The relationship between specific auditory hallucinations and acute PTSD vs. complex PTSD following direct and indirect exposure to the October 7 events in Israel.

This preliminary study examines the link between war-related auditory (pseudo)hallucinations and symptoms of acute ICD-11 posttraumatic stress disorder (PTSD) and Complex PTSD (CPTSD) amidst ongoing conflict, with a specific focus on CPTSD. The research, which analyzed data from 2028 Israeli residents following the traumatic events of October 7, 2023, investigated the perception of non-existent sirens and their association with acute PTSD and CPTSD symptoms. The findings reveal that (pseudo)hallucinations were more prevalent among individuals with acute CPTSD symptoms compared to those with PTSD symptoms alone. Additionally, auditory (pseudo)hallucinations were significantly associated with a higher likelihood of CPTSD versus PTSD. These results were consistent for those directly and indirectly exposed individuals to the October 7 attack. Despite its cross-sectional nature, the study provides valuable insights into trauma-related auditory (pseudo)hallucinations in wartime contexts.

Exploring depression, PTSD, insomnia, and fibromyalgia symptoms in women exposed to Gaza war news: A community-based study from Jordan.

BACKGROUND: The circulating violent news about the war on Gaza is believed to impact the mental health status of people globally especially in Jordan, the closest country to Palestine. Also, women are more vulnerable to mental distress. AIMS: This study investigates the prevalence and correlates of post-traumatic stress disorder (PTSD), depression, insomnia, and fibromyalgia among Jordanian females exposed to the Gaza war news. METHOD: In a comprehensive cross-sectional inquiry, we applied validated scales to assess the severity of PTSD, depression, insomnia, and fibromyalgia symptoms in a dataset comprising 1,044 females. RESULTS: The findings revealed that 32.3% exhibited severe PTSD symptoms, 53.4% had severe depressive symptoms, 48.2% reported severe insomnia, and 17.2% were diagnosed with fibromyalgia. Exploring demographic factors, the study established statistically significant correlations (p < .05) between the evaluated symptoms and various variables. Notably, individuals of Palestinian nationality, employed as teachers or housewives, those using over-the-counter analgesics for fibromyalgia, and those with chronic diseases exhibited elevated prevalence rates of the investigated conditions. CONCLUSIONS: This pioneering study, the first of its kind, delves into the acute psychiatric repercussions of the October 7th conflict on Jordanian females. The alarming prevalence of severe symptoms underscores the urgent need for timely psychiatric intervention.

Psychosocial etiology of post-traumatic stress disorder caused by war trauma among Iran-Iraq war immigrants in Mehran, Iran.

Background: Post-traumatic stress disorder (PTSD) is one of the most important and common disorders caused by war trauma. The aim of this study was to determine the relationship between psychosocial factors and PTSD in war-torn immigrants in Mehran, Iran. Method: The present study was conducted by descriptive and correlational method. The data were collected from 245 people (121 women and 124 men) from war-torn immigrants 45 years and older who migrated from Mehran to Ilam during the Iran-Iraq war. The measuring tools were as follows: Post Traumatic Stress Disorder Scale, Multidimensional Scale of Perceived Social Support (MDPSS), Coping Strategies Scale (CSS-R), Multidimensional Health Locus of Control scale. Results: The prevalence rate of PTSD among war-torn immigrants in Mehran was 35.1 %. A significant negative correlation was observed between perceived social support and PTSD (p < .01). Coping strategies, including seeking social support, reappraisal/adaptation, problem-focused coping, and active coping, all showed significant negative correlations with PTSD (p < .01). Conversely, a significant positive correlation was found between avoidance coping strategies and self-control and PTSD (p < .01). In addition, there was a significant positive correlation between the external locus of control (believing in chance) and PTSD (P < 0.01) and significant negative correlation between internal locus of control and PTSD (P < .01). Conclusion: Weakness in social support, locus of control and also inappropriate coping strategies against war trauma were among the strong risk factors for PTSD. Therefore, social and behavioral interventions are recommended to increase social support, teaching problem-solving skills and strengthen individual control among war-torn immigrants to reduce the risk of developing PTSD.

Peer conformity and competition shape how business managers evaluate withdrawals from Russia amid the Ukraine War.

