Journal of Health Inequalities

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1/2026 vol. 12
Original paper

Mental health of adolescent Ukrainian war refugees in Polish schools: a preliminary study of associations between psychological trauma and well-being

  1. Department of Psychology, Jan Kochanowski University in Kielce, Poland

  2. Institute of Psychology, Maria Curie-Skłodowska University, Poland

J Health Inequal 2026; 12 (1): 58–66

Data publikacji online: 2026/07/15
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Introduction

At the beginning of 2024, when the study was conducted, there was still a substantial demand for studies on the well-being and psychological condition of students. Since the beginning of the Russian-Ukrainian war in 2022, Poland has provided temporary shelter to more than 1.5 million refugees from Ukraine, the vast majority of whom have been women and children [1, 2]. This situation has posed a challenge to Polish education system practices to create a trauma-sensitive learning environment and has uncovered areas of need as the refugee students had different educational and linguistic backgrounds [3, 4]. The World Health Organization (WHO) [5] and the United Nations Children’s Fund (UNICEF) [6] have stressed the need for greater attention to the mental health of children and adolescents. Studies on the trauma and well-being of students from Ukraine fulfilling compulsory education in host countries have been conducted so far in other countries, including Germany [7], Denmark [8], and Estonia [9]. However, to date, there have not been many analyses pertaining to the determinants of well-being of Ukrainian adolescents enrolled in the Polish education system, including the mediating role of personality traits. This study fills the gap of analyzing the mediating role of the Big Five personality traits in the relationship between trauma and well-being in Ukrainian students. The results of this study will allow for the expansion of the current state of knowledge regarding the trauma and well-being of adolescent refugees from Ukraine and will help identify common problems and challenges faced by psychologists and educators working in European educational systems [10–12]. The implementation of effective support programs for these students will help address educational inequalities by preventing social isolation among students from Ukraine and enhancing the prospects for their successful acculturation.

According to the WHO [13], childhood trauma can be defined as repeated maltreatment involving physical, emotional or sexual abuse, or neglect experiences in childhood or adolescence, primarily within the family or social context [14]. Emotional disorders arising after traumatic events most frequently diagnosed in adolescents include mood disorders, anxiety or fear disorders, obsessive-compulsive or related disorders, and stress-related disorders. The eleventh revision of the International Classification of Diseases (ICD-11) places two separate but interrelated disorders in the category “Disorders specifically associated with stress”: posttraumatic stress disorder (PTSD) and complex post-traumatic stress disorder [15]. ICD-11 posits that PTSD is defined by three groups of symptoms, which appear following exposure to trauma: re-experiencing of the event in the here and now, avoidance of traumatic reminders, and a persistent sense of current threat which manifests in arousal and hypervigilance. Additionally, ICD-11 identifies symptoms which it refers to as disturbances in self-organization (DSO) and which are diagnostic for CPTSD. DSO are represented by three clusters of symptoms: affective dysregulation, negative self-concept, and disturbances in relationships, which are frequently associated with protracted, repeated, and multiple forms of traumatic exposure. Qualitatively, the distinction between PTSD and CPTSD is that PTSD is a fear condition (state), and CPTSD involves the additional features of DSO arising from trauma [16].

The Five Factor Model (FFM) proposes that perso­nality is best described by five broad traits: extraversion, agreeableness, conscientiousness, neuroticism (sometimes named by its polar opposite, emotional stability), and openness to experience [17]. A personality trait is a stable psychological characteristic that affects how people experience the world and the impact these experiences have on them. Agreeable individuals are coope­rative and polite, rather than antagonistic and rude. Conscientious individuals are task-focused and orderly, rather than distractible and disorganized. Neurotic individuals are prone to experiencing negative emotions, such as anxiety, depression, and irritation, rather than being emotionally resilient. Finally, highly open indivi­duals have a broad rather than narrow range of interests, are sensitive rather than indifferent to art and beauty, and prefer novelty to routine.

Subjective well-being, according to the WHO, refers to the current affective and hedonic perception of one’s own life as a whole [18]. While it is a relatively current state shaped by previous experiences and emotions, it is susceptible to change, as it can be modified by a wide range of internal and external factors [19]. The study of well-being is a significant emerging frontier in positive psychology, since well-being supports children’s mental health and enables students to thrive [20, 21].

Trauma, personality, and well-being have multiple interconnections. It has been documented in several studies that childhood trauma increases the risk of personality disorders, but that this risk is not specific to any single personality disorder [22]. Core biological vulnerabilities in personality include dimensions of affective instability and cognition/perceptual domains. The underlying neurobiology involves deficits in serotonin function and alterations in the cingulate and the medial and orbital prefrontal cortex [22]. Furthermore, personality disorders may affect subjective well-being through depressed mood or anxiety [15].

