Preventing Mental Disorders Among Women Internally Displaced by War in Ukraine: The SHAWL Trial

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PROJECT SUMMARY The war in Ukraine has provoked the world’s current largest humanitarian displacement: since February 2022, one-third of Ukrainians have been forced to leave their homes, resulting in upwards of 7 million internally displaced persons. Most of Ukraine’s displaced persons are women, and nearly half of them reported that mental health is the area of life most impacted by the war. Approximately one in five persons affected by conflict will develop mental disorders, notably depressive and anxiety disorders. Thus, preventing displaced women from the burden of mental disease is critical. This is particularly significant as women will have difficulty accessing evidence-based mental health care in Ukraine, if early symptoms develop into full disorders. We propose to adapt a community-based Acceptance and Commitment Therapy (ACT) intervention to prevent mental disorders among women displaced by the war in Ukraine. ACT is an evidence-based intervention that uses acceptance, mindfulness, and behavior change processes to improve psychological flexibility. Our transnational, multidisciplinary team of community partners, mental health experts, and behavioral clinical trial scientists has conducted studies with war-affected populations in Ukraine and successfully used ACT to improve health behaviors among disadvantaged populations in Eastern Europe. This project is innovative in the humanitarian context: ACT is only being newly evaluated as a mental health prevention strategy among displaced populations, has not yet been evaluated as such in Ukraine, and has not been evaluated as a single- session intervention. However, existing evidence on ACT as a prevention strategy suggests that adapting ACT for use among women internally displaced by war in Ukraine has strong potential to reduce risks for long-term adverse mental health effects. Guided by insights and lived experience of community members including displaced women in Ukraine, we will adapt and implement the intervention with our community partner, the Alliance for Public Health (“Alliance,” a leading non-governmental organization in Ukraine that serves vulnerable populations across the country), as well as leading mental health experts in Ukraine. As a direct result of the war and the needs of displaced populations, the Alliance is serving the health needs of impacted communities via mobile medical vans. We will evaluate an adapted, single-session ACT group intervention in Western Ukraine. As part of the services offered through the mobile vans, we will use instruments we previously validated to screen and enroll women identified as at risk for depressive and anxiety disorders. Our central hypothesis is that an ACT intervention delivered in a humanitarian context will help displaced women learn skills to improve psychological flexibility, thereby decreasing symptoms of depression and anxiety and preventing onset of mental disorders. The expected outcome of this award is a potentially effective, scalable, and low-intensity intervention that could create capacity beyond this planning grant and prevent at scale the development of mental disorders among displaced women affected by the humanitarian crisis in Ukraine.