States have long used economic sanctions in response to violations of international law as a strategy to restore order. Increasingly, firms also reject doing business with violators. In response to the war in Ukraine, hundreds of multinational corporations voluntarily withdrew from Russia, even when policymakers were still debating the extent of sanctions. How did firm managers evaluate whether to withdraw from the Russian market? Using a survey experiment with Japanese firm managers conducted three months after the Russian invasion of Ukraine in 2022, we explore how peer effects-information on what other firms are doing in response to the crisis-influence support for withdrawal of business activity with Russia. Our findings show that information about withdrawal by other firms from a diverse set of countries promotes peer conformity that increases support. In contrast, information about ongoing business with Russia by Chinese firms fosters competition that reduces support. Market exposure moderates these reactions, although the concern about peer behavior does not appear to be driven by a reputation mechanism. Our research provides insight into how business actors perceive the strategic interplay of peer influence and market dynamics in the context of geopolitical conflicts.

Superconscious processes as mental images of a higher order (in the context of telezombification).

OBJECTIVE: Aim: The paper aims to examine superconscious processes as mental images of a higher order in the context of telezombification. PATIENTS AND METHODS: Materials and Methods: The authors used interpretive research paradigm, psychoanalysis, basic principles of hermeneutics, phenomenological approach along with general scientific methods, such as induction, deduction, generalization, etc. CONCLUSION: Conclusions: With the beginning of the russian full-scale attack on Ukraine, russian atrocities in Bucha, Mariupol and other cities and villages of the country, many Ukrainian citizens asked about what has happened to the russian society, the state authorities, who set the goal of destroying Ukraine as a state and all its inhabitants as a nation. Then Ukrainians have labelled the invaders and the authorities of Russia as non-humans. And this is a fair name for them. The fact is that these occupiers and their neo-Nazi leaders have a destroyed, distorted consciousness as a result of which they became incapable of realizing their thought processes. The consciousness of such persons gradually degrades towards animal thinking, the so-called proto-thinking. This is one direction to not realizing one's intentions and actions at the level of both subconscious and partially conscious analysis of primary mental images (images of a first and second orders). The second direction is the role of superconscious processes, in particular mental images of a higher level, which also form the worldview positions of an individual in the process of viewing and listening to certain information, while remaining, at the same time, unconscious until a certain time. Together, these directions form a person's attitude to existing social and worldview problems.

Ocean wanderers: A lab-based investigation into the effect of wind and morphology on the drift of Physalia spp.

Physalia spp., or Man-of-War, drifts in tropical and subtropical waters, transported by ocean surface conditions. Its unique drifting behavior, influenced by dimorphism (left or right-handedness), complicates stranding predictions. Specifically, the quantification of the influence of the wind on Physalia spp. movements remains an open question, although essential for accurate Lagrangian tracking models. We investigated the wind effect on Physalia spp. by testing 3D-printed replicas in a controlled wind flume. Our findings reveal that under weak winds, left- and right-handed specimens drift symmetrically apart, aligning with strandings observed near Sydney, Australia. As wind speed rises, the drift angle decreases exponentially from approximately 40°, eventually stabilizing near a downwind direction in high winds. On average, the drift speed is 1.7 % of the wind speed. Variations in body shape impact drift angles and stability, adding stochasticity to paths. The proposed empirical relationship might advance knowledge of Physalia spp. sources, distribution and pathways.

Narratives of contingency and practices of comparing in the emergence of German molecular genetics (1958-1968).

This article explores the emergence of molecular approaches in German genetic research during the 1958-1968 decade as a period of contingency and alternative possibilities. We introduce "Narratives of Contingency" as an analytical framework to examine how scientists construct a specific narrative - linking past experiences with expectations of future conditions - in order to outline and navigate pathway-decisions in the present. We apply this framework to Hans-Jörg Rheinberger's developmental model of molecular genetics and illustrate how the stages he identifies - the direction of the field, institutional developments, and epistemological demarcations - were already central themes in the comparative practices underlying narratives of contingency in this early period. Narratives of contingency can thus serve as a systematic framework for analyzing the processes through which new scientific fields, institutions, and epistemic horizons emerge, and possibly also for identifying historically plausible fork moments or alternative pathways not taken.

Targeting dysfunctional endocannabinoid signaling in a mouse model of Gulf War illness.