Research has shown that personality, as a result of both biological and external influences, has a strong effect on subjective well-being and mental health [21, 23]. Subjective well-being is also negatively associated with neuroticism (low emotional stability) and childhood trauma [14]. Low emotional stability has been associated with a higher incidence of negative emotions, such as anxiety, fear, frustration, anger, loneliness, and depression. The positive traits predispose people to seek positive situations and respond to them in ways that enhance their subjective well-being, while the negative traits have the opposite effect [21].

In this study it was hypothesized that the Big Five personality traits might mediate the relationship between trauma and well-being, because personality causes people to react to certain events emotionally in ways that impact their subjective well-being. The FFM was used as the framework for personality traits, since this model is the closest to the scientific consensus and has been widely examined in different health contexts [24]. Since the outbreak of the war in Ukraine in 2022, most studies on Ukrainian adolescent refugees have analysed acculturation processes [1, 8] and schooling experiences [7, 11]. Given the limited research on associations between trauma, personality, and well-being, this study was undertaken to address this gap. The following research question was formulated:

Which of the personality traits are mediators of the associations between trauma and well-being?

We expected two personality traits, extraversion and neuroticism (low emotional stability), to be potential mediators of relationships between trauma and well-being [14; 23]. These personality traits most strongly influence whether people interpret different situations as threats or challenges [25–28], which is why we supposed they might reinforce or attenuate the relationship between trauma and well-being [29]. In difficult situations, extraverted people are more likely than introverts to seek social support, and therefore they may experience higher well-being. Emotionally stable individuals handle stress better than people with low emotional stability because they use more effective coping strategies.

Material and methods

Participants and procedure

A total of 149 adolescent Ukrainian war refugees attending Polish schools were surveyed, including 100 girls (67%), 39 boys (26%), and 10 individuals identifying as other (7%) aged 14–17 (Mage = 15.95; SDage = 1.08). Among the adolescents studied, 132 (89%) came from cities and 17 (11%) lived in rural areas.

The survey was carried out in public secondary schools in eastern and central Poland between February and April 2024 chosen from the website of the regional Polish Education Board. The list of secondary schools attended by students who were Ukrainian war refugees had been downloaded from the website of the rele­vant regional Polish Education Board. This study was performed in line with the principles of psycholo­gical research and the Declaration of Helsinki. The students and their parents or guardians were informed about the anonymity, voluntary and scientific purpose of the survey and that they had the right to refuse to participate without giving any reason. The participants gave their informed consent to the research.

Measures

Trauma. The International Trauma Questionnaire – Children and Adolescent Version (ITQ-CA) is a self-report measure of ICD-11 Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) in children and adolescents (7–17 years old) [16]. It consists of two scales: PTSD and Disturbances in Self-Organization (DSO). The PTSD scale comprises three subscales: re-experiencing, avoidance, and sense of threat. DSO consists of three subscales as well: affective dysregulation, negative self-concept, and disturbances in relationships. A CPTSD diagnosis is made when an individual meets the criteria for PTSD and shows at least one symptom from each DSO subscale [30]. The questionnaire consists of 22 items. The PTSD and DSO scales consist of six items each, measured on a 5-point Likert scale (from 0 – never, to 4 − almost always) and an additional five items with yes/no response options for each scale. In this study, the reliability of the ITQ-CA assessed with Cronbach’s a was 0.83 for PTSD and 0.88 for DSO, which is comparable with the results obtained by Hyland et al. [31], in which internal consistency varied from 0.74 to 0.90.

Personality. The Ten Item Personality Inventory (TIPI) by Gosling et al. [32] is a short self-report measure of the Big Five personality traits (extraversion, emotional stability, conscientiousness, openness to experience, and agreeableness). Each personality trait is measured by two items. Participants rate each item on a 7-point scale ranging from 1 (disagree strongly) to 7 (agree strongly). Cronbach’s a for the specific TIPI subscales in this study ranged from 0.40 to 0.61. They were comparable to the results obtained for the original version of the TIPI (a from 0.40 to 0.73) [32] and for the Ukrainian version of the TIPI (a from 0.44 to 0.74) [33].

Well-being. The 5-item World Health Organization Well-Being Index (WHO-5) is a brief standard questionnaire assessing subjective psychological well-being in people from different populations aged 9 years and older [18]. It is a single-dimension measure with a high clinical face validity. It contains positively phrased, non-invasive items. The respondent is asked to rate how well each of the five statements applies to him or her when considering the last 14 days. Each of the five items is scored from 5 (all of the time) to 0 (none of the time). The raw score, therefore, theoretically ranges from 0 (absence of well-being) to 25 (maximal well-being). WHO-5 is more of a rating system of positive affect than a cognitive judgement of overall life satisfaction [20]. The WHO-5 has been found to have adequate validity in screening for depression and in measuring outcomes in clinical trials. Cronbach’s a in this study was 0.84.

