Stress, coping, and alcohol use in wartime Ukraine: Findings from a national cross-sectional survey

Armed conflict creates highly stressful and traumatic conditions that may increase alcohol use. We aimed to examine how coping strategies and place of residence relate to alcohol consumption among adults in Ukraine during wartime.

In this nationwide online survey, adults (≥18 years) living in Ukraine or abroad were recruited between Oct 6, 2023, and July 6, 2024. Alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT). A generalised linear mixed-effects model (GLMM) using the Tweedie family with a log link was fitted to model AUDIT total scores, with fixed effects for coping strategies, sociodemographic and socioeconomic variables, and trauma exposure, and a random intercept for region to account for geographic clustering.

Data were analysed from 10,226 respondents (19.3% women, 79.2% men, 0.6% non-binary/self-described, and 1.0% preferred not to say). Overall, 68.8% reported past-year alcohol use, including hazardous use in 7.9%, harmful use in 1.2%, and high-risk use in 1.3% of respondents. In the adjusted GLMM (N = 9995) avoidant coping (β = 0.081, SE = 0.003, p < 0.001) and to a lesser extent emotion-focused coping (β = 0.025, SE = 0.003, p < 0.001) were positively associated with higher AUDIT scores, whereas problem-focused coping was inversely associated with AUDIT scores (β = 0.020, SE = 0.003, p < 0.001). Male gender was independently associated with higher alcohol use (β = 0.471, SE = 0.034, p < 0.001), while the association between avoidant coping and alcohol use was stronger among women than men (β = 0.022, SE = 0.007, p = 0.002). Regional variation was small (variance = 0.02, SD = 0.14) and did not align with frontline proximity or intensity of attacks.

Alcohol use during wartime in Ukraine was more strongly associated with individual coping strategies and trauma exposure than with residence in high-risk areas. While men reported higher overall consumption, avoidant coping showed a stronger association with alcohol use among women. These findings highlight the importance of strengthening adaptive coping and trauma-informed, gender-sensitive interventions to prevent escalation of alcohol-related harm.