Digital crisis counseling during wartime: Pre–post outcomes and user experience in Ukrainian and German samples

Background: Armed conflict and forced displacement are associated with elevated risks of anxiety, depression, and trauma. The ongoing war in Ukraine has exacerbated the need for mental health care while simultaneously disrupting access, underscoring the need for scalable and accessible interventions. Objective: (kcUA), a text-based digital counseling service. It explored patterns of distress levels, user satisfaction, and referral outcomes, comparing kcUA users (in Ukraine and in exile) with krisenchat Germany (kcDE) users. Methods: A pre-post observational study with a 4-week follow-up was conducted using feedback from 4436 help-seekers (2877 of kcDE and 1559 of kcUA) between July 2022 and April 2023. Surveys assessed mental health symptoms, user satisfaction, and local referral success at three time points: retrospectively assessed pre-consultation distress ("T0"), post-counseling (T1), and 4-week follow-up (T2). Results: All user groups reported significant reductions in symptoms of depression, anxiety, and stress immediately after counseling. At T2, kcUA users maintained symptom improvements, while kcDE users showed partial symptom rebound. User satisfaction and service acceptance were high across all groups (≥89% at T1). kcUA users more often reported war-related concerns and were more likely to recommend the service to others. Referral success was higher among kcDE users (46.6%) than kcUA users (34.9%). Conclusions: kcUA was associated with sustained reductions in psychological distress and was well accepted by kcUA users. Anonymous, scalable digital services may play a crucial role in supporting mental health during humanitarian crises.