Abstract
Background: While previous studies show the long-term and transgenerational effects of war on mental health, immediate effects on mental health are relatively understudied. The 44-day 2020 Artsakh War (September 27-November 10, 2020) resulted in an estimated 5,000 Armenian casualties, displacement of half the Artsakh population, and ongoing captivity of Armenian prisoners of war. This is the first study post-war to quantify depression, anxiety, and post-traumatic stress disorder (PTSD) levels among the Armenian population. Methods: We conducted a cross-sectional study from February 3-May 31, 2021. Using Google Forms, we implemented a 75-item survey, including depression (PHQ-9), anxiety (GAD-7), and PTSD (PCL-5) questionnaires. We used six binary (yes/no) questions to define direct-exposure (DE) and no direct exposure (NDE) groups. We used independent samples t-tests to compare mean scores between groups. Results: There were 825 participants from 32 countries, 48% from the United States and 33% from Armenia and Artsakh. All participants from Artsakh (100%), 89.2% from Armenia, and 46.6% from the United States were directly exposed to the war. The DE (n=529) group exhibited significantly higher PHQ-9 (p=0.0001), GAD-7 (p=<0.0001), and PCL-5 (p=0.0001) mean scores, than the NDE (n=296) group. Those who sustained a physical injury (n=20) had the highest average clinically relevant PTSD score (mean=39.5, SD=24). Conclusion: Our results suggest an association between direct exposure to war in Artsakh and increased depression, anxiety, and PTSD severity, suggesting an immediate need for mental health resources. Those who lost a loved one, had a loved one get injured, and had a loved one participate in the 2020 Artsakh War had higher PHQ-9, GAD-7, and PCL-5 mean scores relative to those who did not. Implications of this study include the development of targeted evidence-based psychotherapeutic methods based on specific direct exposure factors.
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