In the preceding sections of our study, a detailed examination of the psychological implications of earthquakes was conducted. By bringing together the data and literature discussed, it was elucidated that earthquakes led to various mental health issues among survivors. Our current research provides a comprehensive investigation into the effects of earthquakes on the psychological well-being of survivors. The findings highlight the presence of prominent factors such as PTSD at the core of psychological problems commonly observed among earthquake survivors. In this context, this study underscores the pivotal role of PTSD, which is the focal point of our investigation, in understanding the impact of the Kahramanmaraş earthquakes on survivors. Furthermore, this section delves into how event impact and psychological resilience affect PTSD and how PTSD influences anxiety and depression. It becomes evident in this section that more effective preventive and supportive strategies need to be developed to address the challenges faced by earthquake survivors. Additionally, it is recommended that further research be conducted to support this, with more comprehensive studies utilizing qualitative interviews, case studies, and case analyses.
Consistent with H1, it is observed that the impact of the event has a significant and positive effect on PTSD. Similar findings are evident in the literature. In a study involving individuals who had overcome serious illnesses such as acute lung injury (Bienvenu et al., 2013), the Impact of Event Scale—Revised (IES-R) was utilized to assess PTSD symptoms, while the Clinician-Administered PTSD Scale (CAPS) was used to diagnose PTSD. A significant and positive relationship was found between these two variables. In this study, despite the sample group being different from earthquake survivors, consisting of individuals who had overcome acute lung disease, results were obtained that support our hypothesis. Hence, even following any health issue, symptoms of PTSD are observed in individuals, making it inevitable for PTSD symptoms to occur following a large-scale disaster such as the Kahramanmaraş Earthquakes. In a study involving individuals with substance use disorder (Rash et al., 2008), the psychometric properties of the Impact of Event Scale—Revised (IES-R), a screening tool that can be used to identify Posttraumatic Stress Disorder (PTSD) symptoms, were evaluated. These findings supported the reliability of the IES-R in measuring PTSD symptoms and its utility in clinical trials. A significant and positive relationship was found between the IES-R and PTSD. In our own study, we used the IES-R to measure the severity of the event. In a study by Sveen et al. (2016) (Sveen et al., 2016), which investigated the psychometric properties of the Posttraumatic Checklist for DSM-5 (PCL-5) on parents of children with burns, a significant and positive relationship was found between PCL-5 and IES-R. Following the sarin gas attack on the Tokyo subway in 1995, researchers examined the mental and physical symptoms of victims five years after the attack (Iwanami et al., 2004). They investigated the long-term effects of the attack and identified symptoms associated with PTSD. Victims displaying PTSD symptoms also exhibited high levels of anxiety, and a significant and positive correlation was found between the total score of the Impact of Event Scale—Revised (IES-R) and the Clinician-Administered PTSD Scale (CAPS). Similar to our study, the results we obtained also predicted PTSD symptoms using the IES-R as a measure of trauma severity and determinant. When considering the overall evaluation of the H1 hypothesis, the existing literature indicates that the IES-R has a significant and positive effect on PTSD. One of the main reasons for the high impact of the IES-R on PTSD symptoms in the Kahramanmaraş Earthquakes is thought to be the fact that it was a Level 4 disaster, and that individuals had not experienced such an event before. Regardless of the magnitude of the IES-R, it may be possible to mitigate PTSD. For future research, it is recommended to explore whether increasing awareness and consciousness could serve as a significant tool in reducing PTSD. The reasons for the high occurrence of PTSD symptoms need to be thoroughly investigated. It is thought that this disaster affected all provinces across Turkey. This is because Turkey has a cultural, emotional, and public-spirited structure, causing the pain of the events experienced in 11 provinces to be felt nationwide and shared through various media channels. The psychological effects of the Kahramanmaraş earthquakes should be studied not only in the 11 provinces but also nationwide. In conclusion, trauma can affect not only the immediate area but also the entire environment. It is also thought that there will be both direct and indirect effects of trauma, and that these indirect effects should not be overlooked.
