Acute War Stress in Ukrainian Refugees: Neurobiological and Psychological Impact

Purpose: We raised the question whether the neurobiological and psychological impact of war stress could be observed in Ukrainian refugees during an ongoing war. Ukrainian refugee women (UG, n=43) from the war-torn regions were investigated and were compared to Czech women control group without stress (CG, n=21). Men were not allowed to leave Ukraine due to the war conditions. Method: Psychological testing was performed using tests available in Ukrainian language: Posttraumatic stress disorder Check List; Zung Self-Rating Depression Scale; The State-Trait Anxiety Inventory; Test of Intellectual Potential and Digit Span - WAIS III. Magnetic Resonance Imaging included voxel-based morphometry, functional MR, seed-based connectivity. Finding: UG scored significantly higher than CG in stress (p<0.001), depression (p=0.019) and anxiety (p=0.001) and lower than CG in an abstract reasoning task (p<0.030). The groups did not differ significantly in memory and intellectual tasks. MRI showed an enlargement of the posterior and central parts of the thalamus that were related to the frontal orbital gyrus and insula indicating a connectivity with limbic system regions. Conclusion: The data show the impact of acute and ongoing war-related stress on psychological features as well as on the thalamus and connectivity of stress-related cortical areas. Acute and ongoing war stress had a significant neurobiological impact on refugees from war-torn Ukraine.