Exposure to war, war nightmares, insomnia, and war-related posttraumatic stress disorder: A network analysis among university students during the war in Ukraine

Introduction: Little is known about the prevalence and associations between war-related variables among Ukrainians during the Russian invasion. The present study assesses the prevalence and associations between exposure to war (EW), nightmares of war (NW), insomnia, and war-related post-traumatic stress disorder (WPTSD) among university students from Ukraine. Methods: During the war, an online cross-sectional study was performed among university students (N = 1072) from western Ukraine. Newly developed questions evaluated EW and NW, while insomnia was measured using Athens Insomnia Scale (AIS), and for assessing war-related PTSD symptoms, we adopted an abbreviated six-item PTSD checklist (PCL-6). The associations between exposure to war, nightmares of war, and symptoms of insomnia and PTSD were examined using network analysis (NA). Results: Among university students, 98 % declared exposure to war, 86 % dreamed nightmares of war, 49 % experienced insomnia symptoms, and 27 % presented symptoms of PTSD. A network analysis found that warrelated PTSD has a central and the greatest impact on the frequency of war nightmares and the severity of insomnia symptoms. Limitations: Self-report measurements were applied to a gender-unbalanced sample of university students from the western regions of Ukraine, so it would be inappropriate to generalize to the population directly affected by the war. Conclusions: War-related PTSD symptoms had the most significant impact on the other variables. Therefore, warrelated PTSD should be a priority in treatment among university students in Ukraine. However, multidisciplinary integrative intervention programs that treat nightmares, insomnia, and PTSD, can be the most effective.