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.