# Psychological distress, resilience, and coping among Ukrainian war refugees: cross-national differences across seven European host countries and Ukraine

## TL;DR

This study compares the mental health, resilience, and coping strategies of Ukrainian war refugees across seven European countries and Ukraine, finding significant differences influenced by host-country contexts.

## Contribution

The study provides new insights into cross-national differences in psychological outcomes among Ukrainian refugees, emphasizing the role of host-country environments.

## Key findings

- Refugees in Slovenia, Ukraine, Portugal, Spain, and Germany reported the highest levels of psychological distress.
- Poland and Germany showed the highest resilience, while Spain had the lowest.
- Adaptive coping was most common in Poland, Germany, and Slovenia, and least in Cyprus and Serbia.

## Abstract

Armed conflict and forced displacement pose substantial risks to mental health, yet psychological outcomes among refugees vary considerably across national contexts. Understanding cross-national differences in distress, resilience, and coping is essential for designing effective public health responses to large-scale displacement crises such as the war in Ukraine. This study aimed to identify and compare cross-national differences in psychological distress, resilience, and coping strategies among Ukrainian war refugees residing in seven European host countries and internally displaced persons in Ukraine.

A cross-sectional online survey was conducted among 1,631 Ukrainian adults residing in Poland, Germany, Spain, Cyprus, Slovenia, Portugal, Serbia, or displaced within Ukraine. Psychological distress was assessed using the Refugee Health Screener (RHS-15), the Hopkins Symptom Checklist (HSCL-25), and a DSM-5–based trauma symptom checklist. Resilience was measured with the Resilience Scale (RS-25), and coping strategies were assessed using the COPE Inventory (COPE-60). One-way analyses of variance (ANOVA) were used to examine cross-national differences in distress, resilience, and adaptive and maladaptive coping.

Significant cross-national differences were observed across all mental health indicators (p < 0.05). The highest levels of psychological distress were reported by refugees in Slovenia, Ukraine, Portugal, Spain, and Germany, whereas the lowest distress levels were observed in Cyprus and Poland. Resilience differed significantly between countries (F = 22.01, p < 0.001), with the highest mean levels reported in Poland and Germany and the lowest in Spain. Adaptive coping strategies were most frequently used in Poland, Germany, and Slovenia and least frequently in Cyprus and Serbia (F(7, 1622) = 25.85, p < 0.001). Differences in maladaptive coping were also significant but less pronounced across countries.

The mental health, resilience, and coping strategies of Ukrainian refugees vary substantially across host-country contexts. These findings underscore the importance of institutional, social, and policy environments in shaping psychological adaptation during forced displacement. Public health responses to refugee crises should address not only individual-level coping and resilience but also structural factors such as access to services, stability of reception systems, and integration support to reduce psychological distress and promote mental wellbeing.