Contrary to H2, unexpectedly, it was found that psychological resilience did not affect PTSD symptoms. There are various studies in the literature that contradict this finding. Following the 9/11 terrorist attacks, a group of individuals living in New York exhibited higher resilience, which was more widespread among individuals exposed to trauma (the most significant determinant of PTSD) (Bonanno et al., 2006). Additionally, the study suggested the need for further investigation into how resilience affects different types of exposure. In our own study, we obtained different data due to the different type of exposure, namely the earthquake. The main factor contributing to the different results in our study is the earthquake being a Level 4 disaster and simultaneously affecting 11 provinces destructively. A literature review conducted on employees working in various workplaces affected by disasters (Brooks et al., 2020) found that psychological resilience had a significant and negative impact on PTSD. The study observed an increase in psychological resilience among those involved in disaster relief efforts, which consequently reduced the likelihood of experiencing PTSD. In provinces affected by the Kahramanmaraş Earthquakes (2023), such as Kahramanmaraş and Hatay, there are a total of 21,172 rubble. In provinces heavily affected like these, it is common for individuals to experience PTSD due to witnessing the losses of earthquake victims, whether they participate in relief efforts during the earthquake or not. Furthermore, there is also a study in the literature that failed to find a significant relationship between psychological resilience and PTSD. Following the earthquake in China in 2012, a study conducted on 350 individuals conscripted in Yiliang county (Wu et al., 2015) found results similar to our own study, where psychological resilience did not have a significant impact on PTSD. This was attributed to the low trauma levels among participants and the weak relationship between these two factors. In our study, the earthquake severely affected a region where approximately 15 million people lived. Therefore, the impact of trauma was found to be at high levels in our study. As a result, the participants experienced high levels of PTSD despite their resilience. These findings indicate that psychological resilience does not always affect PTSD symptoms and question the protective role of psychological resilience on PTSD symptoms. Although previous studies suggested that psychological resilience acted as a protective factor against PTSD, differing results were also observed. The Kahramanmaraş Earthquakes stand as the most devastating seismic events in the history of the Republic of Turkey. Registering magnitudes of 7.7 and 7.6 on the Richter scale, respectively, they persisted for 90 seconds, culminating in a tragic toll of 50,000 casualties. Additionally, the earthquakes had a destructive impact on 11 provinces, particularly in Hatay and Kahramanmaraş. In such a massive disaster, the probability of anyone living in the region not having a friend or loved one affected is very low. This also led individuals to experience PTSD. The survivors tried to cope on their own during the first 72 hours after the earthquake. The tragic events they experienced, along with their efforts to rescue their loved ones, forced them to become resilient. All of these factors led to high levels of stress, and they had to be resilient. However, as a result of this complex situation, the resilience level of survivors did not have any impact on experiencing PTSD. Consequently, it was observed that there was a complex relationship between psychological resilience and PTSD, and that these outcomes may vary depending on the sample group, type of event, and its severity. For future research, it is recommended to conduct detailed studies specifically on the psychological effects of the Kahramanmaraş earthquakes. These studies will contribute to the literature and provide insights for decision-makers and policymakers. Additionally, they will support drawing important lessons from the Kahramanmaraş earthquakes.
