Traumatic War-Induced Stressors and Health Status: Cumulative Life Stress and Resources of Resilience
Abstract
War is one of the most potent stressors that humanity can be exposed to. Like any armed conflict, the war in Ukraine is likely to result in devastating consequences for the health of our nation, causing long-term physical and psychological harm to adults and children, a reduction in human capital, an increase in the number of children facing orphanhood and family separation, the development of poverty in regions directly affected during the active phase of the conflict, psychological trauma, a lack of adequate nutrition, the erosion of social networks, and so forth. Recent research confirms a significant increase in the level of distress and emotional suffering among Ukrainians. Simultaneously, the results of these studies demonstrate the high resilience that the Ukrainian population exhibits in opposition to the brutal realities of war. When analyzing the impact of war-induced traumatic stressors on human health, it is necessary to consider the stressful experiences an individual had prior to the war, as this prior experience also carries significant weight. However, the cumulative stress experienced by a person over their lifetime is often not taken into account during assessments of the war's impact on the individual health of Ukrainians. This article focuses on the theoretical and practical significance of studying the consequences of the impact of accumulated lifetime stressful experience in combination with the traumatic stressors of war, which will contribute to the development of comprehensive metrics for stress and its impact on human health. Research into the cumulative effects of stress should be complemented by an analysis of the role of protective factors, which will provide a more exhaustive explanation of the relationship between stress and human health. In the process of studying the impact of wartime traumatic events on the health of Ukrainians, it is also important to emphasize the combination of cumulative lifetime stress and an individual's stress resilience resources.
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American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th edn. Washington, DC: American Psychiatric Association, p. 271.
American Psychological Association (2017) Stress and health disparities: Contexts, mechanisms, and interventions among racial/ethnic minority and low socioeconomic status populations. American Psychological Association. https://doi.org/10.1037/e500202018-001. (дата звернення: 02 травня 2025 р.).
Benjet, C., Lépine, J. P., Shahl, V., et al. (2018) 'Trauma and Posttraumatic Stress Disorder: Global Perspectives from the WHO World Mental Health Surveys', in Bromet, E. J., Karam, E. G., Koenen, K. C., et al. (eds.) Trauma and Posttraumatic Stress Disorder: Global Perspectives from the WHO World Mental Health Surveys. Cambridge: Cambridge University Press, pp. 42–71.
Besser, A., Zeigler-Hill, V., Weinberg, M., Pincus, A. L., & Neria, Y. (2015) ‘Intrapersonal resilience moderates the association between exposure-severity and PTSD symptoms among civilians exposed to the 2014 Israel–Gaza conflict’, Self and Identity, 14(1), pp. 1–15. doi: https://doi.org/10.1080/15298868.2014.966143
Carver, C. S. & Scheier, M. F. (2017) Optimism, coping, and well-being. In Cooper, C.L. & Campbell, J. (eds.) The handbook of stress and health: A guide to research and practice
Einarsdottir, T. S., Asgeirsdottir, B. B., Sigurvinsdottir, R., Ullman, S. E. & Gudmundsdottir, B. (2024) 'Prevalence of trauma exposure and PTSD symptoms among the Icelandic population: gender and regional differences', Scandinavian Journal of Public Health, 52(8), pp. 968–977. https://doi.org/10.1177/14034948231217019;
Fauver, M., Clark, E. M., & Schwartz, C. E. (2024) ‘A new framework for understanding stress and disease: The developmental model of stress as applied to multiple sclerosis’, Frontiers in Integrative Neuroscience, 18, 1365672. doi: https://doi.org/10.3389/fnint.2024.1365672
