A veteran commits suicide every 65 minutes in America. One of the key reasons is PTSD. What will happen to Ukrainian veterans, and whether we will face similar disappointing statistics, depends on the ability to identify PTSD and its treatment. Viktor Dosenko, professor at the Bogomolets Institute of Physiology, head of the development and innovation department at CSD LAB medical laboratory, pathophysiologist, MD, told Interfax-Ukraine about the peculiarities of diagnosis, course and prospects for treatment of PTSD.
Text: Anna Levchenko
– Currently, Ukraine is just beginning to study the issue of PTSD. How relevant is this problem for Ukraine? When will we face the manifestations of PTSD, when will its impact be visible?
– Both extremes – that everyone has PTSD, or that there is no PTSD – certainly do not correspond to the real state of affairs, do not correspond to scientific data, and have negative consequences. How should the scientific and medical community approach this issue? In a balanced, logical, scientific way: Not everyone will have PTSD, of course, and not everyone has it, not even half of the population. Many military men do not have any PTSD. But at the same time, the number of people with PTSD in Ukraine is quite large – unfortunately, we do not have a register of patients with this pathology, so there are no exact figures.
To detect PTSD in a person, there is a screening. In particular, CSD LAB has taken a serious interest in this problem and has a separate section on the medical laboratory’s website where anyone can take a screening test for PTSD. Because in order to treat, you need to identify the patients. The task of finding such people is not an easy one. No one will come to the hospital and say: “I have PTSD, treat me”. A person may not know about his or her condition.
I want to note that the world celebrates the International PTSD Screening Day every year. Currently, the problem of diagnosis is relevant all over the world, because it occurs not only in countries where there are hostilities. Many other factors can also lead to the development of this serious mental illness. The earlier we detect this disease, the better and more effective the therapy will be. Therefore, screening programs to detect PTSD are currently being practiced around the world. In particular, experts from the US National Center for PTSD Research have developed the so-called five questions of perception. If a person gives a positive answer to at least three of them, this does not mean that he or she has PTSD, but it does mean that he or she needs to see a specialist.
– Can we say that PTSD is a mental illness, or is it just a situational problem of a spoiled mood?
– It is a mental illness. In the international classification of diseases, it is classified as a mental health disorder. The diagnosis of PTSD is made by a psychiatrist.
– But in practice, as psychiatrists say, a person with mental health problems usually believes that everything is fine, it’s just that the world around them is different. How do you get a person to pay attention to their condition and start treatment?
– A person needs to take a test and answer these five questions of perception. Our task now is to bring this information to the public. This is a free, evidence-based and very accurate way of screening. Not diagnosis, but screening, which, if necessary, will refer a person to a specialist for treatment.
PTSD is a serious problem. According to statistics from the U.S. Department of Veterans Affairs, a veteran commits suicide every 65 minutes in America. Healthy men who have returned from serving in the U.S. military, with all the support programs and rehabilitation centers, face this problem. We are not saying that all veterans in the United States have PTSD and are suicidal, but if we compare veterans with other men, the presence of PTSD increases the likelihood of suicide six times. For women, this figure is even higher. This is terrible data and, unfortunately, there is no reason to think that it will be any different in Ukraine.
– When, according to your forecasts, can we expect, say, a surge in cases or symptoms of PTSD? Should we expect this now, or will it take some time after the war?
– Most likely, we should expect a surge after returning from the war. A significant number of soldiers may already have PTSD, but unfortunately, we don’t have statistics. Actually, this data is not collected, there are no statistics on mental illnesses. We do not know how many people we have with PTSD and what the dynamics are. To understand the picture, veterans must undergo diagnostics and, if necessary, rehabilitation. But most veterans do not have this opportunity. After defeating the enemy, most of them will return to normal life. And it is then that we can expect this disease to manifest itself and there will be an avalanche-like increase in the number of diagnoses of PTSD. Because now PTSD exists, but there is no screening. Or it is not effective enough.
– What is the root cause of PTSD?
– There are two factors that trigger the development of PTSD. The first is direct contact with death. Not on television, not in photos, not in telegram channels, but direct, visual contact with death. A person sees death, and it strikes at what is called the core of the personality, at their own beliefs about what is good and what is evil. The second factor that can trigger PTSD is indirect contact with death, even without contact. These are two established factors. Everything else is a risk factor that increases the probability. That is, a person with existing mental illness is more likely to have PTSD. People who have used or are using drugs have a higher probability. People who have weak social support, no family, no children, or a traumatic personal life are more likely to have PTSD. Of course, there is also a genetic predisposition. But these are not causes, they are factors that increase the probability.
