Prevalence of depression, anxiety, and PTSD symptoms among patients of opioid agonist treatment programmes in Ukraine during wartime {peer reviewed}

Abstract
Background: The ongoing war in Ukraine has intensified psychological distress, particularly among patients receiving opioid agonist therapy (OAT). This study explores the prevalence and co-occurrence of depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, and suicidal ideation among OAT patients during wartime in 2023.
Objectives: To assess the point prevalence of mental health symptoms among OAT program participants during the second year of the full-scale Russian invasion of Ukraine, and to compare these findings with pre-war baseline data.
Methods: A descriptive cross-sectional study was conducted using standardized screening tools (GAD-7, PHQ-9, and PCL-5) to measure symptoms among patients across OAT centres in Lviv, Sumy, and Vinnytsia between April and October 2023. Additional measures included missed visits and dose satisfaction over the past month. The data were compared to pre-invasion data collected from October 2021 to January 2022 in Kyiv, Sumy, and Lviv.
Results: Among the screened population, 17.43% reported concurrent depressive, anxiety, and PTSD symptoms. Females exhibited higher depressive symptoms (45.26%) compared to males (31.28%). Patients on buprenorphine showed a higher prevalence of suicidal ideation (33.96%) and PTSD symptoms (44.96%) than those on methadone (22.64% and 31.1%, respectively). The mean trauma exposure was 4.11 events per person. A significant increase in depression (mean PHQ-9 score from 7.42 to 7.90) and anxiety (mean GAD-7 from 5.06 to 6.39) was observed, alongside an increase in probable depression (from 26.73% to 32.62%) and generalized anxiety (from 14.72% to 25.51%). Suicidal ideation rates remained largely unchanged.
Conclusions: The findings highlight the compounding mental health burden among OAT patients during wartime and underscore the urgent need to embed psychosocial support services within OAT programs to enhance patient well-being and societal reintegration.
Keywords
opioid agonist therapy , mental health, depression, anxiety, suicidal ideation, PTSD
Author Biography
Viktoriia Gorbunova
Research Scientist, University of Luxembourg, Luxembourg; Professor, Zhytomyr Ivan Franko State University, Ukraine
Vitalii Klymchuk
Postdoctoral Researcher, University of Luxembourg, Luxembourg; Secretary of the National Psychological Association of Ukraine, Kyiv, Ukraine
Vladyslav Romanchuk
State Institution “Public Health Centre of the Ministry of Health of Ukraine”, Kyiv, Ukraine
Iryna Ivanchuk
State Institution “Public Health Centre of the Ministry of Health of Ukraine”, Kyiv, Ukraine
References
- Aas, C. F., Vold, J. H., Skurtveit, S., Lim, A. G., Ruths, S., Islam, K., et al. (2020). Health-related quality of life of long-term patients receiving opioid agonist therapy: A nested prospective cohort study in Norway. Substance Abuse Treatment, Prevention, and Policy, 15, 1–12. https://doi.org/10.1186/s13011-020-00309-y
- Alcaraz, S., Viladrich, C., Trujols, J., Sinol, N., & Perez de los Cobos, J. (2018). Heroin-dependent patient satisfaction with methadone as a medication influences satisfaction with basic interventions delivered by staff to implement methadone maintenance treatment. Patient Preference and Adherence, 12, 1203–1211. https://doi.org/10.2147/PPA.S164181
- Amone-P’Olak, K., Lekhutlile, T. M., Meiser-Stedman, R., & Ovuga, E. (2014). Mediators of the relation between war experiences and suicidal ideation among former child soldiers in Northern Uganda: The WAYS study. BMC Psychiatry, 14(271). https://doi.org/10.1186/s12888-014-0271-2
- Amura, C. R., Sorrell, T. R., Weber, M., Alvarez, A., Beste, N., Hollins, U., et al. (2022). Outcomes from the medication assisted treatment pilot program for adults with opioid use disorders in rural Colorado. Substance Abuse Treatment, Prevention, and Policy, 17, 1–11. https://doi.org/10.1186/s13011-021-00424-4
