Volume 10 - Issue 45
/ September 2021
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http:// www.amazoniainvestiga.info ISSN 2322- 6307
DOI: https://doi.org/10.34069/AI/2021.45.09.15
How to Cite:
Kozhyna, H.M., Zelenska, K.O., Viun, V.V., Khaustov, M.M., & Asieieva, Yu.O. (2021). Clinical specifics of stress-related
disorders in volunteers whose activities are related to Joint Forces Operation. Amazonia Investiga, 10(45), 141-147.
https://doi.org/10.34069/AI/2021.45.09.15
Clinical specifics of stress-related disorders in volunteers whose
activities are related to Joint Forces Operation
Кінічна спеціфіка стресасоціїованих розладів у волонтерів, діяльність яких
пов’язана з ООС
Received: July 20, 2021 Accepted: September 22, 2021
Written by:
Kozhyna H.M.
57
https://orcid.org/0000-0002-2000-707X
Zelenska K.O.
58
https://orcid.org/0000-0002-9190-8211
Viun V.V.
59
https://orcid.org/0000-0001-8889-0228
Khaustov M.M.
60
https://orcid.org/0000-0002-8613-2172
Asieieva Yu.O.
61
https://orcid.org/0000-0003-3086-3993
Abstract
A volunteer movement has emerged in Ukraine
during the Revolution of Dignity and the events
that followed it. Experts consider this event as an
important component of civil society and the
main driving force of the country’s reform.
The clinical structure of post-stress disorders
among examined volunteers was represented by
the following nosologic forms: F 43.2 adjustment
disorders (32.7% of men and 28.1% of women),
F 43.1 - post-traumatic stress disorder (27.6% of
men and 22.9% of women), F 41.0 - panic
disorder (22.4% of men and 29.1% of women), F
41.1 - generalized anxiety disorder (17.3% of
men and 19.9% of women). According to the
Scale of Severity of Traumatic Stress, 62.8% of
respondents have complete manifestation and
37.2% clear manifestation of stress disorder.
According to the Hamilton Anxiety and
Depression Rating Scale, 56.2% of subjects had
a severe depressive episode, 62.1% had severe
anxiety episode, 42.3% had moderate depressive
57
Professor, Academician of the National Academy of Higher Education of Ukraine, PhD, MSc, MD Head of the Department of
Psychiatry, Narcology, Medical Psychology and Social Work of Kharkiv National Medical UniversityUkraine, Ukraine.
58
Associate Professor, PhD, MD Associate Professor of the Department of Psychiatry, Narcology, Medical Psychology and Social
Work of Kharkiv National Medical UniversityUkraine, Ukraine.
59
Associate Professor, PhD, MSc, MD Professor of the Department of Psychiatry, Narcology, Medical Psychology and Social Work
of Kharkiv National Medical UniversityUkraine, Ukraine.
60
Associate Professor, PhD, MSc, MD Professor of the Department of Psychiatry, Narcology, Medical Psychology and Social Work
of Kharkiv National Medical UniversityUkraine, Ukraine.
61
PhD, Head of the Department of General Scientific, Social and Behavioral Disciplines of the Odessa Institute of the Interregional
Academy of Personnel Management, Ukraine.
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episode, and 33.4% had a moderate anxiety
episode.
Severe clinical manifestations of PTSD were
characteristic of volunteers who survived the
fighting, with a high level of exposure to the
traumatic event on all PTSD scales; excessive
signs of stress disorder, severe or moderate
depressive and anxiety episodes by the Hamilton
Anxiety and Depression Rating Scale.
Keywords: PTSD, post-traumatic stress
disorder, depression, anxiety, adjustment
disorder, combat stress.
Introduction
Since 2014, Ukraine has been involved in
hostilities on the territory of its Eastern part
(Donetsk and Luhansk regions). Thus, as a result
of this hybrid war, about 14,000 people died.
Currently, all hostilities are taking place in the
area called the Anti-Terrorist Operation Zone or
the Joint Forces Operation Zone.
Volunteer movement is an important part of
modern society. Volunteering is a voluntary,
socially oriented non-profit activity for providing
free assistance, and a volunteer, respectively, is a
motivated person who by their own beliefs is
engaged in this important socially useful work
(Law of Ukraine «About volunteering» № 3236-
VI, 2011; Maruta & Markova, 2015;
Markova & Kozyra, 2015; Chaban O.S.,
Bezsheyko, Khaustova, Ryvak & Kyrylyuk,
2018).
