Tsunami of PTSD expected in wake of Ukraine and Gaza

A tsunami of post-traumatic stress disorder will inevitably hit both military and civilians alike following the ongoing war in Ukraine and Israel's continuing bombardment of Gaza

Dr Stephen McWilliams, Consultant Psychiatrist, Saint John of God Hospital, Stillorgan

February 1, 2024

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  • In the aftermath of the pandemic, news headlines globally have been dominated by war. February 24, 2024 marks the two-year anniversary of Russia’s invasion of Ukraine, while the ongoing Israeli bombardment of Gaza (as well as the Hamas attacks that sparked it) has been tough viewing. The consequent trauma among civilians and soldiers alike is hard to predict, but we might reasonably expect these events to be marked by a wave of post-traumatic stress disorder (PTSD) in the coming years. 

    The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnoses PTSD by way of eight criteria:1

    • Criterion A is the person’s exposure to actual or threatened death, serious injury or sexual violence, through direct experience, personally witnessing it happening to another person, learning of it happening to a family member or close friend, or repeatedly being personally exposed to the details of the traumatic event. 
    • Criterion B is the presence of one or more ‘intrusion’ symptoms, such as recurrent involuntary distressing memories, dreams, flashbacks and so forth. 
    • Criterion C is persistent ‘avoidance’ of people, places or cues associated with the traumatic event. 
    • Criterion D is negative thinking or low mood beginning shortly after the traumatic event.
    • Criterion E is a marked increase in ‘arousal’ or reactivity beginning or worsening after the traumatic event, for example irritable behaviour, angry outbursts, reckless or self-destructive behaviour, hypervigilance, an exaggerated startle response, or disrupted sleep and concentration. 
    • Symptoms from Criteria B to E must last at least one month (Criterion F) and cause clinically significant distress or impairment in social, occupational or other important areas of functioning (Criterion G). 
    • Finally, Criterion H states that the symptoms cannot be better explained by substances, alcohol or another medical condition. 

    As we can see, PTSD is quite a specific entity. To predict the extent to which it might occur in Ukraine or Gaza in the coming years, we could examine the statistics of a country often involved in war, ie. the US. According to the US Department of Veterans Affairs, PTSD is slightly more common among veterans than civilians. Around 7% of US veterans will have PTSD at some point in their life, compared to 6% of the general population.2 Female veterans have a 13% lifetime risk of PTSD compared to 6% of male veterans.3 But there are also other factors, such as age and what war the veteran served in. Rates of PTSD among ages 18-29, 30-44, 45-64 and over 65s are 15%, 10%, 9% and 4% respectively. The lifetime risk of PTSD for World War II veterans was 3%, compared to 10% for Vietnam veterans, 21% for Desert Storm veterans and 29% for the more recent wars in Iraq and Afghanistan.4 And of course, there are other factors, the most obvious one being whether a soldier was actually deployed. 

    Importantly, the US civilians to whom the veterans are compared have not witnessed a war on their own soil. We must assume PTSD rates among Ukraine and Gaza civilians will be considerably higher.

    © Medmedia Publications/Hospital Doctor of Ireland 2024