Gulf War Illness (GWI) is a chronic disorder characterized by a heterogeneous set of symptoms that include pain, fatigue, anxiety, and cognitive impairment. These are thought to stem from damage caused by exposure under unpredictable stress to toxic Gulf War (GW) chemicals, which include pesticides, nerve agents, and prophylactic drugs. We hypothesized that GWI pathogenesis might be rooted in long-lasting disruption of the endocannabinoid (ECB) system, a signaling complex that serves important protective functions in the brain. Using a mouse model of GWI, we found that tissue levels of the ECB messenger, anandamide, were significantly reduced in the brain of diseased mice, compared to healthy controls. In addition, transcription of the Faah gene, which encodes for fatty acid amide hydrolase (FAAH), the enzyme that deactivates anandamide, was significant elevated in prefrontal cortex of GWI mice and brain microglia. Behavioral deficits exhibited by these animals, including heightened anxiety-like and depression-like behaviors, and defective extinction of fearful memories, were corrected by administration of the FAAH inhibitor, URB597, which normalized brain anandamide levels. Furthermore, GWI mice displayed unexpected changes in the microglial transcriptome, implying persistent dampening of homeostatic surveillance genes and abnormal expression of pro-inflammatory genes upon immune stimulation. Together, these results suggest that exposure to GW chemicals produce a deficit in brain ECB signaling which is associated with persistent alterations in microglial function. Pharmacological normalization of anandamide-mediated ECB signaling may offer an effective therapeutic strategy for ameliorating GWI symptomology.

Addressing neurosurgical challenges in war conflict countries.

The Russo-Ukrainian war caused significant humanitarian and healthcare issues in the Russo-Ukrainian region, which were further aggravated by the escalation of the conflict on February 2022. Because of this ongoing confrontation between the two nations, which has its roots in geopolitical conflicts and historical events, there have been nearly 4 million refugees in only the first month, and 906 healthcare institutions have sustained significant damage. Consequently, the demand for medical services has increased, adding onto the burden of the pre-existing problems within the region's healthcare system, such as inequities, budget shortages, and corruption. With nearly 500,000 military deaths and an estimated 27,1499 civilian casualties, the war's immediate health effects are devastating. Due to inadequate disease surveillance and difficulties with immunization, the risk of infectious illnesses, particularly HIV/AIDS and tuberculosis, increased. Although there were originally few mental health problems, the long-term effects are yet unknown. Some of the indirect effects are the severe refugee situation, the burden on public infrastructure, and problems with the security of food and water. Unprecedented obstacles confronted neurosurgery in the Russo-Ukrainian region, including increased patient loads from war-related cases, resource limitations, and facility devastation. Many countries stepped up to aid in managing neurosurgeries however, the some of the problems still persisted, such as insufficient sterility and power outages. Strengthened security standards, financial incentives, telemedicine services, and cooperation with international medical organizations are the main points of recovery recommendations. Rebuilding the region's healthcare system and guaranteeing ongoing foreign support after the conflict require a comprehensive strategy that addresses both short- and long-term issues.

How is political trust associated with economic and environmental policy prioritization? A longitudinal analysis between 2017 and 2022.

In this article, we examine the longitudinal development of economy-over-environment policy priorities in Finland during a period marked by several significant adverse societal events. In addition, we explore the influence of political trust on these priorities over time. We utilize a five-round panel dataset comprising 2155 observations (N = 431) to examine both within-individual and between-individual variations from late 2017 to early 2023. Our findings reveal a significant increase in the prioritization of the economy in each observation period following the COVID-19 outbreak. However, this trend is not observed among individuals with high levels of political trust. The within-individual analysis indicates that high political trust moderates, rather than causes, higher economy-over-environment prioritization. Our study highlights the significance of political trust as a preventing factor against the deprioritization of environmental policies, particularly when societies confront significant and intersecting adverse events.

Civilians under missile attack: post-traumatic stress disorder among the Jewish and Bedouin population of Southern Israel.

