The prevalence factor of post-traumatic stress disorders among students of Mariupol

Bogachev Aleksei Mikhailovich ORCID: 0000-0002-9430-2274 Researcher at the Center for the Prevention of Extremism in Education and Youth Environment, A. I. Herzen Russian State Pedagogical University; Senior Lecturer of the Department of Practical Psychology, Mariupol State Humanitarian University named after A.I. Kuindzhi 197198, Russia, Saint Petersburg, Bolshaya Pushkarskaya str., 6, sq. 20 amb1976@mail.ru Other publications by this author

Ermakova Natal'ya Georgievna ORCID: 0000-0002-3015-8488 Doctor of Psychology Professor, Department of Clinical Psychology and Psychological Assistance, A. I. Herzen Russian State Pedagogical University 191186, Russia, Saint Petersburg, Moika River embankment, 48, office 7 nataliya.ermakova@yandex.ru

Introduction

The problem of the prevalence of post-traumatic stress disorder (PTSD) among civilians in the territories that have become the scene of military operations in solving the tasks of a special military operation (SVO) is extremely relevant. The mental health of people living in the liberated territories directly depends on solving the problem of relieving stress conditions and, moreover, bringing traumatized persons into the space of potential personal growth. Obviously, at the first stage of solving this problem, it is necessary to assess the situation in the "new territories", in general, and in specific locations, the population of which was exposed to particularly strong negative stressful factors. This paper presents the results of a pilot study aimed at clarifying the prevalence of PSTD among residents of Mariupol a year and a half after the end of the battles for its liberation, as well as developing recommendations for determining basic rehabilitation scenarios

Theoretical overview

The concept of mental trauma is initially one of the "cornerstones" in the field of depth and clinical psychology. As A.I. Kopytin notes, "The concept of "mental trauma" (its analogue may be the concept of "traumatic stress") denotes the destabilizing effect on the personality of various stressors, as a rule, having a more pronounced, extraordinary character compared with everyday difficulties ^{[12, p. 7]}.

At the same time, since the end of the 20th century, the concept of "post-traumatic stress disorder" has become one of the basic terms in the context of the study of both borderline personality and borderline personality disorders in the context of the modern stressful environment. As A.I. Kopytin writes, "the most pronounced clinical manifestations are characterized by post-traumatic stress disorder (PTSD). It develops in the wake of traumatic events that go beyond the normal human experience. Two features characterize PTSD: its distinct psychogenic nature, as well as the severity of psychogeny, the exceptional power of its pathogenic effects" ^{[12, p. 9]}.

From the point of view of clinical psychology, this circumstance is mainly due to serious socio-psychological shifts characterizing the information society (in which stressful situations occur extremely often, and mental "infection" occurs quite quickly) and the general development of applied science, taking into account the psychodynamic and simultaneously delayed (and in a fairly long term) impact on the personality and its the environment of traumatic stressors.

Similarly, the factor of the prevalence of PSTD and, in particular, PSTD among the civilian population in the territories that have become the scene of hostilities, absolutely naturally becomes a matter of national security, and an issue related to the patterns of the collective psyche (and, in a way, the collective unconscious).

As noted by a number of authors, the experiences experienced by persons who were on the territory of certain mass disasters, even in the absence of obvious physical injuries, do not pass without a trace. The corresponding memory complexes are "encapsulated" and can be activated as a result of exposure to even an otherwise weak stressor ("trigger") both on an individual and on a mass level. And this means that a certain "critical mass" of even relatively mild PTSD can at some point call out certain destructive processes of a massive plan and, speaking in the language of clinical psychology, provoke various manifestations of mental maladaptation.

As the basic criteria that distinguish PTSD from other non-psychotic mental disorders, the following are defined:

1. an obvious state of stress during exposure to traumatic factors;

2. attacks of "flashbacks" (that is, obsessive-compulsive reminiscences);

3. nightmarish dreams associated with relevant memories;

4. difficulties with emotional stress transfer;

5. loss of healthy contact with the social environment, a general tendency to antisociality;

6. loss of a healthy, consistent personal identity ^{[1, 2, 3, 9, 10, 11, 12, 13, 14, 15, 16]}.