– How does PTSD differ from other reactions to a stressful situation?
– The fact that this horror of contact with death stays in the brain, in the psyche. It does not leave a person, and they keep returning to the traumatic situation. This event already exists exclusively in memories, it is detached from life, it has nothing to do with the current situation, but it is imprinted in the psyche and begins to dominate consciousness. The situation that caused PTSD has already happened, it does not repeat itself, and the person is still in it. This makes PTSD very different from other diseases, including chronic stress.
PTSD leads to hormonal disruptions. To a certain extent, PTSD is a neurohumoral disease. When the hormonal background changes, when stress is “lame” by one hormone. What this means is that under stress, the level of both adrenaline and cortisol in the blood should increase. But in PTSD, only the level of adrenaline rises, and cortisol is even lower than in healthy people. It’s like stress, but inferior – adrenaline dominates, and there is no cortisol, which should provide negative feedback and stop the stress response.
– And how does this threaten the human body?
– This is fraught with the fact that the body does not receive communication. Cortisol is supposed to come to the brain after stress and trigger recovery mechanisms. But there is no cortisol, the brain believes that the order to mobilize has not been fulfilled, so it gives commands to produce adrenaline and a stress response again and again. This exhausts the body. In medicine, this is called a “vicious circle,” from which the psyche cannot break free on its own.
– If we’re talking about hormones, hormonal levels, are there any tests, such as blood tests, that would allow us to detect the presence of PTSD as a chemical reaction of the body?
– We are on the way to this. We are currently working on this task together with the specialists of the Lisova Halyana psycho-rehabilitation center. We are trying to find the best solution, because the existing solutions are very expensive, and screening should be cheap.
– What does “expensive solution” mean?
– It takes a lot of money to identify people with PTSD. And this is a problem. Because screening means a cheap test that can be done to millions of people: all military personnel, all military families. But when the cost of the test is significant, it significantly complicates the ability to fight PTSD.
– How much is significant?
– According to our calculations, it was about 5 thousand UAH for one test. Therefore, if we talk about determining PTSD “by a drop of blood,” the methodological basis already exists, but there is a nuance – screening should be affordable. The whole world is looking for opportunities to conduct such screenings, but nowhere in the world have PTSD biomarkers been introduced. CSD LAB has developed them, but we hope to find a solution to reduce their cost. On the way to this solution, we have already introduced a test for biomarkers of chronic stress. This is no less dangerous pathology, which is certainly related to the war. Not everyone has contact with death, but the war introduces a state of uncertainty. This is what is happening now: news, traumatic information and sympathy trigger the so-called chronic stress. This is very well known in medicine. And all a person needs to do is take a test and see a psychotherapist, who will prescribe medication if necessary.
But I emphasize that chronic stress and PTSD are different things.
– Are there any medications being developed for PTSD?
– Currently, there are only two antidepressants that have been proven to work and improve the condition. Other drugs are being studied. There are quite a few of them, so we expect that new drugs will appear and be researched. In particular, medicines based on medical cannabis and psychotropic drugs. But, unfortunately, Ukraine is currently outside of these studies not only because of the war, but also because it is forbidden to study these drugs in Ukraine.
However, there is currently a demand for such research in Ukraine and around the world. There are international organizations that are ready to collaborate with Ukrainian experts and institutions to study these issues. For example, we are preparing a number of applications for participation in international research and hope that these studies will eventually begin. This, in my opinion, is a very good solution, because instead of standing with our hand out and asking for money, we will be able to develop it ourselves.
– Once upon a time, young Ukrainians were forced to take part in wars waged by the former Soviet Union, particularly in Afghanistan. Now these people are about 50-55 years old, they are a fairly active category of citizens, but they have a complicated history. We’ve seen many stories of guys returning from Afghanistan with crippled lives, crippled psyches, and not all of them were able to adapt to peaceful life. Are there any studies conducted among Afghanistan veterans?
– In the USSR and in all post-Soviet countries, unfortunately, this diagnosis was ignored. In Ukraine, there used to be no legal definition of PTSD. In this aspect, the question was not raised at all. That is, if a person had the consequences of a military injury or contusion, they could be offered treatment and rehabilitation in a sanatorium, and restored in neurological terms. Psychiatry and psychological assistance were out of the question. Currently, we also do not see work with those who may have suffered from PTSD 30 years ago. Only now have we begun to pay attention to these people. The first diagnoses of PTSD appeared in America in the 80s of the last century, and for quite a long time in other countries, even in Europe, it was believed that it was not a disease. That is, it took decades for PTSD to be accepted. Now it is necessary to develop diagnostic criteria and to communicate these criteria to doctors.
