Impact of the War in Ukraine on the Mental Health of Refugees Residing in Spain

A mixed-methods study will be conducted, combining qualitative methodology through phenomenological analysis and semi-structured interviews with quantitative methodology through structured surveys. The study will be conducted in accordance with the guidelines established by the STROBE (STrenghtening the Reporting of OBservational studies in Epidemiology) statement.

The study will be conducted over a minimum period of three months, which may be extended if it is necessary to expand the sample.

The reference population will be Ukrainian refugees who, due to the start of the Russian invasion of Ukraine in 2022, were forced to flee the country and are currently residing in Spain.

The study population will be Ukrainian refugees who arrived in Spain after the start of the war in Ukraine and are currently residing in the province of Tarragona.

The sample will be selected according to inclusion and exclusion criteria, using non-probability convenience sampling, without dividing participants by gender.

The first part of the study will be conducted through semi-structured interviews with the aim of understanding the experiences of Ukrainian refugees during the war, covering the days leading up to the war, the day it began and the entire period thereafter, as well as the migration process and arrival at their new place of residence. A maximum limit of 10 interviews has been set, although this number may be lower if information saturation is reached.

At the beginning of the interview, the objective of the study will be explained, and participants will be informed that the interview will be recorded in audio format and subsequently transcribed by the principal investigator. Ethical considerations regarding confidentiality will be respected at all times. Informed consent will be signed, and personal data will be coded.

In the second part of the study, structured anonymous surveys will be conducted, with a total of 40 questions divided into 5 sections and lasting approximately 10-15 minutes. The anonymity of the responses will be preserved, and personal identification will not be required to access the survey at any time. The level of anxiety and depression will be assessed using validated scales (PHQ-9 and GAD-7) and the level of adaptation in the host country and exposure to war-related news will be assessed using ad hoc questionnaires.

Analysis: The interview data will be grouped by topics of interest using the ATLAS.ti programme or manually following a process of structuring, categorisation and analysis. The data obtained in the surveys will be analysed using the SPSS programme. Qualitative variables will be described using percentages and quantitative variables using the mean and standard deviation. To determine the relationship between the different variables, the Chi-square test will be applied for qualitative variables and the Student's t-test for quantitative variables. A confidence level of 95% will be assumed, considering a statistical difference between variables p ≤ 0.05 to be significant.

Inclusion criteria

• Ukrainian nationals who arrived in Spain following the outbreak of war in Ukraine in February 2022.
• Have reached the age of majority before participating in the study.
• Have been recognized by the competent Spanish authority as applicants for temporary protection due to the outbreak of war in Ukraine.
• Reside in the province of Tarragona at the time of participation in the study.
• Have given written consent to participate in the study.

Exclusion criteria

• Presence of physical or mental limitations that interfere with the person's ability to participate in the study, such as sensory deficits (visual, auditory), disorders related to motor coordination, cognitive disorders, or disorders that hinder language (comprehension and/or speech).
• Not having electronic devices (computer, mobile phone, etc.) to participate in the study.