K.A. Idrisov emphasizes that "the high prevalence of PTSD among the population living in the war zone is confirmed by a number of population studies conducted in other countries where military operations took place, which indicates the significant strength of the pathogenic effects of wartime factors on the mental health of the population. On the other hand, civilians often find themselves between the warring parties, but unlike combatants, they do not have special training and skills to survive in wartime conditions, do not have weapons for self-defense and a mandate to use them" ^[10].

As is known, data on the prevalence of PTSD in persons exposed to extreme stressors range from 10% detected in witnesses of a traumatic situation to 95% in severely injured persons (including those who have suffered severe physical injuries ^{[1,2,3, 4, 11, 15, 19]}.

According to J. Davidson, the prevalence of PTSD in the general human population varies from 3.6 to 75% ^[2]. Among veterans who took part in the Vietnam War, PTSD was detected by 30% of people ^[14], and those who were in Nazi concentration camps manifested themselves in 85-100% of cases ^[3].

A population-based study conducted in a sample of the urban population in the United States showed that among 1007 surveyed people, 39.1% had experienced various traumatic events during their lifetime, of which 23.6% had PTSD. The prevalence of PTSD in the entire sample was 9.2% ^[10].

In addition, "The prevalence of PTSD is increasing significantly in regions where military operations are taking place or have taken place. <> Studies conducted among Kosovo Albanians after the 1998-1999 war revealed PTSD in 17.1% of cases in 1999 and in 25% of cases in 2000. Data from a study conducted in Afghanistan showed that among 799 Afghan adults, 62% had experienced at least four traumatic events in the last 10 years, and 42.2% had PTSD.  According to another population study, in a sample of 1,011 Afghan residents over the age of 15, 43.7% of people experienced from 8 to 10 traumatic events, and 20.4% had PTSD" ^[10]. As for Chechen civilians, the prevalence of PTSD among them after the completion of the counter-terrorism operation was 31.4% ^[10].

According to the data presented by Yu. V. Popov and V. D., in the case of severe stress, PTSD develops in 50-80% ^[16], however, in a peaceful, relatively favorable environment, the case of PTSD in the population is 0.5% for men and 1.2% for women, whereas less obvious disorders are detected in 1.1—2.6 cases per a thousand people ^[4].

At the same time, the prevalence of PTSD among defenders of the White House in Moscow in October 1993 was about 57.1% ^[14]

As you can see, these are quite high values. Let's try to compare them with similar values in Mariupol obtained as part of a pilot study.

Description and results of the pilot study

61 subjects took part in the pilot study (from 18 to 55 years old, of whom 2 were men and 59 were women). – all students of the Kuindzhi Moscow State University are residents of Mariupol who were there during the period of hostilities (in addition to student status, age and gender, we did not determine other characteristics of the study participants; the study was conducted anonymously). The average age of the study participants was 30.1 years.

We used the following methods: a PTSD screening questionnaire ^[1] and a structured clinical diagnostic interview ^[17], a Scale for clinical diagnosis of PTSD (Clinical-Administered PTSD Scale – CAPS) ^[18]. The study was conducted in December 2023, and all participants gave informed consent to participate in the study.

According to the questionnaire, screening for PTSD (Brewin, C. R., et al.)  of the 61 subjects, PSTD can be assumed in 18 (29.5%). Of these 18 cases, this assumption is consistent with the identification of PTSD by a structured clinical diagnostic interview in 9 cases, that is, in 14.7%. Almost the same, but slightly higher number of matches – 12 - give the results of the subjects passing the Scale for Clinical Diagnosis of PTSD (CAPS) (19.6%), and all of them are also consistent with high rates after passing the PTSD screening questionnaire.

Thus, it can be assumed that the real number of cases of "nuclear" PTSD in Mariupol is approximately 17.5% of civilian local female residents with the "periphery" of this disorder at about 30%.