Fink, G. (2016) Stress, definitions, mechanisms, and effects outlined: Lessons from anxiety. In G. Fink (ed.), Stress concepts, cognition, emotion, and behavior. Handbook of Stress Series, vol. 1, ch. 1, pp. 3-12. Academic Press, New York, NY;
Greene, T., Itzhaky, L., Bronstein, I., & Solomon, Z. (2018) ‘Psychopathology, risk, and resilience under exposure to continuous traumatic stress: A systematic review of studies among adults living in southern Israel’, Traumatology, 24(2), pp. 83–103. doi: https://doi.org/10.1037/trm0000136
Helou, M., Weinstein, E. S., Kalaji, J., Chaaban, T., & Yammine, K. (2024) ‘Pager explosion in Beirut: An unprecedented event’, Disaster Medicine and Public Health Preparedness, 18, Article e215. doi: https://doi.org/10.1017/dmp.2024.281
Helpman, L., Besser, A., & Neria, Y. (2015) ‘Acute posttraumatic stress symptoms but not generalized anxiety symptoms are associated with severity of exposure to war trauma: A study of civilians under fire’, Journal of Anxiety Disorders, 35, pp. 27–34. doi: https://doi.org/10.1016/j.janxdis.2015.08.001
Hoppen, T. H. et al. (2021) ‘Global burden of post-traumatic stress disorder and major depression in countries affected by war between 1989 and 2019: A systematic review and meta-analysis’, BMJ Global Health, 6, e006303. doi: https://doi.org/10.1136/bmjgh-2021-006303
Hughes, K. et al. (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health, vol. 2, no. 8, pp. e356–e366. https://doi.org/10.1016/s2468-2667(17)30118-4;
I-Khoury, J. et al. (2025) ‘Mental health is still a human right during times of war’, International Journal of Social Psychiatry, online first April 13, 2025. doi: 10.1177/00207640251331856
Karam, E., & Bou Ghosn, M. (2003) ‘Psychosocial consequences of war among civilian populations’, Current Opinion in Psychiatry, 16(4), pp. 413–419. doi: https://doi.org/10.1097/00001504-200307000-00007
Karatzias, T. et al. (2023) ‘War exposure, posttraumatic stress disorder, and complex posttraumatic stress disorder among parents living in Ukraine during the Russian war’, Acta Psychiatrica Scandinavica, 147(3), pp. 276–285. doi: https://doi.org/10.1111/acps.13529
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., et al. (2017) 'Trauma and PTSD in the WHO World Mental Health Surveys', European Journal of Psychotraumatology, 8. doi: https://doi:10.1080/20008198.2017.1353383
Kovalenko, J. (2024) ‘Surviving the atrocity: A study of resilience and coping behaviour among Ukrainians during the Russo-Ukrainian war’, Journal of Health Psychology, 29(14), pp. 1688-1703. doi: https://doi.org/10.1177/13591053241274464
Kurapov, A. et al. (2023) ‘Toward an understanding of the Russian-Ukrainian war impact on university students and personnel’, Journal of Loss and Trauma, 28(2), pp. 167-174. doi: https://doi.org/10.1080/15325024.2022.2084838
Leatherman, T. & Goodman, A. (2020) Building on the biocultural syntheses: 20 years and still expanding. American Journal of Human Biology, 32(4), e23360 doi: https://doi.org/10.1002/ajhb.23360
Leatherman, T. & Goodman, A. (2022) Critical biocultural approaches to health and illness. In C. Abadía-Barrero, M. Singer & P. I. Erickson (eds.), A companion to medical anthropology, ch. 2. John Wiley & Sons, Hoboken, Canada,
Lim, I. C. Z. Y. et al. (2022) ‘Prevalence of depression, anxiety and post-traumatic stress in war- and conflict-afflicted areas: A meta-analysis’, Frontiers in Psychiatry, 13, 978703. doi: https://doi.org/10.3389/fpsyt.2022.978703
Maltseva, K. (2024) ‘Stress exposure, perceived stress, protective psychosocial factors, and health status in Ukraine after the full-scale invasion’, Journal of Health Psychology, 29(14), pp. 1640–1652. doi: https://doi.org/10.1177/13591053241259728
Maltseva, K., & Sereda, P. (2025). The relationships between war-induced stressor exposure, endorsement of values dimensions, and quality of life in Ukraine. Journal of Cognition and Culture, 25, 438–467. doi: http://dx.doi.org/10.1163/15685373-12340219
Marín C, Gómez-Gutiérrez M del M, Vázquez C, Crespo M, Hervás G. (2025) ‘Trauma and well-being in terrorism survivors in Spain’, Journal of Health Psychology, 0(0). doi:10.1177/1359105325132424
