At one day care center in Dnipro, Ukraine, children may only attend a nearby primary school in person for two to three hours at a time to protect their safety. Then, they must return to the church-run center to finish their studies so another shift of children can rotate into the school for classes. This is because the school's bomb shelter can only accommodate a limited number of children when the air raid sirens inevitably sound. 

"Our generation has children of war, and we must understand what we can do with them later when the war ends," Serhii Vivchar, who runs the center, told CBS News.

More than two years after Russia launched its brutal invasion, the toll on Ukrainians' mental health continues to climb every day. It affects everyone, from children to soldiers, women who are suddenly single mothers, refugees separated from their families and elderly men and women who cannot leave. 

Along with other volunteers, Vivchar runs several programs at the day center at a church for displaced children and teens ages 7-15. The facility offers homework help, crafts, games and sports.

For Vivchar, the mental anguish of the war is deeply personal. While he's been in Ukraine since the start of the war, his wife and 7-year-old daughter live in Great Britain as refugees. 

The constant threat of airstrikes looms over Vivchar and those around him. Everyone knows someone who's been killed in the war, he said.

"All the time, you know Russian rockets can fall down nearby you, and you can die," he said. "It's a fear, and everyone feels fear. We don't know when and where it happens. It's a very strange feeling."

But talking about the mental-health repercussions of the war and trauma it's caused is uncommon in Ukrainian culture, said Ukrainian-American Andrew Moroz, who founded a faith-based aid organization called the Renewal Initiative to serve Ukrainians. 

"They're not 'feelings' people," said Moroz, the pastor of a church in southwest Virginia who has made multiple trips to Ukraine to support people in the war-torn country where he was born. "They are 'get it done' people: 'Whatever the problem is — I don't care what the manual says — I'm going to figure this out.' And this goes back for centuries and centuries." 

This month — Mental Health Awareness month in the U.S. — Moroz traveled to Ukraine with a group of American therapists and pastors to conduct a mental health retreat and provide individual counseling for nearly 90 aid workers, community leaders, soldiers and soldiers' wives. They visited the hard-hit Donbas region to meet soldiers from the front lines. 

"Ukrainians have been in various conflicts for a long, long time," Moroz said. 

"It's about survival. They kind of repress and suppress their feelings."

But as the war continues without a foreseeable end, Ukrainians are increasingly searching for help to address their stress and anxiety, Moroz said. 

"Soldiers are starting to come home and their communities don't have support systems for them," Moroz said. "(Communities) are beginning to put the puzzle pieces together, realizing, 'we've got to serve these guys better; we have to serve their families.'"

At the retreat, Moroz met two women in their 20s whose husbands were best friends and who had signed up to fight on the first day of the Russian invasion. One woman's husband was killed, while the other woman's husband is still fighting but "is a shell of himself," Moroz said. "He is emotionally and spiritually empty, and physically, and his wife is not sure how to connect with him."

Though many Ukrainians may remain silent, "inside, they have stress, they have depressed" feelings, said Vivchar, who attended one of the mental health retreats. 

"When you start and talk with everyone, in their words, 'We can feel the pain,'" Vivchar said. 

Alessandra Sacchetti, regional technical director for Europe at the Mental Health and Psychosocial Support Network, said Ukrainians are "extremely resilient" but are experiencing high levels of stress day in and day out as the war grinds on. 

"People at this moment are figuring out how to be resilient and how to keep coping," Sacchetti said, adding that two years into the war, "people are just on edge at this point." 

A December 2023 study by the nonprofit refugee advocacy organization HIAS found that 26% of Ukrainians are experiencing psychological distress, including depressive symptoms. An estimated 1.5 million are at risk of having mental health disorders like depression and anxiety, the study found. Respondents with the lowest well being scores included women, Ukrainians in the hardest-hit south and east regions, people over 46 years of age and the poorest groups. 

Although 85% of respondents pointed to life events as the main factors for their psychosocial distress, 38% said they thought the main cause must be character flaws, such as weakness.  

Sacchetti said sleep deprivation, which exacerbates stress and other mental health struggles, is a huge problem. She works with teams who spend nights in the many bomb shelters across Ukraine.

"They keep saying, 'we have sleeping issues, we have an entire country with sleeping issues,'" she said. "When you have alarms and sirens that start in the night or in the morning, that's sleep deprivation." 

Moroz also suggested the U.S. delay in aid and weapons for Ukraine had heightened anxiety. Congress eventually passed a foreign aid package with $61 billion in aid for Ukraine in April, but it remains unclear when much of the desperately needed weapons and ammunition will arrive, or how much impact it will have on the front-line battles that Ukraine has, in recent months, been losing. 

Some Ukrainian soldiers Moroz met said they were grateful for the latest promise of U.S. aid, but they've already waited for months, as supplies and ammunition dwindled and deaths mounted.

"It was like the air was sucked out of the system," Moroz said, "and there was a skepticism about, 'we don't know how quickly this aid is going to get here.'"

The latest round of Ukrainian aid includes some mental health funding from the U.S. Agency for International Development (USAID), Sacchetti noted. 

The Ukrainian government is also working to provide more mental health resources, Sacchetti said, but for now, fighting the war remains its primary concern.

"It's important that everyone understands that even when we pass the emergency, that's the moment that people will need the most," Sacchetti said. "There needs to be attention to long-term recovery." 

Moroz encouraged Americans to give to organizations supporting the mental, physical, emotional and spiritual needs of Ukrainians. 

Ukrainians need to know they're not forgotten, Vivchar said. 

"When Americans visit Ukraine … we see how God reminds us, you are not alone," Vivchar said.

In:
• Ukraine
• Russia
• Mental Health

Kathryn Watson

Kathryn Watson is a politics reporter for CBS News Digital, based in Washington, D.C.