Abstract
Background
Volunteers working in earthquake-stricken areas have personally experienced or witnessed many traumatic events.The aim of this study is to investigate the levels of post-traumatic stress disorder (PTSD), anxiety, and depression in individuals who volunteered during a highly destructive earthquake.
Methods
A descriptive research design was conducted between 20.03.2023 and 20.06.2023, with the study population consisting of volunteers who went to the earthquake-stricken area. An online survey was used as the data collection tool and was distributed to volunteers involved in earthquake-related activities through non-probability sampling via communication groups. The survey included sociodemographic questions, the Generalized Anxiety Disorder 7-item scale (GAD-7), the CES-Depression Scale, and the Post-Traumatic Stress Disorder (PTSD) Checklist.
Results
A total of 237 volunteers responded to the survey. The frequencies of anxiety, depression, and PTSD among participants were 23.6% (n = 56), 58.6% (n = 139), and 13.9% (n = 33), respectively. Multivariable logistic regression showed that participants without earthquake-related training had lower odds of anxiety (aOR = 0.35, 95% CI: 0.16–0.76) and depression (aOR = 0.52, 95% CI: 0.29–0.95). Female sex was associated with higher odds of depression (aOR = 3.87, 95% CI: 2.00–7.50) and PTSD (aOR = 2.71, 95% CI: 1.26–5.82), while non-healthcare workers had higher odds of depression (aOR = 1.85, 95% CI: 1.01–3.37).
Conclusion
Volunteers working in earthquake-stricken areas are at a high risk of depression, anxiety, and PTSD. Therefore, providing appropriate psychosocial support to volunteers involved in disaster response is essential for protecting and maintaining their mental well-being.
Keywords: Earthquake, Post-traumatic stress disorder, Anxiety, Depression, Volunteer
Introduction
Earthquakes are sudden and destructive events that can cause deaths, injuries, displacement, financial loss, and disruption of daily life [1]. Responders to disasters often witness heart-wrenching situations, predisposing them to PTSD, depression, and other psychological disorders [2]. Earthquakes make survivors susceptible to a variety of mental health issues, including anxiety, depression, suicide, and PTSD [3].
Post-traumatic stress disorder is one of the most frequently studied mental health outcomes after disasters [4]. It is a psychiatric condition encompassing cognitive, emotional, behavioral, and social disturbances that can occur when an individual experiences or witnesses a trauma threatening their psychological or physical integrity [5, 6]. The prevalence of PTSD is approximately 6–8% in the general population, rising up to 25% in individuals who have experienced severe trauma [7].
In addition to PTSD, previous research has shown that earthquake exposure may be associated with increased symptoms of other mental health problems, particularly anxiety and depression [8]. Ongoing uncertainty about housing, employment, financial security, and insurance problems may contribute to higher levels of anxiety following a disaster [9]. In a review, the prevalence of depression after disasters has been reported to be approximately 25% [8]. A study conducted in Türkiye after the 1999 earthquake reported that the prevalence of several mental disorders, including major depression, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, remained higher in the affected region even three years after the disaster [10]. Mental health outcomes following disasters may also be influenced by age, sex, education, socioeconomic status, employment status, previous traumatic experiences, pre-existing mental health conditions, personal loss, the level and duration of disaster exposure, and perceived social support [11, 12]. Examining these factors may help identify groups with greater psychosocial needs.
This study focuses on the volunteer response to the catastrophic earthquakes that struck Türkiye in February 2023. In February 2023. Türkiye experienced two major earthquakes on the same day, causing nearly 50,000 deaths [13]. This situation brought earthquakes to the forefront of public attention. In the immediate aftermath, volunteers, public employees, and search and rescue teams from various sectors of society traveled to the affected region, particularly during the first days of the disaster. In the present study, volunteers refer to individuals who participated in earthquake-response activities voluntarily rather than as part of their regular paid professional duties. Unlike professional responders, volunteers may differ in terms of training, preparedness, institutional support, and assigned roles. Volunteers working in earthquake-stricken areas may personally experience or witness traumatic events. Those providing support in areas such as search and rescue, healthcare, and humanitarian aid may also be indirectly exposed to the psychological consequences of the disaster through contact with injured individuals, bereaved families, and distressing scenes [14].
The psychological burden experienced by disaster volunteers may extend beyond direct exposure to traumatic events. Repeated contact with injured or bereaved survivors, witnessing human suffering, and listening to traumatic experiences may result in secondary traumatic stress, vicarious traumatisation, or compassion fatigue [15]. These concepts describe partially overlapping psychological consequences of indirect exposure to trauma and have been particularly discussed among first responders and other helping professionals [15]. A systematic review of first responders demonstrated that secondary traumatisation is associated with a range of individual and work-related factors, highlighting the importance of considering indirect trauma exposure when evaluating the mental health of disaster responders [15].