May, C. L. and Wisco, B. E. (2016) ‘Defining trauma: How level of exposure and proximity affect risk for posttraumatic stress disorder’, Psychological Trauma: Theory, Research, Practice and Policy, 8(2), pp. 233–240. https://doi.org/10.1037/tra0000077
Miguel-Tobal J J, Cano-Vindel A, Gonzalez-Ordi H, Iruarrizaga I, Rudenstine S, Vlahov D, & Galea S. (2006) ‘PTSD and depression after the Madrid March 11 train bombings’ Journal of Traumatic Stress, 19(1), pp. 69–80. doi:10.1002/jts.2009
Miller, K. E., & Rasmussen, A. (2017) ‘The mental health of civilians displaced by armed conflict: An ecological model of refugee distress’, Epidemiology and Psychiatric Sciences, 26(2), pp. 129–138. doi: https://doi.org/10.1017/s2045796016000172
Morina, N. et al. (2018) ‘Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions: A systematic review and meta-analysis of epidemiological studies’, Journal of Affective Disorders, 239, pp. 328–338. doi: https://doi.org/10.1016/j.jad.2018.07.027
Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E. and Kaniasty, K. (2002) ‘60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001’, Psychiatry, 65(3), pp. 207–239. https://doi.org/10.1521/psyc.65.3.207.20173
Oishi, S. and Westgate, E. C. (2022) ‘A psychologically rich life: Beyond happiness and meaning’, Psychological Review, 129(4), pp. 790–811. https://doi.org/10.1037/rev0000317
Oishi, S. and Westgate, E. C. (2025) ‘Psychological richness offers a third path to a good life’, Trends in Cognitive Sciences. Advance online publication. https://doi.org/10.1016/j.tics.2025.04.002
Pavlova, I. et al. (2022) ‘Early evidence on the mental health of Ukrainian civilian and professional combatants during the Russian invasion’, European Psychiatry, 65(1), e79. doi: https://doi.org/10.1192/j.eurpsy.2022.2335
Rigutto, C., Sapara, A. O. and Agyapong, V. I. O. (2021) ‘Anxiety, depression and posttraumatic stress disorder after terrorist attacks: A general review of the literature’, Behavioural Sciences, 11(140). https://doi.org/10.3390/bs11100140
Scoglio, A. A. J., & Salhi, C. (2021) ‘Violence exposure and mental health among resettled refugees: A systematic review’, Trauma, Violence & Abuse, 22(5), pp. 1192–1208. doi: https://doi.org/10.1177/1524838020915584
Segerstrom, S. C., & O'Connor, D. B. (2012) ‘Stress, health and illness: Four challenges for the future’, Psychology & Health, 27(2), pp. 128–140. doi: https://doi.org/10.1080/08870446.2012.659516
Shields G. S, Fassett-Carman A., Gray Z. J., Gonzales J, E., Snyder H. R., & Slavich G. M. (2023) ‘Why is subjective stress severity a stronger predictor of health than stressor exposure? A preregistered two-study test of two hypotheses’, Stress and Health, 39(1), pp. 87–102. https://doi.org/10.1002/smi.3165
Slavich, G. M., & Shields, G. S. (2018) ‘Аssessing lifetime stress exposure using the Stress and Adversity Inventory for Adults (Adult STRAIN): An overview and initial validation’, Psychosomatic Medicine, 80(1), pp. 17–27. doi: https://doi.org/10.1097/psy.0000000000000534
United Nations (2024). Universal declaration of human rights, Article 25. Available at: https://www.un.org/en/about-us/universal-declaration-of-human-rights (дата звернення: 02 травня 2025 р.);
World Health Organization (2024). Constitution of the World Health Organization. Available at: https://www.who.int/about/governance/constitution (дата звернення: 02 травня 2025 р.).
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th edn. Washington, DC: American Psychiatric Association, p. 271.
American Psychological Association (2017) Stress and health disparities: Contexts, mechanisms, and interventions among racial/ethnic minority and low socioeconomic status populations. American Psychological Association. https://doi.org/10.1037/e500202018-001. (дата звернення: 02 травня 2025 р.).
Benjet, C., Lépine, J. P., Shahl, V., et al. (2018) 'Trauma and Posttraumatic Stress Disorder: Global Perspectives from the WHO World Mental Health Surveys', in Bromet, E. J., Karam, E. G., Koenen, K. C., et al. (eds.) Trauma and Posttraumatic Stress Disorder: Global Perspectives from the WHO World Mental Health Surveys. Cambridge: Cambridge University Press, pp. 42–71.
