Longitudinal Trajectories of Post-Traumatic Stress Among Ukrainian Refugees: A Cohort Study

Background Displacement caused by the Russian invasion of Ukraine has subjected millions of Ukrainians to forced displacement, migration, exposing them not only to direct war-related trauma but also to substantial post-displacement stress. Refugees face disrupted employment, residential instability, and ongoing uncertainty in host countries. While prevalence of stress-related disorders is well established, less is known about how war-related stress and life satisfaction evolve over time in this population. Methods A longitudinal cohort study was conducted among Ukrainian refugees in Germany. The analytic sample comprised 164 participants who completed at least two of five survey waves over a six-month period (September 2022–March 2023). Post-traumatic stress symptoms were assessed with the Posttraumatic Symptom Scale at each wave and validated against the Impact of Event Scale – Revised at baseline and follow-up. Life satisfaction was assessed with the Satisfaction With Life Scale . Distinct adjustment patterns were identified through group-based multi-trajectory modelling. Descriptive statistics, group comparisons, and linear mixed-effects modelling were additionally used to contextualize data. Results Multi-trajectory analysis yielded four main groups: persistently high stress with poor satisfaction with life; broadly diverse, but stable profiles; stress reduction without parallel gains in life satisfaction; and combined stress reduction with later improvements in life satisfaction. More favourable courses were associated with younger age, higher education, urban residence, and prior public-sector employment. Across the full sample, post-traumatic stress symptoms declined sharply over time, with the proportion meeting the cutoff for probable PTSD decreasing, whereas mean life satisfaction remained low and showed no systematic change. Conclusion Adjustment following war-related displacement is highly heterogeneous. Although acute symptoms of traumatic stress tended to subside, life satisfaction showed little recovery, underscoring a divergence between symptom relief and overall well-being. Patterns of adaptation were shaped not only by individual resources but also by structural constraints such as job loss and residential downgrading. Interventions for displaced populations should therefore address both clinical needs and socioeconomic integration to enable sustainable recovery of refugees.