Beyond the Battlefield: A Cross-Sectional Study of War-Related Stressors and Mental Health in Four Central European Countries

Prolonged armed conflicts may affect mental health beyond the battlefield through indirect, war-related stressors. However, evidence on populations outside the immediate conflict zone remains limited. This study assessed psychological distress, anxiety, and depressive symptoms and examined their associations with coping strategies among adults in four Central European countries more than two and a half years after Russia’s full-scale invasion of Ukraine.A cross-sectional online survey was conducted in October 2024 with 2,962 participants from Poland (n = 728), Czechia (n = 743), Slovakia (n = 742), and Hungary (n = 749). Participants were recruited from opt-in online research panels using stratified quota sampling based on sociodemographic characteristics. Psychological distress, anxiety, and depressive symptoms were measured using the Kessler Psychological Distress Scale (K10), the Generalized Anxiety Disorder scale (GAD-7), and the Patient Health Questionnaire (PHQ-9), respectively. Between-country differences were examined using one-way analysis of variance, and associated factors were assessed using country-specific linear regression models.Poland had the highest mean scores for psychological distress, anxiety, and depressive symptoms (K10: F(3, 2,958) = 12.61; GAD-7: F(3, 2,958) = 9.40; PHQ-9: F(3, 2,958) = 7.10; all p < 0.001). Czechia had the lowest mean scores for distress and anxiety. Mean depressive symptom scores were lower in Czechia, Slovakia, and Hungary than in Poland, with no significant differences among the three countries. The average item-level selection rate was higher for problem-focused than for emotion-focused strategies in all four countries. Younger age, lower perceived quality of life, and greater use of emotion-focused coping were associated with higher symptom scores. Problem-focused coping was associated with lower symptom scores only in Poland.Mental health symptom scores differed across the four countries, as did some associations between coping strategies and mental health. The findings support continued monitoring and attention to groups reporting poorer outcomes. Given the cross-sectional design, the observed associations do not establish causal effects.