The most common type of modern volunteering
in Ukraine is the support of combatants which
involved in Joint Forces Operation. In conditions
of armed conflict, volunteering is accompanied
by additional physical, psychological and
emotional stress, significant changes in life
rhythm, and sometimes even life risks, which, in
general, characterizes volunteering as extreme,
stressful activity, that hides danger of possible
stress-related disorders (Hlaholych & Markova,
2018; Yuryev & Yuryeva, 2015).
Modern research has shown that a third of
volunteers show signs of severe professional
maladaptation. In the structure of maladaptation
phenomena with increasing signs of burnout,
there is a shift from psycho-emotional disorders
to sleep cycle disorders, somato-vegetative and
psychosocial disorders, which indicates
transition of reactions from the level of emotions
to the level of psychosomatics (Hlaholych, 2016;
Khaustova & Smashna, 2019; Maruta & Gichun,
2000)
32% of internally displaced persons in Ukraine
suffer from post-traumatic stress disorder
(PTSD) caused by the ongoing conflict in the east
of the country. These are the findings of a study
entitled “The Hidden Consequences of Conflict:
Mental Health Problems for Internally Displaced
Persons and the Availability of Psychological
Assistance in Ukraine,” conducted by
International Alert organization in cooperation
with the Global Initiative in Psychiatry, the
London School of Hygiene and Tropical
medicine and Kiev International Institute of
Sociology
As part of the study, 2203 respondents were
interviewed throughout Ukraine. As a result of
the survey especially among the women
surveyed, the prevalence of such mental
disorders as depression (22%) and anxiety states
(17%) was revealed. According to the
researchers, the presence of these symptoms is
associated with a violation of family ties,
relationships with society, working capacity, and
even such elementary functions as walking.
Among the surveyed internally displaced
persons, 74% needed psychiatric help do not
receive it, mainly because of the high cost of
services and medicines. (Roberts, Makhashvili &
Javakhishvili, 2017).
Theoretical Framework or Literature Review
Combat mental injuries of volunteers, that
received in the combat zone, can haunt them for
a long time. They are also a major obstacle to
adapting to a peaceful life after returning from
the Joint Forces Operation zone (Yurieva,
Kozhyna, H.M., Zelenska, K.O., Viun, V.V., Khaustov, M.M., Asieieva, Yu.O / Volume 10 - Issue 45: 141-147 / September, 2021
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Shusterman & Likholetov, 2019; Aimedov,
Asieieva & Tolmachov, 2016; Grinevich, Druz
& Chernenko, 2019).
In addition to the positive trend of increasing
civic activity and responsibility (for example,
increasing the number of people involved in
volunteering), experts also noted the emergence
of a negative trend in the development of
volunteers maladaptation and stress-related
disorders (Druz & Chernenko, 2017;
Kazmirchuk, Lashin, Druz & Chernenko, 2020;
Maruta, Panko, Kalenskaya, Semikina &
Denisenko, 2020).
During the Revolution of Dignity and following
events a volunteer movement emerged in
Ukraine. Experts consider it an important
component of civil society and the main driving
force of the country’s reform (Skrypnikov,
Rakhman, Markova, Shpylovyi & Plevachuk,
2019; Schreiner, Trent, Prange & Allen, 2018;
Maruta & Zavorotnyy, 2018).
According to USA experts, the overall "baseline"
prevalence of PTSD among military conscripts
there ranges from 3 to 6%. Estimates of US
ground forces personnel in Iraq and Afghanistan
(2004-2007) found a prevalence of acute stress or
PTSD (PCL scores of 50 or higher) in the range
of 10-20%, with a clear correlation to frequency
and the intensity of hostilities. (Crumlish &
O'Rourke, 2010)
Also in the United Statesof America, the number
of veterans seeking PTSD assistance from the
U.S. Department of Veterans Affairs increased
from 274,000 to 442,000 in 2004-2008.
(Buckley, Mozley, Bedard, Dewulf and Greif,
2004)
A large meta-analysis states that female
participants were more likely to meet the criteria
for post-traumatic stress than male participants,
although they were less likely to develop PTSD.
Female participants were more frequently
sexually abused and sexually violated in
childhood. Male participants were more likely to
be exposed to accidents, attacks of a non-sexual
nature, witnessed death or injury, natural
disasters or fires, hostilities or wars. Among the
victims of certain groups, female participants
showed a more pronounced post-traumatic stress
disorder. All of this suggests that there are gender
differences in the risk of exposure to certain
types of stress disorders in male and female
participants. (Tolin & Foa, 2006).
The prevalence of PTSD in the world ranges
from 1.3% to 37.4% in different countries, for
Canada, this figure is 9.2%. (Van Ameringen,
Mancini, Patterson & Boyle, 2008). For the
above, The aim of our research was to study the
clinical and psychopathological features of
stress-associated disorders in volunteers who
survived the fighting.