- Andersson, H. W., Mosti, M. P., & Nordfjærn, T. (2022). Suicidal ideation among inpatients with substance use disorders: Prevalence, correlates and gender differences. Psychiatry Research, 317, 114848. https://doi.org/10.1016/j.psychres.2022.114848
- APA (2022). American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, D.C.: American Psychiatric Association; 2022. https://doi.org/10.1176/appi.books.9780890425787
- Applebaum, A. J., Bullis, J. R., Traeger, L. N., O’Cleirigh, C., Otto, M. W., Pollack, M. H., et al. (2010). Rates of mood and anxiety disorders and contributors to continued heroin use in methadone maintenance patients: A comparison by HIV status. Neurobehavioral HIV Medicine, 49–57. http://dx.doi.org/10.2147/NBHIV.S12371
- Archambault, L., Jutras-Aswad, D., Touré, E. H., Artunduaga, A. C., Roy, S., Barbeau, D., et al. (2022). Profiles of patients with opioid use disorders presenting a history of suicidal ideations and attempts. Psychiatric Quarterly, 93(2), 637–650. https://doi.org/10.1007/s11126-022-09978-3
- Au, V. Y., Rosic, T., Sanger, N., Hillmer, A., Chawar, C., Worster, A., et al. (2021). Factors associated with opioid overdose during medication-assisted treatment: How can we identify individuals at risk? Harm Reduction Journal, 18, 1–10. https://doi.org/10.1186/s12954-021-00521-4
- Barry, D. T., Beitel, M., Cutter, C. J., Garnet, B., Joshi, D., Rosenblum, A., et al. (2011). Exploring relations among traumatic, posttraumatic, and physical pain experiences in methadone-maintained patients. Journal of Pain, 12, 22–28. http://dx.doi.org/10.1016/j.jpain.2010.04.006
- Beaumont, S., Magel, T., MacDonald, S., Harrison, S., Schechter, M., & Oviedo-Joekes, E. (2024). Shared decision-making and client-reported dose satisfaction in a longitudinal cohort receiving injectable opioid agonist treatment (iOAT). Substance Abuse Treatment, Prevention, and Policy, 19(1), 1. https://doi.org/10.21203/rs.3.rs-3399610/v1
- Becker, W. C., Ganoczy, D., Fiellin, D. A., & Bohnert, A. S. (2015). Buprenorphine/naloxone dose and pain intensity among individuals initiating treatment for opioid use disorder. Journal of Substance Abuse Treatment, 48, 128–131. http://dx.doi.org/10.1016/j.jsat.2014.09.007
- Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394(10194), 240–248. https://doi.org/10.1016/s0140-6736(19)30934-1
- Dubov, A., Basenko, A., Dymaretskyi, O., & Shoptaw, S. (2024). Impact of the Russian invasion on opioid agonist therapy programs in Ukraine: A qualitative study. Drug and Alcohol Dependence, 255, 111069. https://doi.org/10.1016/j.drugalcdep.2023.111069
- Engstrom, M., El-Bassel, N., & Gilbert, L. (2012). Childhood sexual abuse characteristics, intimate partner violence exposure, and psychological distress among women in methadone treatment. Journal of Substance Abuse Treatment, 43, 366–376. http://dx.doi.org/10.1016/j.jsat.2012.01.005
- Forkus, S. R., Raudales, A. M., Rafiuddin, H. S., Weiss, N. H., Messman, B. A., & Contractor, A. A. (2023). The Posttraumatic Stress Disorder (PTSD) Checklist for DSM–5: A systematic review of existing psychometric evidence. Clinical Psychology: Science and Practice, 30(1), 110. https://doi.org/10.1037/cps0000111
- Hassan, A. N., Bozinoff, N., Jutras-Aswad, D., Socias, M. E., Stewart, S. H., Lim, R., et al. (2023). Patient satisfaction with standard methadone and flexible buprenorphine/naloxone models of care: Results from a pragmatic randomized controlled clinical trial. Journal of Addiction Medicine, 17(1), e49–e56. https://doi.org/10.1097/ADM.0000000000001048
- Himelhoch, S., Weber, E., Medoff, D., Charlotte, M., Clayton, S., Wilson, C., et al. (2012). Posttraumatic stress disorder and one-year outcome in methadone maintenance treatment. American Journal on Addictions, 21, 524–530. http://dx.doi.org/10.1111/j.1521-0391.2012.00271.x
