Anxiety and depression in war-displaced refugees: resilience as a moderating factor: a cross-sectional study

Abstract Background The full-scale Russian invasion of Ukraine in 2022 resulted in the largest refugee crisis in Europe since World War II, with Poland hosting the highest number of displaced Ukrainians. Although the adverse mental health consequences of war-related trauma and forced displacement are well documented, the protective role of resilience in mitigating anxiety, depression, and psychological distress remains insufficiently explored. This study aimed to examine the moderating role of resilience in refugee mental health, while accounting for gender and physical and mental health status. Methods A quantitative cross-sectional study was conducted in 2025 among Ukrainian refugees residing in Poland (n = 390). Data were collected using paper-based questionnaires distributed through governmental and non-governmental aid organizations. Resilience was assessed using the Resilience Scale (RS-25), while symptoms of anxiety, depression, and psychological distress were measured with the Hopkins Symptom Checklist (HSCL-25). Descriptive statistics were calculated, and group differences were analyzed using chi-square tests, Fisher’s exact tests, and Mann–Whitney U tests. Statistical significance was set at p < 0.05. Results Clinically significant psychological distress and anxiety were reported by 38.21% of participants, while depressive symptoms were observed in 34.87%. All three outcomes were approximately twice as prevalent in women compared with men (p < 0.001). The presence of physical and mental health problems was strongly associated with higher levels of distress, anxiety, and depression. Nearly half of the participants (46.67%) demonstrated high resilience. Higher overall resilience and higher scores across all resilience domains (self-reliance, meaningfulness, equanimity, perseverance, and authenticity) were consistently associated with significantly lower levels of psychological distress, anxiety, and depressive symptoms (p < 0.001). Education level and spousal separation due to war were significant determinants of resilience. Conclusions Ukrainian refugees experience substantial mental health burdens following forced displacement, with women and individuals with existing health problems being particularly vulnerable. Resilience plays a crucial protective role against psychological distress, anxiety, and depression. These findings underscore the importance of integrating resilience-building, culturally sensitive interventions into refugee support and healthcare services to promote mental well-being and facilitate successful integration in host countries.