Iryna Frankova

War profoundly affects the well‐being of civilian populations and shapes subsequent mental health outcomes. This study aimed to investigate the effects of continuous traumatic stress (CTS) and coping efficacy on mental health outcomes among adults in Ukraine amid ongoing warfare over time. We examined how changes in CTS responses, coping efficacy, and stressful life events predicted posttraumatic stress disorder (PTSD) symptoms and broad mental health outcomes (depression, anxiety, insomnia, well‐being). Participants were 157 adults who experienced war‐related stress and completed two online surveys approximately 12 months apart. Moderately small but significant symptom reductions were observed, d s = 0.18–0.32, p s = .005–.026. Structural equation models analyzing the associations between initial status and changes in CTS, coping efficacy, and stressful life events and Time 2 PTSD symptoms and broad mental health outcomes explained most of the variance in PTSD symptoms and broad mental health outcomes, R ² = .84‒.85. Higher initial severity and worsening CTS responses over time predicted higher PTSD symptom severity, standardized estimate (Est _std ) = 0.29‒0.32, p s = .001‒.006, and poorer broad mental health outcomes, Est _std = 0.25‒0.28, p s = .001‒.016. Increased stressful life event exposure was linked to worse broad mental health outcomes, Est _std = 0.16, p = .001. Improvements in coping efficacy predicted superior broad mental health outcomes, Est _std = −0.43, p < .001. Assessing and addressing the impact of CTS, considering the toll of stressful life events, and enhancing coping efficacy may help to optimize service delivery in ongoing war environments.

The psychological health of veterans is an important consideration for their successful reintegration into society. The digital format of providing psychological assistance makes it convenient and practical to receive psychological support even at a distance, which makes it accessible and convenient for people. The acceptability of digital tools is an essential criterion for the success of their use among users. Understanding the barriers to providing psychological help, special requests of veterans, and their attitude to the digital format will reduce the level of stigmatization and create practical tools for delivering psychological help, taking into account the urgent needs of veterans and the cross-cultural component. MARTA (Mental Adaptation and Rehabilitation Tools and Analysis) is a digital platform created to meet the mental health needs of Ukrainian veterans, service members, and their families.

Within minutes of the invasion of Ukraine by the soldiers of Russia, a digital front emerged. The Western digital ecosystem mobilized to support communications infrastructure, the safety of displaced people, and the management of state-sponsored propaganda. The response was industry-wide, involving synchronized actions by YouTube, TikTok, X (Twitter), Meta (Facebook), and Snapchat in coordination with government intelligence in Ukraine and other nations. Simultaneously, Russia and their allies engaged in attacks on digital infrastructure and psychological war on the Ukrainian people that was equally well planned and executed via “false flag” narratives to create confusion, hopelessness, and fear. Meanwhile tech companies maintained safe infrastructure for communication, worked to dispel and block propaganda directed internally at Ukraine and Western nations, facilitated community and familial communication, protected identities, “pre-bunked” propaganda, facilitated housing and safe travel for forcibly displaced persons. In this chapter we outline the strategy and counter strategy on what came to be known as the Digital Front. We will discuss key actions including propaganda targeted at the internally displaced and Western policy-makers. Additionally, we will discuss the strategy and coordination to support psychological safety of a wide range of groups including forcibly displaced persons, soldiers, first responders, and parents along with their children. Much of this book chapter relies on threat intelligence reports, government press releases, and platform communications during the period spanning the outbreak of the war.

Digital mental health is no longer an auxiliary support to clinical care: it is emerging as a strategic capability that enables psychological readiness in contemporary conflict. This chapter synthesizes key insights from the NATO Advanced Research Workshop and argues that the future of military mental health lies in continuous digital architectures of care that can anticipate, detect, and respond to stress across complex operational environments. Ukraine demonstrates this in real time: under the pressure of protracted war, digital platforms have become a structural necessity. The chapter shows that the next decisive step is not building more tools, but building the governance, interoperability, and consortium structures that make those tools safe, scalable, and ethical. The integration of lived experience, clinical science, and human-centered AI offers NATO a unique opportunity to create mental health capability that is distributed, adaptive, and sustainable — and to define the future of mental health in conflict.