– Can PTSD be cured, or is it a chronic disease that stays with a person for life?
– PTSD is treatable, of course! In half of the cases, it will go away on its own. But this information is dangerous, because people will think that they don’t need to see a doctor, they say, PTSD will go away on its own. This is a mistake! You need to see a doctor to treat PTSD. In half of the people, PTSD can go away on its own, and in half of them it will not. And no one knows which half a person belongs to. PTSD is perfectly treated with psychotherapy, of course, if you start in time and if there are qualified specialists. In some cases, pharmacotherapy is required. Experts around the world are looking for new techniques, new drugs, new approaches to the treatment of this complex, dangerous disease. I hope that Ukrainian scientists will successfully join this research and together we will find effective methods of screening, diagnosing and treating PTSD.
Ukrainian refugees, almost a million of whom are currently living and working in Germany, are a great opportunity for German companies to both solve the labor shortage and create a foundation for future closer cooperation with Ukraine, German Chancellor Olaf Scholz said at the opening of the 6th Ukrainian-German Business Forum in Berlin on Tuesday.
“Take advantage of this huge potential. Integrate Ukrainians who are here with us into your companies. Even if these women and men return to Ukraine after the war, they will become a valuable asset for their companies. Because then they form “human bridges” with a country that, as a candidate for EU membership, has enormous economic potential,” the Chancellor emphasized.
According to him, many of the Ukrainian refugees in these weeks and months are completing integration courses, many now speak German, and almost all of them are well educated.
“This is a guarantee that the economic relations between Germany and Ukraine will develop even better and more dynamically in the future,” Scholz said of the integration of Ukrainians into German companies.
He noted that Ukraine is a country with millions of hardworking, well-educated citizens. “A country with which we are more closely connected than ever before, thanks to the Ukrainians who now live here with us,” the German Chancellor emphasized.
According to the organizers of the forum, including the German Chamber of Commerce and Industry (DIHK), the Eastern Committee of the German Economy (OA) and the German-Ukrainian Chamber of Commerce and Industry (AHK Ukraine), the event brought together more than 500 participants who wanted to learn about Ukraine’s economic development during the war, as well as about available opportunities for cooperation and investment. This year’s conference is titled “Ukraine’s economy is growing again despite the war / Demand from German companies”. Three panel discussions will focus on infrastructure, energy, and defense.
“Regardless of the war, a dozen investment projects have already been launched, and German companies are currently applying for investment guarantees from the federal government for another 30 projects. Reconstruction has begun, and German companies have joined it,” emphasized Christian Bruch, Deputy Chairman of the OA.
According to him, the risk of war can be controlled, especially in the western and central parts of the country, but more attractive offers of public and private financing, as well as insurance solutions, are needed.
Rainer Perau, Managing Director of AHK Ukraine, also believes that the security situation allows business travel to resume in most regions to start doing business.
It is noted that in the first eight months of 2023, German-Ukrainian trade increased by about 30% to EUR 6.2 billion: imports to Germany decreased slightly again – by 5.5% to EUR 1.8 billion, while exports increased by 52% to EUR 4.4 billion.
As reported with reference to Eurostat, as of August 31, 2023, 4 million 155.6 thousand non-EU citizens who fled Ukraine as a result of the Russian invasion on February 24, 2022, 98% of whom were Ukrainian citizens, had temporary protection status in the EU.
According to Eurostat, as of the end of August, the main EU countries that received temporary protection recipients from Ukraine were Germany (1 million 175.70 thousand people; 28.3% of the total), Poland (960.55 thousand people; 23.1%) and the Czech Republic (365.09 thousand people; 8.8%). The total share of these three countries is 60.2%. At the same time, over the past five months, the number of beneficiaries of temporary protection from Ukraine in Germany increased by 108 thousand people, in the Czech Republic – by 39.8 thousand, while in Poland it decreased by 39.2 thousand.
The shareholders of Slavgorod Reinforcing Plant PJSC (SAZ, Dnipropetrovs’k region) intend to conduct an additional share issue and increase the authorized capital (AC) by UAH 1,375,238.5 million.
The issue of the additional issue is on the agenda of the extraordinary shareholders’ meeting scheduled for November 24 this year.
