Our results show that four months after the earthquake survivors display a high rate of PTSD symptoms and psychological distress. Using the stricter cut-off criteria, 36.9% of the sample fulfilled the screening criteria for PTSD. This prevalence is higher than in some other post-earthquake assessments [11]. Comparing it to the meta-analysis from11[11] the prevalence is not only higher than the total mean, but also higher than the mean of studies up until nine months after the events.
Even with the stricter cut-off 82.2% of the sample showed a critical level of psychiatric burden, measured by the GHQ-12. With only 45 people of the sample still being able to stay at their homes, 87.5% having lost relatives or friends and 65 having lost close family members, this high psychological burden is explainable.
While 75.9% of those who said the needed medical support received some, only 26.56% percent of those who said they need psychological/psychiatric support, have received some four months after the disaster – confirming that a lot more mental health support is needed in the region.
As expected the PTSD and the GHQ score were strongly correlated and therefore not included in the regression analysis. Some of the previously found risk factors were found in this sample as well. In contrast to other studies, we found no difference in GHQ and PTSD based on gender or education level. As reported in many other studies the loss of close family members was found as a risk factor for both PTSD and general mental health [11]. Further a higher fear of aftershocks seems to predict traumatic stress and critical psychiatric burden. Since the region has been hit by more earthquakes in 2023 than in many other years, this fear might continue to play an important role in the maintenance of the other symptoms [27]. The continuous happening earthquakes might make the already difficult reconstruction process even harder and longer. Therefore, it comes with no surprise, that most people answered they needed a safe environment and housing when asked what they wish for most at the moment. Yet these finding can also be a hint, that people might need support in dealing with their fear of aftershocks in order to increase their general mental health. But generally, these aftershocks are likely to destabilize the region further.
Further reasons for a higher psychological burden in the aftermath of this earthquake might be that the region was affected by other potentially destabilizing factors even before the earthquake, like the closeness to the Syrian border (refugee from Syria) with the ongoing Kurdish-conflict, the aftermaths of the pandemic and ethnic and religion conflicts.
It is perhaps necessary to mention that the city of Adiyaman, with a population of over 300,000, is located in southeastern Turkey and is home to a majority of Kurds, as well as religious groups such as Alevis and Sunnis. Due to the existing Kurdish conflict, this city was and is again and again a place of ethnic and religious clashes.
While we didn’t find any age differences in the GHQ, but the younger survivors scored significantly higher in the PTSD scores than the elders. Some previous studies found contrary results, after the Sichuan 2008 earthquake elders were found to have a higher risk for PTSD [14]. Yet, other studies did neither find any age differences after natural disasters[38, 39] either, and some also found that elders had over time a significant decrease in symptoms compared to a younger group [40]. Their explanation that experiences with previous disasters might help the elder subjects to deal with the catastrophe might be one explanation for or findings [40].
Contrary to our assumption alcohol or drug abuse have not seemed to increase in the aftermath of the event, in total only 13 people said that they’ve increased their alcohol use. Yet, a lot more reported their use of nicotine has increased since the event. Since only a few people in total said that they do drink alcohol in general, cultural, social and religious reasons might explain why there is less alcohol increase than it was measured after earthquakes in other reasons [26]. Or maybe people tried to respond socially adapted. Similar findings were made for suicidal ideations, that almost did not change after the earthquake compared to before. As to expect, suicidality after the earthquake is mostly explained by suicidal thoughts before the earthquake, which shows that the experience of the earthquake or the PTSD symptoms don’t have an impact on the suicidal thoughts so far. This results differ from previous studies, were most report an increase [17, 21, 22], while others found an decrease. However, it is important to continue to monitor suicidality, as it may well change if the distress continues. This was also shown by a meta-analysis were most studies, that reported an increase in suicidality, were evaluated not right after the natural disaster, but between one to three years later [21]. Further, cultural and religious reasons are likely to explain the lower suicidal rates in the region, since suicide is expressly condemned in the Qu'ran, and traditionally Islamic countries have reported less suicides compared to Western countries in general [41]. Especially Turkey has reported lower numbers than for example the USA, China or Japan, where other studies on earthquake and suicidality were made [42].
There were some methodological limitations to this study. Firstly, some of the interviews were hold in Kurdish, while others were in Turkish. Yet, since all interviewers are fluent in both languages, this can also be a change since the survivors were given the possibility to answer in their preferred language. This might also have decreased the hesitation of Kurdish participants who otherwise would have had to answer in Turkish. Secondly, besides the information on suicidal ideation no data on past psychiatric illnesses were collected. From the PTSD screening alone, it cannot be said for sure that the PTSD symptoms were due to the earthquake and not in consequence of previous traumatic events. Yet, since the interviewers are mental health professionals, we can assume that they would have noted if people were taking about different events. Since depression is also common in earthquake survivors, another limitation is that no validated measure of depression was used. The GHQ-12 is a general measure of mental health. Our decision on using the GHQ-12 and the PTSD Screening and no further explicit depression or anxiety screening was based on the try to keep the interviews short. Further, many other post-earthquake studies have used the GHQ, which makes our findings easily comparable.
The short time that has passed between the disaster and the interviews can be seen as a strength of this study. With the personal one-on-one interviews with mental health professionals and the open questions leaving space for own wished, the survivors were given a chance to use their voice.
Still, another assessment is desirable to see how the mental health of the survivors develops over time, dependent on support, time, and aftershocks. Yet, since four years after the two severe earthquakes in Turkey 1999 still 25% of the survivors, who were relocated, suffered from PTSD [10], it is to assume that although the numbers might decrease somewhat over time, a large number of people will still be affected. Especially if the requests for mental health support and a safe environment, which are also evident in the responses to the open questions, are not met.
Unfortunately, we were not able to interview survivors in the Syrian regions in this survey. With war, conflict and displacement, and COVID-19, these Syrian areas have been experiencing ongoing emergencies for about twelve years and have already an overwhelmed health system. According to the WHO just half of Syrian health care facilities were operational prior to the earthquake [2]. Due to the long-lasting burden even before the earthquake, it can be assumed that the prevalence there will be significantly higher. Therefore, a further survey there would be important.