- Huang, C. L. C., & Lee, C. W. (2013). Factors associated with mortality among heroin users after seeking treatment with methadone: A population-based cohort study in Taiwan. Journal of Substance Abuse Treatment, 44(3), 295–300. https://doi.org/10.1016/j.jsat.2012.08.003
- Huhn, A. S., & Dunn, K. E. (2020). Challenges for women entering treatment for opioid use disorder. Current Psychiatry Reports, 22, 1–10. https://doi.org/10.1007/s11920-020-01201-z
- Hyland, P., Vallières, F., Shevlin, M., Karatzias, T., Ben-Ezra, M., McElroy, E., et al. (2023). Psychological consequences of war in Ukraine: Assessing changes in mental health among Ukrainian parents. Psychological Medicine, 53(15), 7466–7468. https://doi.org/10.1017/S0033291723000818
- Iskandar, S., van Crevel, R., Hidayat, T., Siregar, I. M., Achmad, T. H., van der Ven, A. J., et al. (2013). Severity of psychiatric and physical problems is associated with lower quality of life in methadone patients in Indonesia. American Journal on Addictions, 22(5), 425–431. https://doi.org/10.1111/j.1521-0391.2013.00334.x
- Karam, E. G., Salamoun, M. M., Mneimneh, Z. N., Fayyad, J. A., Karam, A. N., Hajjar, R., et al. (2012). War and first onset of suicidality: The role of mental disorders. Psychological Medicine, 42(10), 2109–2118. https://doi.org/10.1017/S0033291712000268
- Karatzias, T., Shevlin, M., Ben-Ezra, M., McElroy, E., Redican, E., Vang, M. L., 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), 276–285. https://doi.org/10.1111/acps.13529
- Klymchuk, V. (2025). Annex to the paper: Prevalence of depression, anxiety, and PTSD symptoms among patients of opioid agonist treatment programmes in Ukraine during wartime. Zenodo. https://doi.org/10.5281/zenodo.15640272
- Klymchuk, V., Gorbunova, V., & Ivanchuk, I. (2024). Prevalence of alcohol use, depressive and anxiety symptoms among patients of opioid agonist treatment programmes in Ukraine. Academic Mental Health and Well Being, 1(1). https://doi.org/10.20935/MHealthWellB6210
- Kumari, S., Manalai, P., Leong, S., Wooditch, A., Malik, M., & Lawson, W. B. (2016). Factors associated with non-adherence to buprenorphine-naloxone among opioid dependent African-Americans: A retrospective chart review. American Journal on Addictions, 25, 110–117. http://dx.doi.org/10.1111/ajad.12325
- Lester, D. (1994). Suicide rates before, during and after the world wars. European Psychiatry, 9(5), 262–264. https://doi.org/10.1017/S092493380000362X
- Machavariani, E., Bromberg, D. J., Dumchev, K., Dvoriak, S., Zeziulin, O., Morozova, O., et al. (2023). Design, implementation and preliminary results of a type-2 hybrid cluster-randomized trial of integrating screening and treatment for major depressive disorder into specialty clinics providing opioid agonist therapies in Ukraine. Contemporary Clinical Trials, 131, 107248. https://doi.org/10.1016/j.cct.2023.107248
- Madison, C. A., & Eitan, S. (2020). Buprenorphine: Prospective novel therapy for depression and PTSD. Psychological Medicine, 50(6), 881–893. https://doi.org/10.1017/s0033291720000525
- Manea, L., Gilbody, S., & McMillan, D. (2012). Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): A meta-analysis. Canadian Medical Association Journal, 184(3), E191–E196. https://doi.org/10.1503/cmaj.110829
- Marchand, K. I., Oviedo-Joekes, E., Guh, D., Brissette, S., Marsh, D. C., & Schechter, M. T. (2011). Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency. BMC Health Services Research, 11, 1–10. https://doi.org/10.1186/1472-6963-11-174
- McElroy, E., Hyland, P., Shevlin, M., Karatzias, T., Vallières, F., Ben-Ezra, M., et al. (2024). Change in child mental health during the Ukraine war: Evidence from a large sample of parents. European Child & Adolescent Psychiatry, 33(5), 1495–1502. https://doi.org/10.1007/s00787-023-02255-z
- Meshberg-Cohen, S., MacLean, R. R., Martin, A. M. S., Sofuoglu, M., & Petrakis, I. L. (2021). Treatment outcomes in individuals diagnosed with comorbid opioid use disorder and posttraumatic stress disorder: A review. Addictive Behaviors, 122, 107026. https://doi.org/10.1016/j.addbeh.2021.107026
