Risk factors for generalized anxiety disorder, depression, PTSD, and their co-occurrence among Ukrainian women working in healthcare during wartime: a cross-sectional study

Civilian healthcare personnel operating in active war zones are exposed to sustained traumatic stress, yet determinants of GAD, depression, PTSD, and their co-occurrence in this workforce, particularly among women, remain insufficiently characterised. The aim of this study was to examine factors associated with GAD, depressive, and PTSD symptoms and their co-occurrence among female civilian healthcare personnel in Ukraine during wartime. A cross-sectional survey of 238 Ukrainian female medical personnel recruited during Tactical Combat Casualty Care training (March-October 2024) assessed GAD symptoms (GAD-7), depression (PHQ-9), PTSD (PCL-5), trauma exposure (LEC-5), perceived social support (MSPSS), and resilience (CD-RISC-10). Multivariable logistic regression was used to identify disorder-specific determinants. Ward’s hierarchical clustering followed by K-means clustering was used as an exploratory approach to identify empirical groups differing in cumulative symptom burden. Logistic regression was subsequently used to identify factors associated with membership in the higher-symptom-burden cluster. Clinically significant GAD symptoms, depression, and PTSD were prevalent among participants at 31.1%, 26.9%, and 42.0%, respectively. Cluster analysis identified a higher-symptom-burden group comprising 30% of participants, with elevated scores across all three symptom domains. Employment at a hospital and war-related bereavement were among the factors most strongly associated with membership in this cluster. Additional associated factors included the presence of the aggressor’s army in the area of residence, mental health problems before the war, and greater lifetime exposure to trauma. Greater resilience demonstrated robust protective associations, whereas perceived social support was not independently protective. Female frontline healthcare personnel in Ukraine experience a substantial mental health burden, with cumulative symptom burden associated with occupational and war-related exposures and lower among participants with greater resilience. These findings support the need for targeted screening and scalable resilience-focused interventions.