Methodology
To achieve this goal, a comprehensive clinical,
psychopathological and pathopsychological
examination of 97 persons, was conducted in
accordance with the principles of bioethics and
deontology. All people were volunteers to
support soldiers in combat zone for at least 1
year. Among surveyed were 57 women and 40
men with an average age of 30.6±4.7 years.
The work was performed in accordance with the
research plan of the Department of Psychiatry,
Narcology, Medical Psychology and Social
Work of Kharkiv National Medical University of
the Ministry of Health of Ukraine on the topic
“To develop a prevention system of non-
psychotic mental disorders and rehabilitation of
hostilities victims”, state registration
No 0119U002902
Following examination methods were used in the
study. Сlinical and psychopathological research
was based on generally accepted approaches to
psychiatric and narcological examination
through interviews and observations, using
diagnostic and research criteria ICD-10.
Psychodiagnostic method using the "Impact of
Event Scale-Revised" (IES-R) (Weiss, D. S., &
Marmar, C. R.,1996); Questionnaire on the
severity of psychopathological symptoms of
Derogatis (Symptom Check List-90-Revised -
SCL-90-R) (Derogatis, L. R., Rickels, K., &
Rock, A. F., 1976) (according to Tarabrina,
2007); clinical scales - The Hamilton Anxiety
Rating Scales (Hamilton, 1959); clinical scales -
The Hamilton Depression Rating Scales
(Hamilton, 1960); Mississippi Scale for Combat-
Related PTSD (Keane, Caddell, & Taylor, 1988),
"The Combat Exposure Scale (CES)" by T.
Keane (Keane T.M., Fairbank J.A., Caddell J.M.,
Zimering R.T., Taylor K.L., Mora C.A ,1989).
Results and Discussion
As the results of the study showed, clinical
structure of post-stress disorders among
examined volunteers was represented by the
following nosologic types: F 43.2 adjustment
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disorders (32.7% of men and 28.1% of women),
F 43.1 - post-traumatic stress disorder (27.6% of
men and 22.9% of women), F 41.0 - panic
disorder (22.4% of men and 29.1% of women), F
41.1 - generalized anxiety disorder (17.3% of
men and 19.9% of women).
In the clinical picture of adjustment disorders in
examined patients was a low mood and affect of
sadness (64.8% male, 71.2 female patients),
unreasonable anxiety, feelings of internal tension
with inability to relax (67.1% and 62.1%
respectively), feelings of inferiority (32.1%
males, 39.2% females), apathy (32.8% and
33.1% respectively), various fears and
obsessions (64.2% of men and 60.2% of women),
anhedonia (35.8% and 36.1 % accordingly),
asthenic symptoms (46.8% of men and 40.2% of
women), increased vulnerability (25.8% and
33.1% respectively) in most cases.
Adjustment disorders included prolonged
depressive reaction (21.1% of men and 31.2% of
women), mixed anxiety-depressive reaction
(33.2% and 45.2%), adjustment disorders with
predominant disturbance of other emotions (45.7
% and 23.6% respectively).
It was found obsessive memories of hostilities
that caused depressive feelings (65.8% of men
and 63.3% of women), sleep disorders in the
form of nightmares associated with combat
stress, flashback effects (52.1% and 49.8%
respectively), efforts to avoid memories and
conversations related to combat trauma (41.1%
of male and 45.6% of female subjects),
psychogenic amnesia (28.1% and 31.1%
accordingly), dysphoria (35.8% of men and
29.9% of women), apathy (38.5% and 35.6%
respectively), feelings of alienation and distance
from other people (55.1% of men and 56.2% of
women), anxiety (66.8% and 69.9% accordingly)
and depressive (55.2% of men and 52.2% of
women) symptom complexes іn post-traumatic
stress disorder.
The clinical structure of PTSD was represented
by anxiety (33.2% of men and 45.9% of women),
dysphoric (38.5% and 8.9%) and asthenic (28.3%
and 45.2%) syndromes.
Panic disorder was manifested by unpredictable
attacks of severe anxiety (99.9% of men and
96.8% of women), extreme fear (66.8% and
68.5% respectively), feelings of insecurity, death
threats (75.8% of men and 76.1% of women),
psychogenic suffocation (69.2% and 70.1%
accordingly), tachycardia (81.1% of men and
79.3% of women), cardialgia (49.8% and 49.2%
respectively), sweating (39.8% of men and
40.1% of women). Between attacks, patients are
anxiously awaiting its recurrence.