- Morin, K. A., Eibl, J. K., Gauthier, G., Rush, B., Mushquash, C., Lightfoot, N. E., et al. (2020). A cohort study evaluating the association between concurrent mental disorders, mortality, morbidity, and continuous treatment retention for patients in opioid agonist treatment (OAT) across Ontario, Canada, using administrative health data. Harm Reduction Journal, 17, 1–13. https://doi.org/10.1186/s12954-020-00396-x
- Morozova, O., Dvoriak, V., Dumchev, K., Machavariani, E., Bromberg, D. J., Dvoriak, S., et al. (2024). Prevalence and correlates of depression and bipolar disorder among patients maintained on methadone and buprenorphine in Ukraine. International Journal of Mental Health and Addiction, 1–18. https://doi.org/10.1007/s11469-024-01353-6
- Naji, L., Rosic, T., Sanger, N., Dennis, B., Worster, A., Paul, J., et al. (2021). The role of cannabis use in suicidal ideation among patients with opioid use disorder. Journal of Addiction Medicine, 15(5), 370–375. https://doi.org/10.1097/adm.0000000000000781
- Ngo, H. T., Tait, R. J., & Hulse, G. K. (2011). Hospital psychiatric comorbidity and its role in heroin dependence treatment outcomes using naltrexone implant or methadone maintenance. Journal of Psychopharmacology, 25(6), 774–782. https://doi.org/10.1177/0269881110364266
- Padmanathan, P., Forbes, H., Redaniel, M. T., Gunnell, D., Lewer, D., Moran, P., et al. (2022). Self-harm and suicide during and after opioid agonist treatment among primary care patients in England: A cohort study. The Lancet Psychiatry, 9(2), 151–159. https://doi.org/10.1016/s2215-0366(21)00392-8
- Pant, S. B., Thapa, S. B., Howard, J., Ojha, S. P., & Lien, L. (2022). Mental disorders and suicidality among opioid agonist treatment service users in Nepal: A cross-sectional study. SSM - Mental Health, 2, 100165. https://doi.org/10.1016/j.ssmmh.2022.100165
- Peck, K. R., Moxley-Kelly, N., Badger, G. J., & Sigmon, S. C. (2021). Posttraumatic stress disorder in individuals seeking treatment for opioid use disorder in Vermont. Preventive Medicine, 152, 106817. https://doi.org/10.1016/j.ypmed.2021.106817
- Peles, E., Schreiber, S., & Adelson, M. (2006). Factors predicting retention in treatment: 10-year experience of a methadone maintenance treatment (MMT) clinic in Israel. Drug and Alcohol Dependence, 82(3), 211–217. https://doi.org/10.1016/j.drugalcdep.2005.09.004
- Preti, A., Demontis, R., Cossu, G., Kalcev, G., Cabras, F., Moro, M. F., et al. (2021). The lifetime prevalence and impact of generalized anxiety disorders in an epidemiologic Italian National Survey carried out by clinicians by means of semi-structured interviews. BMC Psychiatry, 21, 1–8. https://doi.org/10.1186/s12888-021-03042-3
- Rathi, P., Joseph, J., Devi, R., & Arya, S. (2024). Assessment of the mental and physical health problems of clients undergoing opioid substitution therapy: A hospital-based cross-sectional study. Annals of Indian Psychiatry, 8(4), 328–331. https://doi.org/10.4103/aip.aip_125_23
- Roberts, A. L., Kubzansky, L. D., Chibnik, L. B., Rimm, E. B., & Koenen, K. C. (2020). Association of posttraumatic stress and depressive symptoms with mortality in women. JAMA Network Open, 3(12), e2027935. https://doi.org/10.1001/jamanetworkopen.2020.27935
- Roncero, C., Barral, C., Rodríguez-Cintas, L., Pérez-Pazos, J., Martinez-Luna, N., Casas, M., et al. (2016). Psychiatric comorbidities in opioid-dependent patients undergoing a replacement therapy programme in Spain: The PROTEUS study. Psychiatry Research, 243, 174–181. https://doi.org/10.1016/j.psychres.2016.06.024
- Rosen, D., Smith, M. L., & Reynolds, C. F. III. (2008). The prevalence of mental and physical health disorders among older methadone patients. American Journal of Geriatric Psychiatry, 16, 488–497. https://doi.org/10.1097/JGP.0b013e31816ff35a
- Rosic, T., Au, V. Y., Worster, A., Marsh, D. C., Thabane, L., & Samaan, Z. (2021). Trauma and post-traumatic stress disorder in patients treated for opioid use disorder: Findings from a 12-month cohort study. BJPsych Open, 7(4), e138. https://doi.org/10.1192/bjo.2021.971