BACKGROUND: Over the past 20 years, Jewish and Bedouin civilians in southern Israel have faced the ongoing threat of missile attacks from Gaza, with possible mental health consequences. This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) among Jewish and Bedouin adult civilians in southern Israel in a period with few missile attacks from Gaza, and no military operations. METHODS: The study population included 389 participants (246 Jews, 143 Bedouins) living within 40 km/25 mi from Gaza for at least 2 years and interviewed between January and March 2023 (before the ongoing war that started on October 7th, 2023). The PTSD Checklist (PCL-5) was used, with a score of 33 as a cutoff point for the presence of PTSD. RESULTS: Compared to Jews, a significantly lower proportion of Bedouins reported accessibility to bomb shelters and siren warning systems. Overall, 20.3% of the respondents exhibited PTSD. Multivariate analysis revealed that after adjustment for demographic and household characteristics, Bedouins had a six-fold significantly higher probability of PTSD in comparison to Jews (OR 5.6, 95%CI 2.8-10.8). Compared to participants with high socioeconomic status (SES), participants with low SES had a six-fold significantly higher probability of PTSD (OR 6.0, 95%CI 2.2-16.5). Participants who did not have an alarm system had more than two-fold odds for PTSD (OR 2.3, 95%CI 1.1-5.5). Being single, living in urban areas, or having a disability significantly increased the probability of PTSD. CONCLUSIONS: The findings of this study demonstrate a significantly higher prevalence of PTSD among the Bedouin population of Southern Israel. Several sociodemographic characteristics were associated with the increased prevalence of PTSD, the most prominent of which was low SES. Healthcare professionals and authorities should be proactive in screening for PTSD, and provide tailored treatment and support, taking into account ethnical and cultural background. Authorities should address the disparity in bomb shelter access and siren warning coverage between Bedouin and Jewish communities.

Associations of maternal stress, gene expression, and newborn birthweight in the Democratic Republic of Congo.

Objectives: Maternal stress has long been associated with lower birthweight, which is associated with adverse health outcomes including many adult diseases. The underlying mechanisms remain elusive although changes in gene expression may play a role. Studies are only beginning to test how maternal stress impacts gene expression as reflected in the transcriptome. Materials and Methods: In a cohort of mothers and newborns in the eastern Democratic Republic of Congo (n=93), we studied the effects of four maternal stress measures (chronic stress, war trauma, sexual trauma, and general trauma) on the transcriptomes of maternal venous blood, newborn venous blood, and placental tissues, and on newborn birthweight. Maternal stress was investigated as independent measures, principal components, and clusters identified through machine learning. The transcriptome was assayed using the ClariomD chip. Multiple regression models were used to test for associations between maternal stress measures, the transcriptome, and newborn birthweight. Results: None of the maternal stress measures showed an association with expression of individual genes. In contrast, when testing global gene expression, war trauma was significantly associated with the placental transcriptome. War trauma was also significantly associated with birthweight in multiple models. Mediation analysis indicated that ~14% of the effect of war trauma on birthweight was mediated by a placental gene expression component. Discussion: Our results suggest that gene expression in the placenta, which represents the interface between mother and developing fetus, may partially mediate the negative impact of maternal stress on newborn birthweight.

"PTSD symptoms among patients with multiple sclerosis in Jordan during October 7th gaza war outbreak".

OBJECTIVE: Clinicians have noted that the ongoing war on Gaza has had a psychological impact on people with multiple sclerosis (PwMS) whose mental health is particularly vulnerable during times such as these. The present study sought to examine the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms among PwMS in Jordan during the Gaza war outbreak. METHODS: This was a cross-sectional study involving 171 patients (PwMS) out of 372 patients approached (46% response rate) who were being seen in the MS unit at Al Bashir Hospital, Ammann, Jordan. Inclusion criteria required that participants had been following daily news updates of the October 7 war in Gaza for the past 4 months. RESULTS: Of participants, 125 (73.1%) were female, 98 (57.3%) were on therapy for less than five years, and 30 (17.5%) reported having a relapse during the past 6 months. Significant PTSD symptoms were identified in 58.5% (100 of 171 participants). Those at higher risk were the unemployed (OR = 2.14, 95% CI = 1.13-4.07, P = 0.02), whereas patients receiving dimethyl fumarate (19.9%) were at lower risk (OR = 0.43, 95% CI = 0.19-0.94, P = 0.02). CONCLUSION: The high rate of significant PTSD symptoms among people with MS in this study underscores the need for attention by primary care providers and implementation of a comprehensive multidisciplinary approach to optimize the mental well-being of this fragile population.

Dynamics of components of physical and mental health of law enforcement officers during the period of martial law.