Data analysis

Data were analyzed statistically using SPSS 25.0. In the preliminary analysis, descriptive statistics and Pearson’s correlation coefficients were calculated for all variables. Next, Model 4 of the PROCESS was employed to evaluate the relationship between trauma and well-being and the mediating role of personality traits.

Results

Table 1 gives means, standard deviations, skewness, kurtosis, and correlations for the analyzed variables. The absolute values of skewness and kurtosis were not greater than one, which supported normality of the variables. As shown in Table 1, each of the trauma domains – PTSD, DSO and CPTSD – was negatively correlated with personality traits and current psychological well-being. These correlations revealed that the relationships between the variables were significant but weak.

The results presented in Tables 2 and 3 show that trauma associated with PTSD, DSO, and CPTSD is significantly related to well-being when taking into account selected personality traits. The path mediation results indicate significant associations of PTSD, DSO, and CPTSD with emotional stability: PTSD (a: B = −0.087, p < 0.001), DSO (a: B = −0.077, p < 0.001) and CPTSD (a: B = −0.046, p < 0.001); and emotional stability was positively associated with well-being: PTSD (b: B = 1.197, p < 0.001), DSO (b: B = 1.166, p < 0.001), and CPTSD (b = 1.146, p < 0.001). Bootstrap analyses revealed that emotional stability partially mediated the relationships of PTSD, DSO, and CPTSD with well-being; the indirect effects were as follows: PTSD = −0.107 (95% CI = −0.178, −0.049), DSO = −0.090 (95% CI = −0.159, −0.037), and CPTSD = 0.053 (95% CI = −0.089, −0.023).

Additionally, the results point to a significant relationship between DSO, CPTSD, well-being, and openness to experience. The path mediation results indicate significant associations of DSO and CPTDS with openness to experience: DSO (a: B = −0.057; p < 0.01) and CPTDS (a: B= −0.036; p < 0.001). Openness to experience was negativly associated with well-being: DSO (b: B = −0.628; p < 0.05) and CPTSD (b: B = −0.682; p < 0.05). Openness to experience was found to partially mediate the relationship between DSO and well-being, with an indirect effect size of 0.036 (95% CI = 0.003, 0.080) and CPTSD and well-being, with an indirect effect size of 0.024 (95% CI = 0.004, 0.055).

Thus, the results in Table 3 indicate that the personality traits of emotional stability and openness to experience are mediators of the relationship between trauma and well-being. This relationship is stronger in students with lower emotional stability and openness to experience.

Discussion

It was hypothesized that selected Big Five personality traits, namely, emotional stability and extraversion, would mediate the relationship between trauma and well-being in Ukrainian adolescents attending Polish secondary schools. Extraversion and emotional stability influence how people cope with stress and interpret equivocal situations. The study of their role in cognitive interpretations of ambiguous situations has a long history in psychological research [25, 27, 28, 34]. Traits associated with low emotional stability may lead to a skewed perception of ambiguous stimuli as more threatening than they really are, while traits underlying extraversion make people more prone to perceive positive aspects of situations [25, 34]. Research indicates that they play a crucial role in coping strategies among adolescents [26, 29, 35]. Extraverted people, when faced with stress, tend to seek the help of other people, which in turn strengthens their well-being. People with low emotional stability often focus on negative aspects of situations, which makes them more prone to be unhappy [29]. Given these observations, it was assumed that the relationship between trauma and well-being could be mediated by extraversion and emotional stability. Their contribution may be associated with strengthening (low extraversion and low emotional stability) and attenuating (high extraversion and high emotional stability) the relationship between different aspects of trauma and well-being. The results of this study only partially confirmed this hypothesis. The analysis revealed that emotional stability was a mediator of the relationship between all aspects of trauma – PTSD, DSO, and CPTSD – and well-being. This result points to the important role of neuroticism as a pre-existing tendency toward emotional instability, worry, susceptibility to distress, and decline in well-being [36]. This result is not surprising, as lower emotional stability is associated with mood fluctuations, ruminations, and greater sensitivity to negative aspects of a situation [29]. Low emotional stability is associated with biased cognitive appraisals of the causes of adverse events, their excessive significance for daily functioning, or exaggerated feelings of personal responsibility for failures [37]. Intense negative emotions may imply the continuation of unresolved problems or uncontrollable threatening situations leading to health-damaging behaviors, such as substance use, to reduce negative affect [29]. Moreover, the results revealed that negative effects of CPTSD on a person’s well-being are much worse for individuals who are also low in emotional stability. This result confirms that low emotional stability exacerbates the damage caused by trauma in a long-term perspective through e.g. affective dysregulation leading to hypervigilance and generalised anxiety [28]. The same effect for low emotional stability was also found for DSO, which is a core component of CPTSD in ICD-11, characterized by problems in affective dysregulation, negative self-concept, and disturbances in relationships [36].