- Rosic, T., Naji, L., Bawor, M., Dennis, B. B., Plater, C., Marsh, D. C., et al. (2017). The impact of comorbid psychiatric disorders on methadone maintenance treatment in opioid use disorder: A prospective cohort study. Neuropsychiatric Disease and Treatment, 13, 1399–1408. https://doi.org/10.2147/ndt.s129480
- Rosic, T., Worster, A., Thabane, L., Marsh, D. C., & Samaan, Z. (2020). Exploring psychological symptoms and associated factors in patients receiving medication-assisted treatment for opioid-use disorder. BJPsych Open, 6(1). https://doi.org/10.1192/bjo.2019.99
- Saad, S. N. S., Mohamed, S., Abdullah, N., Ariaratnam, S., & Isa, M. R. (2021). Prevalence of major depressive disorder and its association with erectile dysfunction among clients on methadone maintenance therapy. ASEAN Journal of Psychiatry, 22(4). https://www.aseanjournalofpsychiatry.org/articles/prevalence-of-major-depressive-disorder-and-its-association-with-erectile-dysfunction-among-clients-on-methadone-mainten.pdf
- Saraiya, T. C., Helpinstill, S., Gray, D., Hien, D. A., Brady, K. T., Hood, C. O., et al. (2024). The lived experiences and treatment needs of women with opioid use disorder and posttraumatic stress symptoms: A mixed methods study. Journal of Substance Use and Addiction Treatment, 161, 209344. https://doi.org/10.1016/j.josat.2024.209344
- Serafini, G., Adavastro, G., Canepa, G., De Berardis, D., Valchera, A., Pompili, M., et al. (2018). The efficacy of buprenorphine in major depression, treatment-resistant depression and suicidal behavior: A systematic review. International Journal of Molecular Sciences, 19(8), 2410. https://doi.org/10.3390/ijms19082410
- Smith, J. A., Doidge, M., Hanoa, R., & Frueh, B. C. (2019). A historical examination of military records of US Army suicide, 1819 to 2017. JAMA Network Open, 2(12), e1917448. https://doi.org/10.1001/jamanetworkopen.2019.17
- Smoller, J. W. (2016). The genetics of stress-related disorders: PTSD, depression, and anxiety disorders. Neuropsychopharmacology, 41(1), 297–319. https://doi.org/10.1038/npp.2015.266
- Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
- Teoh Bing Fei, J., Yee, A., & Habil, M. H. B. (2016). Psychiatric comorbidity among patients on methadone maintenance therapy and its influence on quality of life. American Journal on Addictions, 25(1), 49–55. https://doi.org/10.1111/ajad.12317
- Trafton, J. A., Minkel, J., & Humphreys, K. (2006). Opioid substitution treatment reduces substance use equivalently in patients with and without posttraumatic stress disorder. Journal of Studies on Alcohol, 67, 228–235. http://dx.doi.org/10.15288/jsa.2006.67.228
- Villagonzalo, K. A., Dodd, S., Ng, F., Mihaly, S., Langbein, A., & Berk, M. (2011). The relationship between substance use and posttraumatic stress disorder in a methadone maintenance treatment program. Comprehensive Psychiatry, 52, 562–566. http://dx.doi.org/10.1016/j.comppsych.2010.10.001
- Vold, J. H., Løberg, E. M., Aas, C. F., Steier, J. A., Johansson, K. A., & Fadnes, L. T. (2022). Prevalence and correlates of suicide attempts in high-risk populations: A cross-sectional study among patients receiving opioid agonist therapy in Norway. BMC Psychiatry, 22(1), 181. https://doi.org/10.1186/s12888-022-03829-y
- Wu, L. T., Blazer, D. G., Gersing, K. R., Burchett, B., Swartz, M. S., Mannelli, P., et al. (2013). Comorbid substance use disorders with other Axis I and II mental disorders among treatment-seeking Asian Americans, Native Hawaiians/Pacific Islanders, and mixed-race people. Journal of Psychiatric Research, 47(12), 1940–1948. https://doi.org/10.1016/j.jpsychires.2013.08.022
- Zeziulin, O., Mollan, K. R., Shook-Sa, B. E., Hanscom, B., Lancaster, K. E., Dumchev, K., et al. (2021). Depressive symptoms and use of HIV care and medication-assisted treatment among people with HIV who inject drugs. AIDS, 35(3), 495–501. https://doi.org/10.1097/QAD.0000000000002774