“To increase the authorized capital of SAZ PJSC by placing additional shares in the amount of 5 million 500 thousand 954 pieces of existing nominal value at the expense of additional contributions in the amount of UAH 1 million 375 thousand 238.5,” the agenda states.
It is also assumed that the participants in the placement of shares (without a public offer) are exclusively the company’s shareholders: PJSC Promarmatura and PJSC Interindustry Component Base “Generalmashkontrakt”.
Slavgorod Valve Plant was founded in 1926 as a cast-iron valve manufacturing company. After reconstruction in 1965, it has specialized in the production of forged steel shut-off and control valves with manual and electric actuators, thermodynamic condensate traps, ball valves and cast iron stopcocks. In 2012-2014, the plant mastered mass production of shut-off and control valves for thermal power plants. In addition to pipeline valves, the plant also mass-produces products for the mining and machine-building industries.
According to the second quarter of 2023, Promarmatura owns 53.5661% of SAZ, and Intersectoral Assembly Base Generalmashkontrakt owns 22.0307%.
The authorized capital of SAZ PrJSC is UAH 45 thousand, the nominal value of a share is UAH 0.25.
Prime Minister of Ukraine Denys Shmyhal says that German construction materials company Fixit has received investment insurance from the German government to build a second plant in Ukraine.
“We want German business to invest in Ukraine, to invest in recovery, and within the framework of the forum we are signing important documents… The building materials company Fixit will build a second plant in Ukraine and will receive investment insurance from the German government for this purpose, which will be signed here on the sidelines of the business conference,” Shmyhal said at a press conference at the sixth German-Ukrainian Economic Forum in Berlin on Tuesday.
According to the prime minister, Fixit will also receive a EUR12 million loan from the German bank KfW. “This is a very important and significant project,” he emphasized.
BUILD, CONSTRUCTION MATERIAL, Fixit, GERMANY, INSURANCE, PLANT
In July-September this year, the cargo turnover of the port of Kolobrzeg increased by 52% due to the resumption of transshipment of Ukrainian agricultural products, the Polish edition of Rynek Infrastruktury reports.
According to the report, Kolobrzeg was not previously included in the Polish government’s resolution on the transit of Ukrainian grain. In the third quarter, the port resumed accepting Ukrainian agricultural products, which helped increase cargo turnover.
In the third quarter, the Polish port handled more than 73 thousand tons of cargo, which is 52% more than in the same period of 2022, when 48 thousand tons were handled. The cargo included grain, logs, limestone, pellets and fertilizers. Grain accounts for half of the transshipment. Among the grains transshipped in Kolobrzeg, corn and barley were the most common.
The port temporarily suspended operations in April this year. Back then, the Polish authorities banned imports of Ukrainian grain but allowed its transit. At first, Kolobrzeg was not on the list of ports that could handle Ukrainian grain, but later the Polish government allowed the company to handle Ukrainian cargo.
“We have demonstrated that we are unpredictable in our actions as a country, so building long-term business relations is perceived as risky, as one decree can turn everything upside down”, said Artur Lievski, head of the port’s administration.
A week after the ban was imposed by the Polish government, the mistake was corrected: Kolobrzeg was included in the list of seaports through which grain can be transited from Ukraine. However, it took a long time to restore trust, and for some time no freight trains with Ukrainian products arrived in Kolobrzeg. After a three-month break, the first train with corn from Ukraine arrived at the seaport of Kolobrzeg in late July, the newspaper said.
The Kvitna Charitable Foundation has conducted free breast cancer screenings for more than 2,000 women over the five months of its Mobile Medical Platform.
According to the foundation’s press release, the mobile medical platform project began operating in May 2023. As part of the project, visitors can receive a free medical examination and consultation.
“The idea of creating a mobile medical platform has been around since the beginning of the full-scale war. This initiative is relevant for providing medical care to people in the destroyed regions, in settlements with many internally displaced persons, as well as in those cities and towns where there is simply no access to medical examination,” the foundation reports.
In addition, the foundation has purchased equipment and reagents worth more than UAH 1.5 million for the National Cancer Institute (NCR), and has implemented more than 40 awareness-raising campaigns.
The mobile medical platform is a converted room on wheels specially designed for medical purposes. Its autonomy is ensured by its own power generator to provide comfortable conditions for visitors. The platform is connected to the Starlink network to ensure constant communication.
Inside there are two rooms, a bathroom and a refrigerator for storing medicines. The platform is equipped with an ultrasound diagnostic apparatus with a set of sensors for various examinations, including ultrasound of the thyroid gland, breast, abdominal organs, pelvic organs, etc.