The results did not confirm the hypothesized mediating effect of extraversion on the relationship between trauma and well-being. Previous studies have demonstrated that people who are more extraverted experience positive emotionality, greater subjective well-being and resilience, than those inclined to introversion. Extraverts are more likely to use coping strategies that involve engaging with a challenge, such as problem-solving, than strategies of disengagement or avoidance. Also, in difficult situations, they formulate positive expectations towards future events [38]. Despite this, in this study extraversion was not a mediator of relationships between trauma and well-being. This result is puzzling. There are a few possible interpretations. Firstly, some data suggest that emotional stability and extraversion may interact with each other [37]. For example, low emotional stability and the underlying traits, e.g. irritability or hostility, may hinder the use of social support and compromise social interactions. This line of interpretation mostly applies to cases of particularly low levels of emotional stability (i.e. high levels of negative traits). Secondly, it is possible that in refugee adolescents, factors other than personality may also mediate relationships between different aspects of trauma and well-being. Examples of these influences are support networks, a sense of integration into a new community, and possibly financial stability or resources [14]. This hypothesis suggests that environmental factors might exert at least as much influence as personality traits on how trauma affects well-being, but further investigation is required to confirm it.

The results showed that the relationships between DSO, CPTSD, and well-being were mediated by openness to experience. The relationships were stronger in students who showed lower levels of openness to experience. This observation is consistent with the previous finding that stressful life events may reduce openness to experience [39]. CPTSD may develop secondary to a deficit in mentalization, i.e. imaginative mental acti­vity, which allows one to become aware of and interpret one’s own and other people’s behavior in terms of needs, desires, and beliefs. This may lead to persons acting more conventionally in everyday circumstances and responding in the same, repetitive, but safe, way to different life situations [8]. The disturbances in self-organization (DSO), reinforced by reduced openness to new experiences, may manifest in rigidity of behavior and giving up on self-development or establishing new relationships, which may worsen the everyday well-being of war refugee students [9].

As this study shows, openness to experience is an important cognitive and developmental resource of young Ukrainians studying in Polish schools. Psychological interventions focused on this personality trait as a mediator of the relationships of PTSD, DSO, and CPTSD with well-being are designed to help students to cognitively process their trauma [40] and, as a consequence, strengthen their mentalization skills, which they can use in their school environment. Most often, this involves teaching students how to build positive beliefs about themselves and the events they experience, as well as boost faith in their abilities. In educational terms, fostering openness may also be understood as supporting students’ readiness to adopt new perspectives, knowledge, as well as thinking and acting strategies. As young people learn to open up to new possibilities, they experience responsibility, independence, and emotional control, which makes them engage in the present and enables posttraumatic growth [40].

Conclusions

Understanding why some individuals experience worse well-being due to trauma exposure than others remains a challenge and requires investigating which personality and environmental factors could be possible mediators of relationships between trauma and well-being. Personality plays a key role in how individuals are affected by trauma [37]. This study revealed the significance of two personality traits: emotional stability and openness to experience. Low emotional stability was a mediator of relationships between all aspects of trauma and well-being, while openness to experience was a mediator of CPTSD, DSO, and well-being.

While we may assume that the situation of Ukrainian adolescents in Polish schools has stabilized in the past months, there is still a need for creating crisis intervention programs for those students who may manifest symptoms of distress. This includes creating a trauma-sensitive classroom for Ukrainian refugee students in the hosting country [3] and promoting resilience and well-being in the school setting. International comparisons of procedures and support systems for these students in different countries, within the context of a common global educational policy, are of particular significance in this area [8–10].

In-depth qualitative interviews are indeed particularly useful for assessing the current mental state of students with reference to their life situation. In turn, more tailored analyses could be undertaken and used in practical solutions offered for all students, including refugees: mindfulness, self-exploration workshops, cooperation and interpersonal integration activities, and intercultural competence workshops. It is important to integrate personality-adapted interventions and trauma-informed practices into clinical practice of mental health professionals, including psychiatrists, clinical psychologists, and other healthcare providers.

Disclosures

1. Institutional review board statement: Not applicable.

2. Assistance with the article: AI assistance was used for language editing and grammar correction.

3. Financial support and sponsorship: None.

4. Conflicts of interest: None.

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