Besser, A., Zeigler-Hill, V., Weinberg, M., Pincus, A. L., & Neria, Y. (2015) ‘Intrapersonal resilience moderates the association between exposure-severity and PTSD symptoms among civilians exposed to the 2014 Israel–Gaza conflict’, Self and Identity, 14(1), pp. 1–15. doi: https://doi.org/10.1080/15298868.2014.966143
Carver, C. S. & Scheier, M. F. (2017) Optimism, coping, and well-being. In Cooper, C.L. & Campbell, J. (eds.) The handbook of stress and health: A guide to research and practice
Einarsdottir, T. S., Asgeirsdottir, B. B., Sigurvinsdottir, R., Ullman, S. E. & Gudmundsdottir, B. (2024) 'Prevalence of trauma exposure and PTSD symptoms among the Icelandic population: gender and regional differences', Scandinavian Journal of Public Health, 52(8), pp. 968–977. https://doi.org/10.1177/14034948231217019;
Fauver, M., Clark, E. M., & Schwartz, C. E. (2024) ‘A new framework for understanding stress and disease: The developmental model of stress as applied to multiple sclerosis’, Frontiers in Integrative Neuroscience, 18, 1365672. doi: https://doi.org/10.3389/fnint.2024.1365672
Fink, G. (2016) Stress, definitions, mechanisms, and effects outlined: Lessons from anxiety. In G. Fink (ed.), Stress concepts, cognition, emotion, and behavior. Handbook of Stress Series, vol. 1, ch. 1, pp. 3-12. Academic Press, New York, NY;
Greene, T., Itzhaky, L., Bronstein, I., & Solomon, Z. (2018) ‘Psychopathology, risk, and resilience under exposure to continuous traumatic stress: A systematic review of studies among adults living in southern Israel’, Traumatology, 24(2), pp. 83–103. doi: https://doi.org/10.1037/trm0000136
Helou, M., Weinstein, E. S., Kalaji, J., Chaaban, T., & Yammine, K. (2024) ‘Pager explosion in Beirut: An unprecedented event’, Disaster Medicine and Public Health Preparedness, 18, Article e215. doi: https://doi.org/10.1017/dmp.2024.281
Helpman, L., Besser, A., & Neria, Y. (2015) ‘Acute posttraumatic stress symptoms but not generalized anxiety symptoms are associated with severity of exposure to war trauma: A study of civilians under fire’, Journal of Anxiety Disorders, 35, pp. 27–34. doi: https://doi.org/10.1016/j.janxdis.2015.08.001
Hoppen, T. H. et al. (2021) ‘Global burden of post-traumatic stress disorder and major depression in countries affected by war between 1989 and 2019: A systematic review and meta-analysis’, BMJ Global Health, 6, e006303. doi: https://doi.org/10.1136/bmjgh-2021-006303
Hughes, K. et al. (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health, vol. 2, no. 8, pp. e356–e366. https://doi.org/10.1016/s2468-2667(17)30118-4;
I-Khoury, J. et al. (2025) ‘Mental health is still a human right during times of war’, International Journal of Social Psychiatry, online first April 13, 2025. doi: 10.1177/00207640251331856
Karam, E., & Bou Ghosn, M. (2003) ‘Psychosocial consequences of war among civilian populations’, Current Opinion in Psychiatry, 16(4), pp. 413–419. doi: https://doi.org/10.1097/00001504-200307000-00007
Karatzias, T. et al. (2023) ‘War exposure, posttraumatic stress disorder, and complex posttraumatic stress disorder among parents living in Ukraine during the Russian war’, Acta Psychiatrica Scandinavica, 147(3), pp. 276–285. doi: https://doi.org/10.1111/acps.13529
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., et al. (2017) 'Trauma and PTSD in the WHO World Mental Health Surveys', European Journal of Psychotraumatology, 8. doi: https://doi:10.1080/20008198.2017.1353383
Kovalenko, J. (2024) ‘Surviving the atrocity: A study of resilience and coping behaviour among Ukrainians during the Russo-Ukrainian war’, Journal of Health Psychology, 29(14), pp. 1688-1703. doi: https://doi.org/10.1177/13591053241274464
Kurapov, A. et al. (2023) ‘Toward an understanding of the Russian-Ukrainian war impact on university students and personnel’, Journal of Loss and Trauma, 28(2), pp. 167-174. doi: https://doi.org/10.1080/15325024.2022.2084838
Leatherman, T. & Goodman, A. (2020) Building on the biocultural syntheses: 20 years and still expanding. American Journal of Human Biology, 32(4), e23360 doi: https://doi.org/10.1002/ajhb.23360
Leatherman, T. & Goodman, A. (2022) Critical biocultural approaches to health and illness. In C. Abadía-Barrero, M. Singer & P. I. Erickson (eds.), A companion to medical anthropology, ch. 2. John Wiley & Sons, Hoboken, Canada,