OBJECTIVE: Aim: To investigate the dynamics of law enforcement officers' physical and mental health components while performing their duties during the war in Ukraine. PATIENTS AND METHODS: Materials and Methods: The research, which was conducted in 2022-2024, involved 114 law enforcement officers (male) from the Kharkiv oblast (Ukraine) of different ages: under 30 (n = 35), under 40 (n = 41), over 40 (n = 38). To test law enforcement officers' physical and mental health indicators, we used 3 methods: 1) "Fatigue-Monotony-Oversaturation-Stress"; 2) "Well-being-Activity-Mood"; 3) "Assessment of Nervous and Emotional Stress". RESULTS: Results: The negative dynamics of most components of the physical and mental health of law enforcement officers of all three groups while performing their duties during the martial law were revealed. The most pronounced significant changes occurred in such components as "Fatigue", "Oversaturation", "Stress", "Well-being", "Mood", "Nervous and Emotional Stress". The most pronounced negative changes in most components occurred in law enforcement officers over 40 years old, which is due to both the age characteristics of the subjects and their length of service. CONCLUSION: Conclusions: The research confirms the high complexity and extremity of law enforcement officers' service activities during the martial law, as well as the high requirements for law enforcement officers' readiness to perform tasks in the context of a significant expansion of the National Police's powers. The results obtained also necessitate the search for effective ways to preserve and maintain the physical and mental health of law enforcement officers.

Teachers' assessment of the mental health of children with special educational needs during the war.

OBJECTIVE: Aim: To study the results of teachers' assessment of the mental health of high schoolers with special educational needs (SEN) after the 1.5 years of war in Ukraine. PATIENTS AND METHODS: Materials and Methods: Teachers' assessment of the mental health of high schoolers with SEN was conducted through an anonymous survey of teachers using the questionnaire developed by the authors. The research, conducted in 2023, involved 739 teachers working with high schoolers (ages 6-10) with SEN. RESULTS: Results: It was found that 32.3 % of high schoolers were in the combat zone or on the temporarily occupied territory; 31.7 % of high schoolers were forced to leave their homes and were temporarily displaced, 17.7 % went through a separation from their parents, 15.8 % witnessed hostilities, and 3.8 % suffered bullying from their peers. In the educational process, high schoolers with SEN most often experienced anxiety (55.2 %), "emotional swings" (48.4 %), restlessness (44.8 %), fear (37.2 %). During the 1.5 years of war, 15.4 % of high schoolers began to study worse, 12.9 % began to spend more time playing computer games and on social media. It was found that 59.9 % of teachers need more information on maintaining the mental health of high schoolers with SEN. CONCLUSION: Conclusions: The results obtained proved the negative impact of hostilities on the territory of Ukraine on the mental health of high schoolers with SEN, which necessitates the provision of adequate psychological support by teachers of such high schoolers in the educational process.

Medical perspectives on Israeli children after their release from captivity - A retrospective study.

AIM: Following the Hamas terror attack on Israeli towns on October 2023, 250 individuals were taken into captivity. On November-December 2023, during the cease-fire deal, 26 women and children were released. This study is the first to describe the physical and behavioural findings in children and their mothers in the immediate phase of returning home from captivity. METHODS: This is a retrospective study describing the clinical characteristics of the returnees after 49-53 days in captivity. Patients were admitted to a designated unit in the Schnieder Children's Medical Center of Israel on November-December 2023. The hospitalisation duration was 1-9 days. All patients were evaluated according to a detailed protocol and were treated respectively. RESULTS: Patient population included 19 children (ranged 2-18 years old) and 7 women (ranged 34-78 years old). The most common clinical findings upon return included significant weight loss, psychological trauma, complications of poor hygiene and complications of recent shrapnel injuries. Microbiology tests were positive for multiple gastrointestinal pathogens. Serologic screening tests were positive for various infectious diseases. CONCLUSION: Clinical findings in this time period were diverse and required the attention of a multidisciplinary team. Long term clinical and psychological effects are yet to be known.

Emergency response and preparedness among Polish human milk banks: a comparison of the COVID-19 pandemic and the 2022 Ukrainian refugee crisis.

