Uncertainty Breeds Anxiety and Depression: The Impact of the Russian Invasion in Ukraine on a Swedish Clinical Population Receiving Internet-Based Psychotherapy

Abstract: Recent global crises, such as the COVID-19 pandemic and the 2022 Russian invasion of Ukraine, have contributed to a rise in the global prevalence of anxiety and depressive disorders. This study examined the indirect impact of the Ukraine war on emotional disorders within a Swedish clinical population (n = 1222) participating in an internet-based psychotherapeutic intervention (cognitive-behavioral, psychodynamic, waitlist). We hypothesized that the severity of anxiety and depressive symptoms would increase immediately after the war's onset. The Patient Health Questionnaire 9-item scale and the Generalized Anxiety Disorder 7-item scale were used to measure depression and anxiety. Results indicated that anxiety and depressive symptom severity increased following the war's onset, with an average weekly increase of 0.77-points for anxiety and 0.09-points for depression; however, the increase was not statistically significant for depression. Furthermore, higher socioeconomic status predicted declines in depression and anxiety over the course of treatment, with a 0.69-point average weekly decrease in anxiety and a 1.09-point average weekly decrease in depression, per one unit's increase in socioeconomic status. Finally, treatment efficacy for anxiety and depression was high, with average weekly symptom reductions of 0.12-points for anxiety and 0.15-points for depression. These findings have implications for mitigating the development of psychopathology during crises, interpreting treatment efficacy during such events, and emphasizing the potential of internet-based psychotherapy for addressing emotional disorders during crises. To the best of our knowledge, this is the first internet-based semi-longitudinal study investigating the effects of the war in Ukraine on emotional disorders in a clinical population.