It should be noted that the data we have obtained (albeit within the framework of a pilot study) are currently substantially unique and have not previously been presented in open sources.

Interpretation of the received data

In our opinion, the prevalence of PTSD among residents of Mariupol, which survived the fighting, is relatively small compared to Chechens, Muscovites after the events of October 1993, Afghans and To a significant extent, Albanians can be explained by the fact that Mariupol residents (at least those who remained in the city and (or) returned to it) mostly take a pro-Russian position and initially advocated reunification with Russia, as well as rejected the ideology imposed in modern Ukraine.

Thus, unlike many other cases, traumatization was combined with a sense of justice and a certain (at least partial) victory. By the way, it is in this regard that we can consider the relatively low number of PSTRS among the Kosovo Albanians who have joined the actual separation from Serbia. This assumption is consistent with the logic of M.M. Reshetnikov's work "Mental trauma" ^[19], according to which the socio-psychological feeling of "defeat" significantly affects the severity and prevalence of PTSD.

 At the same time, the figures recorded by us are quite significant and require active rehabilitation work with the population of Mariupol.

Conclusions and recommendations

Based on the above, it seems to us necessary to carry out active work in Mariupol and other territories reunited with Russia to form a Russian civilizational and civic identity, which can become an additional and massive rehabilitation psychotherapeutic factor for residents of the city

It should be noted that the testing of such a program has already begun within the framework of the agreement between the A.I. Herzen State Pedagogical University and the A.I. Kuindzhi MGK ^{[6, 7]}, taking into account the fact that a significant part of teenagers and young people living in Mariupol and St. Petersburg are currently experiencing a crisis of civil and civilizational identity. At the same time, they also feel, often unconsciously, the need for such a civil and civilizational identity that would allow them to perceive themselves as part of a historical whole originating in Kievan Rus and continuing in modern Russia.

According to a survey conducted in the liberated territories, about 47.9% of respondents (203 respondents in a sample of 423 people, consisting of students of Mariupol State University named after A.I. Kuindzhi, among whom a significant majority are young people) They do not believe that the current Russian statehood comes from Kievan Rus, that is, they implicitly accept the concept of the isolation of present-day Russia from its own roots ^[7]. At the same time, the overwhelming number of young people surveyed have difficulty identifying themselves as belonging to a single community (the distorted opposition of "we are them" persists, which can increase the impact of stressful factors). This is caused, among other things, by a small number of personal contacts, a short period of finding new regions in a single state.

At the same time, we note that, as the data of the same study show, "half of the respondents – students of the Kuindzhi Moscow State University – are already in the field of Russian (Russian) civilizational identity. More than 50% believe that Russia (RF) is the heir of Kievan Rus. At the same time, surprisingly, almost half, if not more, of young people (respondents under 30 years old studying at Moscow State University) think so" ^[7]. Here we see confirmation of our conclusion that inclusion in the general field of national identity is an essential factor that can have a mitigating effect on the prevalence of PTSD in Mariupol and be a condition for possible personal growth (in social and socio-psychological spheres).

Based on the above, upon completion of the pilot study, it is planned to conduct a more in-depth study of the psychological state of Mariupol residents, which will make it possible to give a more comprehensive and objective picture of the consequences of psychological trauma and, in turn, will allow to develop and test a program of psychological assistance, including through innovative methods in psychological psychotherapy ^{[5, 8, 12]}. This will become a factor in preventing various kinds of tragedies ^[9] and building a creative personal identity among the youth of the territories reunited with Russia ^{[6, 7, 9]}.

In our opinion, within the framework of such a program, various modules aimed at promoting the formation of an all-Russian identity should be tested. These modules should cover the main elements of the structure of civic identity from the standpoint of deep psychology: cognitive, value and emotional elements, as well as an activity component and be aimed at forming an idea of the continuity of the historical line, the community of historical destiny, the adoption of a single civic community among representatives of target groups and the implementation of community in action in the process of common social practices. All this can and should reduce the prevalence of PTSD and relapses of this disorder in the liberated territories.