A longitudinal study on depression, trauma, and resilience in war-exposed Ukrainian adolescents

Background Extreme and prolonged adversities like armed conflicts increase risk of detrimental mental health outcomes for adolescents, highlighting resilience as key for preserving mental health and recovery. We assessed how depression, PTSD, and resilience changed over time among Ukrainian adolescents, and investigared the association between mental health symptoms and later resilience. Methods Participants (adolescents aged ≥15 years at baseline) were drawn from the AUDRI cohort (Adolescents of Ukraine During the Russian Invasion) and completed three survey waves spaced six months apart. Of 559 respondents at wave 3, 311 participated in all three waves and were included in the current analysis. Longitudinal changes were examined using linear mixed-effects models; latent trajectory analyses, and causal modelling g-estimation to assess associations between earlier mental health symptoms and later resilience. Results By the third wave 90% of adolescents reported experiencing at least one traumatic event, with 43% reporting moderate to severe depression and 42% clinically significant PTSD, compared to baseline (42% and 46%). Adjusted analyses showed significant improvements in PTSD (− 11.47, 95% CI: − 16.08 to—6.86) and depression (− 5.59, 95% CI: − 8.06 to − 3.10) by third wave. Resilience decreased in the second wave (− 0.89, 95% CI: − 1.52 to − 0.26) and increased in the third (5.86, 95% CI: 3.35 to 8.37). Witnessing family violence predicted lower resilience and higher symptoms, whereas social capital had a protective effect. Trajectory analyses revealed substantial heterogeneity, ranging from stable adaptation to persistent distress and declining adjustment. Associations between earlier depressive symptoms and later resilience were weak and did not reach statistical significance. Conclusions Despite general improvements in depression, PTSD, and resilience by the third wave, clinically significant PTSD declined modestly, and nearly half of adolescents still experienced moderate to severe depression. Resilience levels gradually recovered to baselines after initial decline. The coexistence of resilience and psychological distress in some cases suggests that adaptation during prolonged adversity cannot be understood solely through symptom reduction. Interventions should address distress while strengthening family, peer, and community resources that support resilience during ongoing conflict.