Associations of war exposures, post-migration living difficulties and social support with (complex) PTSD: a cohort study of Ukrainian refugees resettled in Denmark

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BACKGROUND: The war in Ukraine has forced millions of Ukrainians to flee their country, many after exposure to actions of war. Previous research found that both war exposures (WE) and post-migration living difficulties (PMLD) are associated with risk of PTSD. In the current study, we test associations between WE, PMLD and PTSD/Complex PTSD (CPTSD). Further, we test if the associations are moderated by social support. METHODS: In a representative prospective cohort study of adult Ukrainians arriving in Denmark in the first year after Russia's full-scale invasion (N = 4,229), we test associations between WE, PMLD, and (C)PTSD using multinomial logistic regression analysis. Interaction terms were added to assess if associations were moderated by SS. RESULTS: Prevalence of PTSD and CPTSD was 12.1 % and 12.2 %, respectively. We found statistically significant associations between family-related PMLD, health-related PMLD, and general PMLD and CPTSD (AORs from 1.25 to 1.56), and between health-related PMLD and family-related PMLD and PTSD (AORs from 1.18 to 1.35). WE were associated with PTSD (AOR (CI): 1.15 (1.07-1.25)), but not CPTSD (AOR (CI): 1.05 (0.97-1.13)). Social support was associated with CPTSD (AOR (CI): 0.69 (0.60-0.78)) but not PTSD (AOR (CI):0.94(0.83-1.07)). Interaction terms were significant only for PTSD, where social support attenuated the negative association between PMLD and PTSD. CONCLUSION: PMLDs are important risk factors for post-trauma psychopathology in war refugees. Social support mitigates the negative association between PMLDs for PTSD, while low social support is an independent risk factor for CPTSD. Attention should be paid to refugees' daily life challenges and social support networks.