Clinical features of anxiety-depressive disorder in adolescents in the conditions of war and a large frontline city

Background. The relevance of the problem of anxiety disorders is determined by their clinical heterogeneity, the tendency toward a protracted course, and the formation of comorbid relationships with depressive and somatoform symptomatology. Purpose – to determine the clinical features of anxiety-depressive disorder (ADD) in adolescents under conditions of war, taking into account stressful factors as well as sociopsychological and biological factors in their formation. Materials and methods. In compliance with the requirements of biomedical ethics and based on informed consent, 92 adolescents with a diagnosis of ADD according to the ICD-10 criteria were clinically examined during 2024–2025. The study sample consisted of 92 patients aged 12–18 years with anxiety-depressive disorders, including 54 boys (40.8%) and 38 girls (59.2%). Gender distribution by age: 12–14 years – 13 boys and 16 girls; 15–18 years – 41 boys and 22 girls. The study design was clinical-psychopathological. Pathopsychological methods included: screening for emotional disorders related to anxiety in children and parents (SCARED scale), the Childrenʼs Depression Rating Scale-Revised (CDRS-R) for adolescents aged 16–18 years. The following instruments were also used: the Generalized Anxiety Disorder-7 scale (GAD-7), B.D. Mendelyevichʼs test for assessing neurotic states, the Spielberger State-Trait Anxiety Inventory, A.E. Lichkoʼs Pathocharacterological Diagnostic Questionnaire (PDQ) for determining types of character accentuation, O.S. Chabanʼs Anxiety Self-Assessment Scale, projective drawing tests, Lusinʼs test of emotional intelligence and cognitive social functioning, the Clinical Global Impression scale (CGI), CDRS-R scale, L.N. Sobchikʼs Modified Color Choice Test (MCT), family sociogram, and the Connor–Davidson Resilience Scale. Results. The clinical and psychopathological features of ADD in adolescents were established, as well as the specific impact of war as a complex traumatic factor on the childʼs psyche. This creates a theoretical basis for the methodology of early diagnosis and the development of promising models of medical-psychological intervention and support. In the structure of clinical manifestations of ADD in adolescents under war conditions, the following are present: the depressive symptom complex (depressed mood, irritability, sleep disturbances, fatigue), the anxiety symptom complex (anxiety, emotional tension and exhaustion, social anxiety, specific phobias related to war), the cognitive symptom complex (low self-esteem, difficulties with concentration, loss of motivation, suicidal thoughts), and the somato-vegetative symptom complex (headache, abdominal pain, bodily symptoms such as dyspnea, tachycardia, tremor). Among the clinical variants, the «anxiety = depression» variant significantly predominates (48.5%). The «anxiety > depression» variant was observed in one third of cases (35.9%), while the «depression > anxiety» variant occurred in 15.2% of adolescents. The clinical profile of ADD in adolescents shows age-related differences: in 12–14-year-olds, somatic and emotional clusters predominate; in 15–18-year-olds, psychological, emotional, cognitive, and behavioral clusters are more prominent. The traumatizing factors in adolescents with ADD under war conditions are diverse and most often occur in combined form (from three to five or more). The specific manifestations of traumatic stress in adolescents with ADD include PTSD symptoms such as intrusive thoughts, nightmares, avoidance of discussing the traumatic event, social withdrawal, sleep problems, behavioral disturbances, and mood changes. Severity indicators of neurotic disorder (ADD) in adolescents under war conditions according to the Clinical Global Impression scale (CGI) show that in 12–14-year-olds it most frequently corresponds to the «marked» level (55.1%), while in 15–18-year-olds it corresponds to the «severe» level (65.1%). This indicates insufficient early diagnosis and the presence of significant functional impairments. The mechanism of ADD formation in adolescents under war conditions is influenced by biological factors (changes in neurochemical systems under chronic stress), psychological factors (cognitive component, levels of stress, anxiety, depression, and adaptation/resilience), and social factors (quality of family relationships, level of social support, educational process involving social isolation, and internally displaced person status). Conclusions. The clinical and psychopathological features of ADD in adolescents were established, along with the specific impact of war as a complex traumatic factor on the childʼs psyche. This creates a theoretical foundation for the methodology of early diagnosis and the development of promising models of medical-psychological intervention and support.