91. TELEHEALTH IN WAR: THE STATE OF GERIATRIC MENTAL HEALTH IN UKRAINE

Introduction

In February 2022 the Russian Federation invaded Ukraine. The ongoing conflict, including 1682 verified attacks on healthcare infrastructure, strained the Ukrainian healthcare system. TeleHelp Ukraine (THU), a nonprofit organization based in the United States, intervened to provide free telemedicine services to individuals living in Ukraine, including areas of active conflict and occupied territories. This paper addresses how age, gender, geographic location, and significant wartime events affect psychiatric symptoms and mental healthcare utilization in older adults.

Methods

Data extraction:

Data was extracted from Cliniko, a secure telemedicine platform utilized by THU. 618 patient visits for all medical specialties were extracted from 8/12/2022-6/27/2023 containing the following variables: date of visit, geographic location, age, sex, chief complaint. A subset of 394 mental health visits with recorded patient ages was isolated. These visits were divided into 2 groups for comparison, patients age 50 or older (31 visits) and patients younger than age 49 or younger (363 visits).

Data analysis:

The Wilcoxon rank sum test was used to compare median ages between older and younger patients. Fisher exact test was used to compare reported sexes. Simple statistics described the geographic distribution of older adult visits.

The number of psychiatric symptoms or “chief complaints” (CCs) recorded for each visit ranged from 0 to 6. 628 and 53 CCs were reported for the younger and older age groups respectively. The large number of unique CCs made meaningful comparisons unrealistic, so CCs were reclassified into categories for comparison: depressive, anxious, PTSD, nonspecific symptoms, psychosocial stress, and other. CCs were compared between groups for each individual category using a Chi Square test. The resulting p-values were adjusted using a Benjamini-Yakutieli correction for multiple testing.

Significant war events were identified using sources from government and news media. These events were mapped onto the number of patient visits each week over time.

Results

Demographics: The median age of the younger and older groups was 33 and 68, respectively (p < 0.0001). Only 3% of visits in the older group were for male-identifying patients, versus 39% in the younger group (p < 0.0001). Geographically, visits in the older adult group were approximately evenly distributed between Kyiv, the occupied territories, and undisclosed locations (35%, 32%, and 29% respectively).

Chief complaint: Non-specific mood symptoms were more likely in older patient visits than in younger patient visits (26% and 8% respectively; p = 0.001).

War Events: There was an apparent increase in telemental health utilization around the time of the Russian Bakhmut offensive. There was an apparent decrease in utilization around the time of the Ukrainian counteroffensive.

Conclusions

Psychiatric symptom burden in older Ukrainian adults reflects established patterns, including higher likelihood of nonspecific or somatic symptoms and male-identifying patients being less likely to seek mental health care. The reported point prevalence of PTSD symptoms exceeds the estimated global lifetime prevalence of PTSD, however, the PTSD symptoms reported in this study may be subsyndromal. There is evidence that active conflict exacerbates psychiatric symptom burden and healthcare utilization.