000 population.

A comparative analysis of the above mental health indicators between the peaceful and wartime periods was conducted.

Statistical processing and interpretation of the data employed the Mann-Whitney U-test for independent samples; differences were considered statistically significant at p < 0.05. This nonparametric test was selected as an alternative to the t-test when normal distribution assumptions were not met.

To determine trends in various mental health indicators over time, regression equations were constructed to characterize yearly changes, assess the statistical significance of increases or decreases, and forecast future values through extrapolation, accompanied by graphical presentations.

Statistical analyses were performed using Statistica 6.0 software.

Results

At the first stage, indicators reflecting the mental health of the population in the city of Luhansk were compared. The results showed that, compared to 2004–2013, the following mental health indicators increased in the city in 2014–2023:

• Incidence of mental and behavioral disorders among the total and adult populations;
• Prevalence of mental and behavioral disorders among the total, adult, adolescent, and child populations;
• Disability rates and new disability registrations among patients diagnosed with mental and behavioral disorders.

These data are presented in Table 1.

An evaluation of mental health indicators across the Luhansk region (calculated for the administrative territories incorporated into the LPR) revealed that in 2014–2023, compared to 2004-2013, the following indicators increased:

• Incidence of mental and behavioral disorders among the total, adult, and adolescent populations;
• Prevalence of mental and behavioral disorders among the total and child populations;
• Incidence of mental and behavioral disorders among the total population with diagnoses F00-F09 and F30-F39;
• Prevalence of mental and behavioral disorders among the total population with diagnoses F00-F09, F40-F69, F80-F99, and F70-F79;
• Disability rates and new disability registrations among patients diagnosed with mental and behavioral disorders.

These data are presented in Table 2.

Regarding the duration of inpatient treatment for patients with mental and behavioral disorders, it was established that in Luhansk in 2014–2023, compared to 2004–2013, treatment durations increased for patients with diagnoses F00-F09, F20-F29, F40-F69, F80-F99, and F70-F79. For the entire Luhansk region, treatment durations increased for patients with diagnoses F00-F09, F20-F29, F30-F39, F40-F69, F80-F99, and F70-F79.

These data are presented in Table 3.

Using extrapolation methods, a statistically significant increasing trend was identified over the entire study period (2004–2023) in Luhansk for:

• Incidence of mental and behavioral disorders among the total population (correlation coefficient r = 0.90, p << 0.05), adult population (r = 0.92, p << 0.05), and children (r = 0.49, p = 0.03) (see Fig. 1);
• Prevalence of mental and behavioral disorders among the total population (r = 0.67, p = 0.001), adult population (r = 0.89, p << 0.05), adolescents (r = 0.64, p = 0.002), and children (r = 0.74, p = 0.002) (see Fig. 2);
• Disability rates among patients diagnosed with mental and behavioral disorders (r = 0.83, p << 0.05) (see Fig. 3);
• Average duration of inpatient treatment for patients with diagnoses F00-F09 (r = 0.68, p = 0.001), F40-F69 and F80-F99 (r = 0.63, p = 0.003), and F70-F79 (r = 0.67, p = 0.001) (see Fig. 4).

Discussion

The data indicate that during the wartime period (2014–2023), compared to the peaceful period (2004–2013), key indicators of mental and behavioral disorders increased in the Luhansk region (including territories incorporated into the LPR), as well as in the city of Luhansk. These increases include incidence and prevalence rates of disorders among the total population (including specific nosological groups), adults, adolescents, and children, as well as the duration of inpatient treatment for patients with mental and behavioral disorders. Additionally, disability rates rose over the compared periods, reflecting an increase in the severity of these conditions. Statistical analysis suggests that the wartime emergency situation has a direct or indirect negative impact on the mental health of various age groups within the population of the Luhansk People’s Republic.

However, the statistical evidence does not show a uniform deterioration of mental health indicators across all territories of the Luhansk region. For example, while these indicators significantly worsened over the 20-year period across the region as a whole (including Luhansk city, Slavyanoserbsk, and Perevalsk districts), the cities of Kirovsk, Sverdlovsk, Krasnyi Luch, and Alchevsk demonstrated stabilization of these indicators. Conversely, Antratsyt, Bryanka, Krasnodon, Pervomaisk, Rovenky, and Stakhanov experienced improvements. This pattern may be explained by the uneven availability of medical staff, especially psychiatrists, in certain cities and district centers, as well as the centralization of psychiatric services in the regional capital, Luhansk. Therefore, the decision was made to base the analysis of mental health in the Luhansk region primarily on data from Luhansk city, supplemented by aggregated information for the region as a whole.

Conclusions

The data indicate a rising trend in the morbidity of mental and behavioral disorders among the total population (adults, adolescents, and children) throughout the entire study period (2004–2023). However, a statistically significant worsening of all mental health indicators was confirmed when comparing the wartime period to the peaceful period. Based on this long-term study in the Luhansk region, we conclude that the depressive environment created by wartime conditions in the Luhansk People’s Republic represents a significant risk factor for the onset or exacerbation of mental disorders. It also contributes to prolonged inpatient treatment durations, worsened clinical prognoses, and increased rates of disability. Therefore, the most pressing current challenge is to enhance the stress resilience of residents of the Luhansk People’s Republic against the persistent psychological trauma induced by ongoing wartime stressors. In this context, timely preventive measures for mental and behavioral disorders become critically important. Psychological support should be provided not only to mentally healthy individuals but also to patients with existing mental disorders through continuous application of psychotherapeutic and rehabilitative interventions alongside mandatory pharmacotherapy. These interventions include various forms of art therapy (visual arts, cinema, and music therapy), relaxation techniques, stress-coping strategies, cognitive-behavioral therapy, and others.