Mental health treatment gaps among the forcibly displaced from Nagorno-Karabakh

Background

Displaced populations face heightened risks of mental health conditions due to the trauma associated with displacement events. In September 2023, the entire population of Nagorno-Karabakh (NK) was forced to flee their homeland following a 9-month blockade and full-scale military attack. To better understand their needs, we assessed mental health outcomes and service utilization among the NK forcibly displaced population currently residing in Armenia.

Methods

In 2025, as part of the Community Wellbeing Project, a cross-sectional, community-based survey was conducted in Masis, Armenia. The project aims to support the overall health, wellbeing and resilience of the displaced NK population. The survey captured data on sociodemographics, service utilization, mental health, and health-related behaviors. Respondents were screened for depression with CES-D, and PTSD with PCL-5.

Results

Among the 746 displaced persons surveyed, 61.0% screened positive for depression (mean age=50.6 years; 80.4% F) and 67.6% for PTSD (mean age=49.8 years; 74.9% F). Most who screened positive for depression (93.7%) and PTSD (94.8%) did not seek care. Common reasons for not seeking care were not serious/urgent (depressed:74.4%, PTSD:74.2%), cost of care (depressed:7.7%, PTSD:7.3%), culturally uncommon (depressed:6.7%, PTSD:5.5%), and unsure of where to go (depressed:5.0%, PTSD:5.1%). No significant differences in utilization were found among those screening positive for depression or PTSD.

Conclusions

High rates of depression and PTSD, coupled with low perceived need and utilization of services, reveal significant mental health treatment gaps. Many did not think it serious enough, a potential reflection of cultural norms or competing interests. To bridge the treatment gaps and shift attitudinal resistance, community-based programs among the forcibly displaced from NK should focus on normalizing mental health concerns, emphasizing long-term impacts on health and well-being.

Key messages

• The displaced population from Nagorno-Karabakh carries a heavy burden of depression and PTSD, but due to low perceived need, usage of mental health services is disproportionately low.

• To narrow the treatment gap among the displaced population from Nagorno-Karabakh, programs should focus on reducing stigma and normalizing mental health, while ensuring access to services.