Generalized anxiety disorder was characterized
by persistent constant anxiety (99.9% of men and
100.0% of women), feelings of tension (89.9% of
men and 91.1% of women), unmotivated bad
feelings (56.6% of men and 58.2% of women),
timidity, unwarranted anxiety for various reasons
(89.2% of men and 91.0% of women), sleep
disorders, especially process of falling asleep,
caused by repeated "scrolling" in the head of
previous day events (56.5% of men and 56.1% of
women), restlessness, restless movements
(68.8% of men and 71.1% of women), tremor
(45.8% of men and 46.2% of women), constantly
tense face (66.2% of men and 67.8% of women),
psychogenic dyspnea (36.9% and 49.2%
respectively).
Regular for all patients were sleep-wake cycle
disorders, autonomic paroxysms, obsessive
memories of combat events, decreased appetite,
the desire to drink psychostimulants (coffee,
strong tea, energy drinks and alcohol), avoid
watching TV news.
According to the results of psychodiagnostic
research, the indicators of signs of post-traumatic
stress disorder on the Mississippi scale in the
subjects exceeded the norm and amounted to
99.2 ± 2.2 points for men and 98.7 ± 2.2 for
women, and their symptoms were ranked as
follows (in descending order, score): prevention
(41.1 ± 0.9 in men and 43.2 ± 0.9 in women),
intrusion (22.6 ± 0.8 and 19.9 ± 0.6 points,
respectively) , hyperactivity (23.3 ± 0.6 and 21.9
± 0.6), guilt (11.5 ± 0.5 and 11.2 ± 0.5 points).
Analysis of the Impact of Event Scale-Revised
(IES-R) indicates a high level of traumatic event
impact on the scale of invasion (68.9% of
surveyed men and 71.1% of women), avoidance
(61.1% and 58.1%, respectively) and
physiological excitability (69.8% of men and
55.6% of women).
According to the Combat Exposure Scale 62.8%
of respondents had a complete manifestation and
37.2% a clear manifestation of stress disorder.
According to the Hamilton Depression and
Anxiety Rating Scales 56.2% of males and
55.6% of female subjects had a severe depressive
episode, 62.1% of males and 66.5% females had
a severe anxiety episode, 42.3% of males and
40.5% females had a moderate depressive
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episode, and 33.4% and 35.2% patients
respectively had a moderate anxiety episode.
Analysis of the data obtained from the
questionnaire on the severity of
psychopathological symptoms (Symptom Check
List-90-Revised-SCL-90-R) shows that the
surveyed volunteers are characterized by high
levels of somatization (45.6% of men and 51.1%
of women), depression (62.1 % and 66%,
respectively), anxiety (85.2% of surveyed men
and 88.5% of women) and obsessive-compulsive
symptoms (49.2% and 51.1% of respondents,
respectively).
According to the psychodiagnostic study, the
indicators of the Combat Exposure Scale in
65.9% of men and 65.2% of women were in the
range of high severity of combat experience,
indicating presence of repeated long-term
situations of imminent life threatening, death and
injuries of comrades during hostilities.
Thus, according to the study results, a high level
of impact of a traumatic event, excessive signs of
symptoms of intrusion, avoidance, physiological
excitability; high levels of somatization,
depression, anxiety, obsessive-compulsive
symptoms on the scale SCL-90-R; severe
depressive and anxiety episodes on clinical
scales of anxiety and depression by Hamilton and
medium-high severity of combat experience is
prognostically significant in the formation of
stress-related disorders in volunteers whose
activities are associated with Joint Forces
Operation.
A comprehensive system of medical and
psychological support was developed for
volunteers, based on the data obtained during this
study.
Conclusions
1. The clinical structure of post-stress disorders
in the examined volunteers is represented
by: adjustment disorders (with a
predominance in men of mixed anxiety-
depressive reactions and adjustment
disorders with predominant disturbance of
other emotions; in women - prolonged
depressive reaction and mixed anxiety-
depressive reaction); post-traumatic stress
disorder (with a predominance in men of
anxiety and dysphoric syndromes, in women
- anxiety and asthenic syndromes), panic
disorder (mostly in women) and generalized
anxiety disorder (occurring with
approximately equal frequency in men and
women).Volunteers who survived fighting
are characterized by severe clinical
manifestations of PTSD, with a high level of
impact of the traumatic event was observed
by all scales of PTSD; excessive signs of
stress disorder, severe or moderate
depressive and anxious episodes by the
Hamilton Depression and Anxiety Rating
Scales, high levels of somatization,
depression, anxiety, obsessive-compulsive
symptoms on the SCL-90-R scale and a
medium-high level of severity of combat
experience by the Combat Exposure Scale.
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