Psychological distress among disaster responders may also arise through occupational and organisational mechanisms. High levels of disaster exposure, perceived threat, emotionally demanding tasks, prolonged deployment, inadequate preparation, role-related stressors, and insufficient social or organisational support have been associated with poorer mental health outcomes among responders [16]. Conversely, preparedness, training, self-efficacy, and social support may reduce psychological vulnerability [16, 17]. These mechanisms may be particularly relevant to volunteers, who may differ from professional responders in their previous disaster experience, level of formal training, preparedness, and integration into organised response systems. A review focusing specifically on disaster volunteers found that volunteers may experience greater psychological complaints than professional responders and identified severity of exposure, identification with victims, anxiety sensitivity, and lack of post-disaster social support as potential risk factors [18].
Although previous studies have investigated psychological outcomes among disaster survivors and professional responders, evidence specifically addressing disaster volunteers remains relatively limited. Furthermore, volunteers constitute a heterogeneous group with differing levels of training, previous disaster experience, response roles, and personal exposure to the disaster. Because PTSD, depression, and anxiety may coexist after traumatic events [19] and reflect different but related aspects of psychological distress, assessing these outcomes together may provide a more comprehensive understanding of volunteers’ mental health after disasters. Therefore, examining these outcomes together with demographic, experiential, and disaster-response-related factors may help identify vulnerable subgroups and inform preparedness and psychosocial support strategies for future disasters. Accordingly, this study aimed to assess PTSD, anxiety, and depression among individuals who volunteered in the earthquake-affected region and to identify factors associated with these psychological outcomes.
Methods
Population, sample, design
Descriptive research was conducted between March 20, 2023, and June 20, 2023, with the study population consisting of volunteers who went to the earthquake-stricken area. An online survey was used as the data collection tool. Since some volunteers working in the earthquake-stricken area operate independently, and there is no volunteer list, a non-probability sampling method was used to reach volunteers through communication groups. The survey was distributed online to volunteers involved in earthquake-related activities through non-probability sampling via communication groups. Because recruitment was conducted through online communication groups using convenience sampling, the total number of individuals who received or viewed the study invitation could not be reliably determined; therefore, a response rate could not be calculated.
Measurements
The first part of the applied survey included sociodemographic questions. The second part of the survey included the 7-item 4-point Likert scale Generalized Anxiety Disorder (GAD-7) test. The third part consisted of the 20-item 5-point Likert scale CES-Depression Scale, and the fourth part included the 20-item 5-point Likert scale Post-Traumatic Stress Disorder (PTSD) Checklist. Sociodemographic information constituted the independent variables of the study, while the scores obtained from the scales constituted the dependent variable.
Generalized anxiety disorder (GAD-7)
The GAD-7 was developed by Spitzer et al. according to DSM-IV-TR criteria [20] and validated for Turkish by Konkan et al. [21]. The scale evaluates generalized anxiety disorder by querying experiences in the last 2 weeks through 7 items using a four-point Likert scale (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day). If we look at the cutoff points of the scores obtained from the scale; 0–4 indicates mild, 5–9 indicates moderate, 10–14 indicates high, and 15–21 indicates severe anxiety [20]. The total score a person can get is 21. In the original scale, the cutoff point was 10 and above, while in the Turkish validation study, it is 8 [20, 21].
CES-depression scale
The CES Depression Scale was developed by the National Institute of Mental Health in the United States to measure depression [22]. Its adaptation into Turkish was carried out by Tatar and Saltukoğlu [23]. The four-point Likert scale consists of 20 items. Each item is scored between 0 and 3, with “Not at all-Rarely (less than 1 day)” being marked as 0, “A little-A few times (1–2 days)” as 1, “Sometimes-Occasionally (3–4 days)” as 2, and “A lot-Most of the time (5–7 days)” as 3. Items numbered 4, 8, 12, and 16 are scored in the opposite direction, and the scale’s score range is between 0 and 60. High scores indicate a tendency toward depressive states. The cutoff point for the scale is 16 points and above [23].
Post-traumatic stress disorder (PTSD) checklist
Developed by Weathers et al. with the aim of measuring PTSD symptoms [24], this checklist consists of 20 items. It is scored on a 5-point Likert scale ranging from 0 to 4. The checklist comprises 4 factors: re-experiencing, avoidance, negative changes in cognition and mood, and hyperarousal. It is a 5-point Likert scale. The Turkish adaptation of the scale was conducted by Boysan et al. [25]. The adaptation revealed that, as in the original scale, there are 4 factors. A score of 47 and above on the scale indicates a higher likelihood of PTSD.
Statistical analysis
Statistical analysis of research data was made with SPSS 24.0 package program. In the study, median, minimum and maximum values, numbers (n) and percentages (%) were used for descriptive data. Conformity of continuous variables to normal distribution was examined by histograms, probability graphs and analytical methods. The Mann Whitney U test was used to compare the two groups in the data that did not fit the normal distribution, and the Fisher Exact test and Pearson chi-square tests were used to compare the categorical data. The internal consistency of the scales was assessed using Cronbach’s alpha coefficient. Binary logistic regression analyses were performed to identify factors associated with the development of anxiety, depression and PTSD. Variables with a p-value below 0.20 in the univariable analyses and variables considered theoretically relevant were included in the multivariable model. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Statistical significance level was determined as p < 0.05.
