How research supported mental health campaigning in Ukraine

Last year, the first lady of Ukraine, Olena Zelenska, initiated the All-Ukrainian Mental Health Program to improve access to mental health services for Ukrainians.

A communications campaign from the initiative, ‘How are you?’, encouraged people in Ukraine to take care of their mental health, recognise the need for help and be able to access the services they need.

“Against the background of daily alarming news, missile attacks, human grief and trouble, it doesn’t seem appropriate to ask yourself ‘How are you?’ But in fact, psychological wellbeing and understanding of what is happening in our inner world is more timely than ever,” said Zelenska at the time.

To support the campaign, Brand Ukraine, an independent organisation working to strengthen the country’s brand since February 2022, commissioned research with BVA BDRC and Alligator to better understand the mental health and resilience of Ukrainians as well as other countries.

“Research was required to support the content of the Third Summit of First Ladies and Gentlemen. The focus of the summit was on mental health and resilience and the Brand Ukraine team wanted primary research to support this. Research was required in countries where there was current or historic experiences of conflict,” says Jacqui Banerjee, director, financial and business at BVA BDRC.

Shared at the Third Summit of First Ladies and Gentlemen – an annual event founded by Olena Zelenska – the findings offer a snapshot of attitudes towards mental health across global regions, highlighting how different countries’ populations feel about mental health and resilience.

Perceptions of mental health

Mental health was seen as the fourth biggest challenge facing the world today and an average of 28% of respondents rated theirs negatively. Of the 11 countries studied, Ukraine’s mental health ratings were not the weakest – Japan had the lowest rating, with 47% of participants stating that their mental health is ‘poor’. In contrast, respondents in Brazil rated their mental health better on average, with 45% reporting ‘good’ mental health and 19% reporting it is ‘poor’.

The findings also indicated that only 2% of people in Ukraine are diagnosed with a mental health condition, compared with 20-24% in the UK, US and Germany. Yet, the country scored the least likely to associate stigma to mental ill-health, with 79% of people agreeing with the statement “mental illness is an illness like any other”. Additionally, half of Ukrainians felt emotionally worse compared with three years ago and 77% viewed war as a major challenge over the next five years.

An analysis produced by the World Health Organization in 2019 estimated that 22.1% of the population in conflict-affected settings has depression, anxiety disorder, post-traumatic stress disorder, bipolar disorder, or schizophrenia.

Ukrainians were more likely to feel resilient in the face of war, with 69% of respondents agreeing that war ‘might not feel great sometimes but they'll get over it’, according to the BVA BDRC/Alligator research. Meanwhile, 62% of survey respondents ‘very affected by world conflict’ stated that they expect their mental health to improve over the next three years, compared with 52% of those who are not affected by conflict.

The researchers accounted for cultural differences in how open people are to discussing or disclosing mental health issues, including spending time ensuring that the questionnaire was fit for purpose in all countries. “One of the things we were most aware of was the language used to talk about different types of mental health,” says Banerjee. “For example, in the UK, terms such as PTSD, anxiety and bipolar are phrases we’re familiar with, and if diagnosed you will have a very good understanding of terms used to describe mental health illnesses. We knew this wouldn’t be the case in some countries – we’ve become accustomed to talking about mental health more freely in the UK, and it’s the same in some other countries, but not all, therefore awareness is low.”

Therefore, instead of talking about mental health symptoms, the researchers asked about feelings, and extended bouts of feelings, to measure mental health wellness.

Banerjee says: “Of course, when the data came in, we could see the obvious differences in attitudes to mental health, but also the extent of mental health care provision, which impacts on awareness.”

Young people’s views

The survey also explored young people’s wellbeing and attitudes specifically, finding that young people aged 18 to 24 reported the lowest ratings for mental health, and 13 to 15-year-olds most likely to feel affected by conflict.

Additionally, nearly 80% of people aged 18 to 24 responding to the survey are aware of the risks to their mental health presented by smartphones and social media engagement.

In addition to the research being used at the summit, and by the Brand Ukraine team to inform data stories for the campaign via social media channels, findings were used at a roundtable in London during Olena Zelenska’s visit to the UK in 2024, with Zelenska and the researchers taking part in a discussion with representatives from the two countries’ healthcare sectors.

The roundtable, organised by Professor Dennis Ougrin of Queen Mary University of London in partnership with the Department of Health and Social Care, the Ukrainian embassy and East London NHS Foundation Trust, looked to share knowledge, best practice and approaches to caring for young people with mental health needs. It also aimed to overall support the development of clinical services in Ukraine post-war, as well as facilitate training of mental health professionals to meet the demand for services.

“We were invited to present the research to this senior team to stress why it was important there was support for Ukraine – they needed little convincing,” says Banerjee. “It was a very intimate event, with no press involved – this wasn’t about ‘show’, it was about taking action, this made this project even more personally rewarding,” says Banerjee.

• The development and implementation of the All-Ukrainian mental health program is coordinated by the Ministry of Health of Ukraine, with the World Health Organization as a partner.
• Research was conducted online with 11,000 respondents in 11 countries between 1 and 24 August 2023.