Conference Agenda

The combined stress experienced by military personnel as a result of combat trauma, chronic fatigue, traumatic brain injury, and various psychological problems upsurges their risk of developing suicidal behavior (SB). Suicidal risk (SR) in military with such disturbances suggestively increased when joint with substance abuse (SA).

This presentation analyzes the differential diagnostics of SB, formed in the comorbidity with reactive depression and organic depressive disorders in conjunction with combined SA in military personnel during the Russian-Ukrainian war of 2022–2025.

Research data shows that asthenic-depressive symptoms resulting from prolonged participation in combat operations, the effects of multiple brain injuries, and experiencing a multitude of socio-psychological problems combined with chronic alcohol dependence and various drugs abuse, often as a form of “self-medication” for asthenia and emotional dysregulation, leads to a critical SR increase among military. A specific trigger for suicidal acts is asthenic-dysphoric impulsivity in the context of acute or repeated conflict situations.

The key pathogenetic link in high suicide risk in cases of combined pathology is the combined use of SA with pronounced asthenic-depressive symptoms. A significant disruption of regulatory neurobiological mechanisms (neurotransmission of biogenic amines and the GABA-glutamate system) reduces an individual's ability to engage in constructive coping and sharply increases impulsivity as key factor in the transition from suicidal thoughts to action.

Integrated protocols for complex crisis intervention methods have been designed to prevent SB among military personnel with dual diagnoses. It was proposed to apply psychopharmacotherapy and crisis psychotherapeutic intervention, including the principles of a trauma-informed approach, individual and specialized group work, which take into account the specifics of military service in wartime during the stages of rotation or inpatient treatment, ensuring the cessation of SA, reduction of depressive symptoms and SB aimed of preventing abuse relapse and suicides among military personnel.

The presentation focuses on the complex therapy for persons with pathologically complicated grief who bereaved close ones in the Russian-Ukrainian war (2022-2025): military personnel killed or missing in action, held captive; relatives shot during the occupation or killed in bombings. In such cases, grief is complicated by the development of acute stress disorder, prolonged depressive reaction, dysthymia, and post-traumatic personality changes combined with various features of self-destructive behaviour (SDB) - suicidal thoughts, suicide attempts, and other equivalent forms of SDB.

Effective therapy in such cases is provided by an integrated therapeutic approach (ITA). ITA is based on the Trauma-informed Care approach (TIC) aimed at forming trust and treatment compliance, ensuring psycho-emotional personality stabilization, and preventing retraumatization in the active phase of grief. ITA is a complex of psychoeducation (explaining trauma-related reactions with a focus on finding and creating reliable social support), developing self-regulation skills, timely and adequate use of psychopharmacotherapy for severe depression accompanied by depersonalization/dissociation or dysphoric impulsivity in a comorbid combination with life-threatening variants of SDB, crisis psychotherapeutic intervention with a trauma-informed approach, and transition to long-term existential therapy. ITA allows us to create a model that provides safety for working with trauma in the post-traumatic grief stage, recognising loss not only as personal grief but also as a systemic consequence of the trauma that has been experienced, relieve depressive symptoms, and then use the therapeutic space for deep self-reflection, coping resources, and goal setting in the post-traumatic stage of life.

The implementation of ITA into the routine clinical practice of professional working with victimized populations helps minimize the long-term psychopathological consequences of trauma, prevent development of the chronic severe forms of SDB and reduce suicide risk, as well as maintaining an adequate level of social competence and quality of life.

This case study analysis examines how prolonged war-related trauma shapes the emergence of self-harm among Ukrainian clients (residents of Ukraine, internally displaced persons and refugees), highlighting self-injury as a maladaptive coping mechanism for managing overwhelming emotional and somatic distress.

Findings illustrate how continuous exposure to threat disrupts cognitive and affective regulation, increasing vulnerability to suicidal ideation and repetitive self-injuring behaviors. The analysis further identifies key trauma-specific patterns - such as dissociation, hyperarousal, and impaired interoceptive awareness - that influence the function and reinforcement of self-harm.

Many clients received counselling online counselling. Providing online counselling to patients with prolonged war-related trauma, suicidal ideation and repetitive self-injury ensured quick access to help in an environment to which the client was accustomed (at home), which contributed to faster stabilisation of their psycho-emotional state and a sense of control on the own life.

Implications for the Trauma-informed care emphasize the need for stabilization-focused, safety-oriented interventions that address both the traumatic context and the coping role self-harm plays in clients’ psychological survival.

This presentation analyzes the personal experience of volunteers coping with Secondary Traumatic Stress (STS) while assisting military personnel and populations affected by the Russian-Ukrainian war (2014–2025), particularly since the full-scale invasion in 2022.

STS (vicarious trauma ) is a psycho-physical reactions’ complex for specialists who are working in abnormal conditions with deep constant help for suffering people as indirect influence of the deep traumatic experience of another person for them.

The primary traumatic factors driving STS include personal psychological trauma from a anxiety about combat participation of relatives (close friends) or the death of them, constant stress time-pressed lifestyle, difficulties in organizing volunteer assistance, and profound helplessness when confronting the extensive consequences of war and the intense grief of others.

Psychopathologically, STS presents a symptom complex mirroring PTSD criterion: intrusion (involuntary flashbacks of traumatic scenes of death or funerals), avoidance, hyperarousal, and periods of anxiety or depression fueled by chronic fatigue, sleep deprivation as the exhaustion of adaptive resources. STS is often manifesting as an equivalent form of self-destructive behavior (SDB).

Crucially, the key factor enabling volunteers to persist is an existential resource: a profound sense of duty, responsibility, and the desire to help, even at personal risk.

This helps them to persevere in doing the necessary work, travelling to military units or residents of frontline areas who cannot obtain the necessary support in any other way. This awareness of their mission allows them to remain functional and humane. To prevent STS chronicity, volunteers emphasize accessible psychological recovery spaces—communication, art, and nature—as sources of «light and hope» contrasting the darkness of war.

Understanding their mission and finding individual ways to recover allows volunteers to provide essential first aid to military personnel and civilians exhibiting SDB who are unable or unwilling to seek professional help.