The ongoing war in Ukraine presents unprecedented challenges to the mental health and readiness of its soldiers. Frontline mental health workers face immense pressure, operating with limited resources and often in isolation, while navigating complex clinical presentations amidst active combat. This chapter details the development and validation process of a novel Large Language Model (LLM) agent designed to serve as a digital companion for these frontline professionals. This AI tool aims to bridge the gap in immediate peer consultation and expert guidance, offering decision support grounded in established Combat and Operational Stress Control (COSC) principles and tailored to the unique cultural and operational context of the Ukrainian military. The development process involves collecting rich narrative case studies and decision-making challenges directly from experienced Ukrainian frontline mental health workers. These narratives form the basis for prompt engineering and few-shot learning, iteratively refining the LLM agent’s ability to understand context, assess symptom severity, functionality, and safety risks, and provide relevant disposition options (Return to Duty, In-Theater Support, Evacuation). The validation framework emphasizes accuracy against expert annotations, adherence to established COSC guidelines, and sensitivity to Ukrainian cultural nuances, including the historical context of mental health services and the importance of military identity rooted in figures like the Zaporozhian Cossacks. The chapter addresses key challenges, including overcoming stigma, the need for standardized assessment tools, and the ethical considerations of deploying AI in a high-stakes environment. By simulating collaborative decision-making, the AI companion seeks to enhance the capacity of frontline workers, promote consistent application of best practices like Combat Path Debriefing, and ultimately bolster the resilience and combat effectiveness of Ukrainian soldiers facing prolonged and intense operational stress. This project represents a crucial step in leveraging AI to augment human expertise in crisis situations, offering a scalable solution to support mental health providers on the most demanding frontlines.

Perinatal loss is a significant psychologically traumatic experience associated with an increased risk of prolonged grief disorder, post-traumatic stress disorder, and somatic distress. The role of farewell and burial experience in the process of psychological adaptation remains insufficiently studied. In the context of forced displacement in Ukraine, access to a complete farewell and regular visits to the burial site may be limited, potentially affecting the integration of loss. Aim - to determine the relationship between components of farewell and burial experience and indicators of psychological adaptation in women following perinatal loss. Materials and methods. A cross-sectional online study was conducted involving 67 women who had experienced perinatal loss. Grief intensity, post-traumatic symptoms, anxiety-depressive distress, somatic symptoms, avoidance, negative cognitions, relationship satisfaction, and coping efficacy were assessed using validated psychometric instruments. Non-parametric group comparison methods and correlation analysis were applied. The level of statistical significance was set at p<0.05. Results. The ability to perform a burial ritual to the desired extent was associated with higher relationship satisfaction (p=0.003) and greater coping efficacy (p=0.014). The presence of a burial site was associated with higher coping efficacy (p=0.033), while only a trend toward higher relationship satisfaction was observed (p=0.063). Barriers to visiting the burial site were associated with higher post-traumatic stress symptoms (p=0.008) and lower relationship satisfaction (p=0.001). Physical contact with the infant’s body did not demonstrate statistically significant relationships with mental health outcomes. Conclusions. A more complete farewell and burial experience following perinatal loss is associated with better adaptive outcomes, particularly greater coping efficacy. A trend toward higher relationship satisfaction was also observed. In contrast, barriers to visiting the burial site are associated with more pronounced post-traumatic stress symptoms and lower interpersonal relationship satisfaction. No conflict of interests was declared by the authors.

Background. In the context of Russia’s full-scale war against Ukraine, special attention is warranted to the emergence of new memorial, spiritual, artistic, volunteer, and media rituals as ingredients of collective healing. They shape a shared space of memory, spiritual solidarity, and psychosocial resilience. Objective: To delineate a typology of new rituals and analyze their impact on the psychosocial resilience and spiritual recovery of Ukrainian society during wartime. Methods. A study conducted in 2023-2024 among students, medical interns, trainees, and faculty at Danylo Halytsky Lviv National Medical University and O. O. Bogomolets National Medical University (n = 618). Tools included a survey; RS-14, PCL-5, MLQ, and MSPSS scales; in-depth interviews (n = 26); and statistical analyses (t-tests, χ², ANOVA, regression; p < 0.05). The article forms a part of several dissertation projects by the authors at their respective institutions. Results. Participants in rituals demonstrated higher resilience (78.2% vs. 52.5%) and perceived social support (84.5% vs. 57.9%), lower PTSD symptom levels (23.1% vs. 48.7%), and higher meaning in life (81.0% vs. 49.2%). Core ritual functions included mnemonic, integrative, therapeutic, and preventive. Conclusions. New rituals function as mechanisms of collective healing, restoring spiritual dignity, meaning, and social cohesion. Rituals act as active ingredients of psychosocial support and facilitate post-traumatic growth in Ukrainian society.