Introduction: In recent years, Poland has faced two major emergencies: the COVID-19 pandemic, a global-scale public health emergency in 2020, and the outbreak of a full-scale war in Ukraine, which forced over 9 million Ukrainians-mostly women and children-to flee from their country through the Polish-Ukrainian border in 2022. Methods: In 2020 and 2022, we conducted two online questionnaires with human milk bank personnel to assess the impact of these emergencies on the human milk banking sector and its preparedness to face them. All 16 human milk bank entities operating in Poland were contacted and invited to participate in the study. For the first questionnaire, which was distributed in 2020, we obtained a 100% response rate. For the second questionnaire, the response rate was 88%, i.e., 14 out of 16 human milk banks completed the questionnaire. We compared these two emergencies in terms of the extent to which the potential of the Polish human milk bank network was exploited to support vulnerable infants who were not breastfed. Results and discussion: Our findings indicate that recommendations to provide donor human milk to infants separated from their mothers during the COVID-19 pandemic were never fully implemented. Meanwhile, during the refugee crisis, national legislation allowing equal access to public healthcare for Ukrainian citizens were rapidly implemented, enabling a more effective response by human milk banks to support vulnerable infants. However, no specific measures were introduced to support refugees outside the standard criteria for donor human milk provision. Our results highlight the limited response from the sector during emergencies and the underutilization of the potential of a nationwide network of professional human milk banks. Drawing on Polish experiences, we emphasize the importance of having procedures and legal regulations regarding human milk banking in place even in non-crisis settings, which would facilitate a rapid emergency response. We also emphasize the need to include the implementation of emergency procedures in building a strong and resilient human milk banking system.

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

Background: 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 examines the indirect impact of the Ukraine war on emotional disorders within a Swedish clinical population. Method: The sample comprised participants (n = 1,222) actively engaged in an internet-based psychotherapeutic intervention (cognitive-behavioral, psychodynamic, and waitlist) when the war broke out. The Patient Health Questionnaire-9 scale and the Generalized Anxiety Disorder-7 scale were used to measure depression and anxiety. Results: Anxiety and depressive symptom severity increased following the war's onset, with an average weekly increase of 0.77-points for anxiety (p = .001, Cohen's d = 0.08) and 0.09-points for depression (p = .70, Cohen's d = 0.01); however, the increase was negligible for depression. Furthermore, higher socioeconomic status (SES) predicted declines in depression and anxiety during the study period, with a 0.69-point average weekly decrease in anxiety (p < .001, Cohen's d = 0.32) and a 1.09-point decrease in depression (p < .001, Cohen's d = 0.48) per one unit increase in SES, suggesting that SES may serve as a protective factor that buffers against psychopathological development during crises. Conclusions: These findings have implications for mitigating the development of psychopathology during crises and interpreting treatment efficacy estimates during such events. Our findings also emphasize the potential of internet-based psychotherapy in addressing emotional disorders during crises. This study presents up-to-date information about the reaction of treatment-seeking individuals to abrupt uncertainty.

Explaining post-traumatic stress symptoms and sleep disturbance in Ukrainian civilians: perceived threat versus objective war exposure.

Objective: This study investigated the impact of war exposure on post-traumatic stress symptoms (PTSS) and sleep disturbance across Ukraine. Subjective and objective indicators of war exposure were modelled as predictors of these symptoms.Methods: We created two predictors: first, we used governmental and crowd-sourced data to create an objective war exposure index for each of the 21 non-occupied regions of Ukraine, based on the number of air raid alarms, explosions, and proximity to frontline; and second, we obtained self-report cross-sectional data, using convenience sampling, from a nation-wide survey (N = 991) on subjective experience of threat triggered by the war. The survey also measured the outcome variables of PTSS and sleep disturbance. Hierarchical multilevel regressions modelled the relationship of this objective war exposure index with the two outcome variables, after accounting for demographics. A final regression step modelled subjective threat as predictor of these symptoms.Results: We observed strongly elevated levels of PTSS and sleep disturbance and strong regional differences in objective and subjective war indicators. Objective war exposure predicted PTSS but not sleep disturbance, whereas subjective threat predicted both symptom domains.Conclusion: The study demonstrates the utility of objective war exposure data for predicting the prevalence of PTSS in the different regions. The results further underscore the prominent role of subjective appraisal processes in the symptomatology of PTSS and sleep disturbance, thus informing theories on trauma-related disorders. Our results can guide the allocation of mental health services by identifying highly affected regions.

Objective data on air raid alarms and explosions have been prospectively collected in Ukraine.We related those objective data to symptom reports of 991 responders in most Ukraine regions.Objective data explained symptoms of post-traumatic stress but not sleep disturbance.