Abstract
<title>Abstract</title> <p>Protracted war may generate sustained population stress, yet distress may not translate into professional mental health care. A national online cross-sectional survey of adults residing in Ukraine (April 2024) assessed perceived stress (PSS-10), war-related experiences, self-rated mental state, perceived need for psychological help, recent help-seeking, barriers, and coping strategies (N = 1,323). Mean PSS-10 was 21.89 (SD 5.73); 27.04% met the high-stress threshold (≥ 27), and 69.91% reported moderate stress. In adjusted models, perceived stress was strongly patterned by sociodemographic factors, whereas most single war-event indicators showed limited independent associations, potentially reflecting the ubiquity and clustering of war exposures. The stress-to-care cascade revealed a pronounced gap between need and care receipt: perceived need increased sharply with stress severity but help-seeking among those reporting need remained low, yielding substantial unmet need. Among respondents with unmet need, the most frequently endorsed barriers were cost, doubts about effectiveness, difficulties finding or contacting providers, and norms discouraging psychological help. High stress was also associated with reduced social and activity-based coping and increased alcohol use. These cross-sectional self-report findings indicate that, under protracted war, unmet need concentrates among those with the greatest distress, underscoring the importance of affordable, navigable, low-threshold pathways from need recognition to help-seeking.</p>