Lim, I. C. Z. Y. et al. (2022) ‘Prevalence of depression, anxiety and post-traumatic stress in war- and conflict-afflicted areas: A meta-analysis’, Frontiers in Psychiatry, 13, 978703. doi: https://doi.org/10.3389/fpsyt.2022.978703
Maltseva, K. (2024) ‘Stress exposure, perceived stress, protective psychosocial factors, and health status in Ukraine after the full-scale invasion’, Journal of Health Psychology, 29(14), pp. 1640–1652. doi: https://doi.org/10.1177/13591053241259728
Maltseva, K., & Sereda, P. (2025). The relationships between war-induced stressor exposure, endorsement of values dimensions, and quality of life in Ukraine. Journal of Cognition and Culture, 25, 438–467. doi: http://dx.doi.org/10.1163/15685373-12340219
Marín C, Gómez-Gutiérrez M del M, Vázquez C, Crespo M, Hervás G. (2025) ‘Trauma and well-being in terrorism survivors in Spain’, Journal of Health Psychology, 0(0). doi:10.1177/1359105325132424
May, C. L. and Wisco, B. E. (2016) ‘Defining trauma: How level of exposure and proximity affect risk for posttraumatic stress disorder’, Psychological Trauma: Theory, Research, Practice and Policy, 8(2), pp. 233–240. https://doi.org/10.1037/tra0000077
Miguel-Tobal J J, Cano-Vindel A, Gonzalez-Ordi H, Iruarrizaga I, Rudenstine S, Vlahov D, & Galea S. (2006) ‘PTSD and depression after the Madrid March 11 train bombings’ Journal of Traumatic Stress, 19(1), pp. 69–80. doi:10.1002/jts.2009
Miller, K. E., & Rasmussen, A. (2017) ‘The mental health of civilians displaced by armed conflict: An ecological model of refugee distress’, Epidemiology and Psychiatric Sciences, 26(2), pp. 129–138. doi: https://doi.org/10.1017/s2045796016000172
Morina, N. et al. (2018) ‘Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions: A systematic review and meta-analysis of epidemiological studies’, Journal of Affective Disorders, 239, pp. 328–338. doi: https://doi.org/10.1016/j.jad.2018.07.027
Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E. and Kaniasty, K. (2002) ‘60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001’, Psychiatry, 65(3), pp. 207–239. https://doi.org/10.1521/psyc.65.3.207.20173
Oishi, S. and Westgate, E. C. (2022) ‘A psychologically rich life: Beyond happiness and meaning’, Psychological Review, 129(4), pp. 790–811. https://doi.org/10.1037/rev0000317
Oishi, S. and Westgate, E. C. (2025) ‘Psychological richness offers a third path to a good life’, Trends in Cognitive Sciences. Advance online publication. https://doi.org/10.1016/j.tics.2025.04.002
Pavlova, I. et al. (2022) ‘Early evidence on the mental health of Ukrainian civilian and professional combatants during the Russian invasion’, European Psychiatry, 65(1), e79. doi: https://doi.org/10.1192/j.eurpsy.2022.2335
Rigutto, C., Sapara, A. O. and Agyapong, V. I. O. (2021) ‘Anxiety, depression and posttraumatic stress disorder after terrorist attacks: A general review of the literature’, Behavioural Sciences, 11(140). https://doi.org/10.3390/bs11100140
Scoglio, A. A. J., & Salhi, C. (2021) ‘Violence exposure and mental health among resettled refugees: A systematic review’, Trauma, Violence & Abuse, 22(5), pp. 1192–1208. doi: https://doi.org/10.1177/1524838020915584
Segerstrom, S. C., & O'Connor, D. B. (2012) ‘Stress, health and illness: Four challenges for the future’, Psychology & Health, 27(2), pp. 128–140. doi: https://doi.org/10.1080/08870446.2012.659516
Shields G. S, Fassett-Carman A., Gray Z. J., Gonzales J, E., Snyder H. R., & Slavich G. M. (2023) ‘Why is subjective stress severity a stronger predictor of health than stressor exposure? A preregistered two-study test of two hypotheses’, Stress and Health, 39(1), pp. 87–102. https://doi.org/10.1002/smi.3165
Slavich, G. M., & Shields, G. S. (2018) ‘Аssessing lifetime stress exposure using the Stress and Adversity Inventory for Adults (Adult STRAIN): An overview and initial validation’, Psychosomatic Medicine, 80(1), pp. 17–27. doi: https://doi.org/10.1097/psy.0000000000000534
United Nations (2024). Universal declaration of human rights, Article 25. Available at: https://www.un.org/en/about-us/universal-declaration-of-human-rights (дата звернення: 02 травня 2025 р.);
World Health Organization (2024). Constitution of the World Health Organization. Available at: https://www.who.int/about/governance/constitution (дата звернення: 02 травня 2025 р.).