Consistent with H3 and H4, PTSD has a significant and positive effect on anxiety and depression. Similar results can be found in the literature. In a study examining the impact of depression and anxiety on health satisfaction among PTSD-afflicted veterans (Rauch et al., 2010), depression and anxiety were found to accompany PTSD-afflicted veterans. In a study conducted on adolescents affected by the 2016 Aceh earthquake (Marthoenis et al., 2019), a significant and positive relationship was observed between PTSD and anxiety and depression. In a study conducted on survivors eight years after the 2008 Wenchuan earthquake (Guo et al., 2017), a significant and positive relationship was found between PTSD and depression. In a study conducted on children and adolescents living in Ana Loisa and Dafni cities affected by the 1999 Athens earthquake (Roussos et al., 2005), a significant and positive relationship was observed between PTSD and depression. This study concluded that the strongest determinant affecting PTSD was depression (β = 0.52). When compared to Roussos et al., 2005 (Roussos et al., 2005), there are some similarities and differences in our study. In our study, too, PTSD has a significant and positive relationship with anxiety (β = 0.936) and depression (β = 0.643). However, in our study, anxiety (β = 0.936) has a greater impact on PTSD compared to depression. The reason for this is thought to be the questions included in the survey. While the questions related to anxiety include phrases such as "I felt scared" and "I felt uneasy", the questions related to depression include phrases such as "I felt helpless" and "I felt sad". As understood from these questions, factors such as experiencing continuous aftershocks may have led to a constant state of fear, anxiety, and restlessness among the earthquake survivors. Additionally, the earthquake in Athens occurred at 14:56 and had a magnitude of 5.9, resulting in a total of 140 deaths (Lekkas, 2001). The earthquake in Athens occurred during waking hours, especially during working hours when people were not at home. However, the first earthquake in Kahramanmaraş (magnitude 7.7) occurred during sleeping hours, and the second earthquake (magnitude 7.6) occurred during midday, resulting in greater loss. We think that there are more anxiety-related outcomes in our study regarding the magnitude and timing of the earthquakes. In a longitudinal study conducted on sexually assaulted women (Nickerson et al., 2013), it was found that PTSD had a significant and positive effect on depression and anxiety symptoms. Since the research was longitudinal, a 12-month process was followed, and over time, PTSD symptoms did not decrease, indicating that survivors had difficulty recovering from the traumatic experience. It is recommended to examine the long-term effects of the Kahramanmaraş earthquakes. In a study conducted on Turkmen students who had experienced war in Iraq and were studying at universities in Turkey (Magruder et al., 2015), a significant and positive relationship between PTSD and depression was observed. While PTSD symptoms caused by trauma were seen in 11.2% of the sample, post-traumatic growth was also observed. In the United Kingdom, frontline healthcare workers who experienced PTSD during the early stages of the COVID-19 pandemic also experienced psychological problems such as anxiety and depression (Greene et al., 2021). This may be due to the long-term psychological effects of the COVID-19 pandemic, healthcare workers not feeling safe, and constantly fearing infection. Similarly, earthquake survivors experiencing constant fear and a sense of being on edge are prone to developing symptoms of anxiety and depression. Therefore, the Kahramanmaraş earthquakes are likely to have long-term effects. In a longitudinal study conducted on children who experienced the Lushan earthquake (Cheng et al., 2020), a significant and positive relationship was found between PTSD symptoms and depressive symptoms. Similarly, in our study, the earthquake survivors experienced anxiety and depression after PTSD. These results suggest that individuals experiencing PTSD are at risk of developing other mental health symptoms such as anxiety and depression. PTSD, anxiety, and depression are serious mental health issues following highly traumatic events like earthquakes. To prevent them from exacerbating each other, it is crucial to reduce long-term effects and provide support such as preventive social support, resilience, and psychological support. The emotional upheaval endured by survivors of the Kahramanmaraş earthquakes – from the initial shock of the disaster to grappling with the profound devastation in the area, the heart-wrenching loss of loved ones, homes, and workplaces, the disruption of their everyday routines, the relentless aftershocks, and the persistent feelings of fear and despair – may have precipitated these mental health challenges.
5.1. Limitations
This study has certain limitations. Firstly, our research has limited capacity for generalization. This is because, during the first 72 hours after the earthquake, a significant number of individuals were evacuated or voluntarily moved to different cities, including those with medical needs, losses, those needing healthcare services, and those experiencing housing and nutrition problems. As a result, some individuals could not be reached during the field research process. Secondly, due to the significant impact of the earthquake, some survivors found it difficult to answer the questions. Those heavily affected by the earthquakes experienced further trauma upon seeing the survey questions and abandoned them halfway through. During the data collection period, these individuals were informed that they could discontinue the survey at any time if they wished, and efforts were made to avoid further traumatization. Thirdly, self-report scales were used as the measuring instrument. Despite being validated, such measuring instruments may be insufficient in measuring the psychological effects of such a large-scale earthquake. Therefore, it is recommended to assess the psychological consequences of the Kahramanmaraş Earthquakes using qualitative research techniques. The limitations encountered during the data collection process should be considered as they may affect the generalizability of the results. Fourthly, the study is cross-sectional and does not demonstrate long-term effects. This could affect the interpretation of the results. For future research, it is recommended to evaluate the consequences of earthquake survivors' psychological effects through long-term longitudinal studies.