Anxiety, posttraumatic stress, insomnia and quality of life in Ukrainian schoolchildren during wartime

Children who have remained in Ukraine during the ongoing war are continuously exposed to threat and disruption of services, which places them at high risk of internalizing and trauma-related symptoms. In a school-based cross-sectional survey conducted in Ukraine (January-February 2024), 781 students aged 10–17 years completed standardized measures of quality of life (QoL) (PedsQL 4.0), depressive symptoms (CDI 2:SR), state and trait anxiety (STAIC), posttraumatic stress symptoms (CRIES-8), insomnia (Athens Insomnia Scale), resilience (CYRM-R) and coping (JSR). Four multiple linear regression models with forward stepwise selection were estimated. All models were significant and explained 25–50% of the variance. Emotional functioning (R² = 0.50) was inversely associated with trait anxiety, PTSD symptoms, state anxiety and insomnia, while caregiver/relational resilience and situational emotion-focused coping made small positive contributions. Social functioning (R² = 0.33) was negatively related to trait anxiety and PTSD and positively related to personal resilience. School functioning (R² = 0.26) was negatively related to PTSD, depressive symptoms and insomnia, and positively related to situational resilience and caregiver/relational resilience. Physical functioning (R² = 0.25) was inversely related to state anxiety, PTSD and insomnia, and positively related to caregiver/relational resilience and active coping. Among war-exposed Ukrainian children who stayed in the country, QoL is mainly determined by symptom burden, especially anxiety, PTSD and sleep disturbance. Resilience and coping have smaller and domain-specific effects. School-based, trauma-informed and sleep-focused interventions should be prioritised in ongoing conflict settings.