Ethics
Ethics committee approval was obtained from Istanbul Medipol University (date: 16.03.2023, protocol code: 239). Written informed consent was obtained from all participants prior to their participation in the study. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Results
The survey was answered by 237 volunteers. The median age of the respondents was 33 (18.0–62.0). Of the participants, 30.4% (n = 72) were female, and 69.6% (n = 165) were male. Among those who completed the survey, 32.9% (n = 78) were healthcare professionals. The majority of participants were university graduates (77.2%, n = 183). The prevalence of chronic illness and psychiatric diagnosis among participants was 11.0% (n = 26) and 3.8% (n = 9), respectively. The rate of those who had previously experienced an earthquake was 42.6% (n = 101), while the rate of those who had lost their homes in an earthquake was 2.5% (n = 6), and the rate of those who had previously lost their relatives in an earthquake was 6.3% (n = 15) (Table 1).
Table 1.
Sociodemographic and other features of the participants
| N (%) | ||
|---|---|---|
| Gender | Female | 72 (30.4) |
| Male | 165 (69.6) | |
| Profession | Healthcare worker | 78 (32.9) |
| Other | 159 (67.1) | |
| Education | Primary school | 4 (1.7) |
| Secondary school | 9 (3.8) | |
| High school | 41 (17.3) | |
| University | 183 (77.2) | |
| Marital status | Married | 127 (53.6) |
| Single | 96 (40.5) | |
| Widowed/Divorced | 14 (5.9) | |
| Presence of chronic disease | 26 (11.0) | |
| Presence of psychiatric illness | 9 (3.8) | |
| Have experienced an earthquake before | 101 (42.6) | |
| Hose collapsed in earthquake before | 6 (2.5) | |
| Losing relatives in an earthquake before | 15 (6.3) | |
| Receiving training about earthquake | 164 (69.5) | |
In the present study, Cronbach’s alpha coefficients for the GAD-7 and CES were 0.906 and 0.908, respectively. The Cronbach’s alpha coefficient for the total PTSD scale was 0.971, while the coefficients for its four subscales ranged from 0.883 to 0.930. The frequencies of anxiety, depression, and PTSD among participants were determined based on values above the cutoff point for each scale. Accordingly, the frequencies of anxiety, depression, and PTSD were 23.6% (n = 56), 58.6% (n = 139), and 13.9% (n = 33), respectively. The median values of participants’ scale scores and the percentages of anxiety, depression, and PTSD are provided in Table 2.
Table 2.
Scale scores and anxiety, depression, PTSD frequencies according to scale scores
| Scale scores and depression, anxiety, PTSD frequencies | ||
|---|---|---|
| GAD 7 Total, median (min-max) | 3.0 (0–21.0) | |
|
High anxiety (above cut off value of GAD-7), n (%) |
Yes | 56 (23.6) |
| No | 181 (76.4) | |
| CES Total, median (min-max) | 18.0 (0–49.0) | |
|
High depression (above cut off value of CES), n (%) |
Yes | 139 (58.6) |
| No | 98 (41.4) | |
| PTSD Total, median (min-max) | 18.0 (0–80.0) | |
| Presence of PTSD (above cut off value of PTSD), n (%) | Yes | 33 (13.9) |
| No | 205 (86.1) | |
| PTSD Re-Experiencing, median (min-max) | 5.0 (0–20.0) | |
| PTSD Avoidance, median (min-max) | 2.0 (0–8.0) | |
| PTSD Negative Alterations, median (min-max) | 6.0 (0–28.0) | |
| PTSD Hyperarousal, median (min-max) | 5.0 (0–24.0) | |
PTSD Post-Traumatic Stress Disorder, GAD 7 Generalized Anxiety Disorder 7-item scale, CES CES Depression Scale
Factors associated with anxiety and depression among participants were evaluated. It was observed that those who received earthquake-related training had higher levels of anxiety (p = 0.009). Gender, age, education level, occupation, and previous earthquake experience did not show statistically significant effects on anxiety development. The risk of depression was higher in female participants compared to male participants (p < 0.001). Age, education level, occupation, previous earthquake experience, and earthquake-related training did not show statistically significant effects on depression development (Table 3).
Table 3.
Factors associated with anxiety and depression
| Presence of anxiety | Presence of depression | ||||||
|---|---|---|---|---|---|---|---|
| No n (%) |
Yes n (%) |
P value | No n (%) |
Yes n(%) |
P value | ||
| Sex | Female | 53 (73.6) | 19 (26.4) | 0.509 | 17 (23.6) | 55 (76.4) | < 0.001 |
| Male | 128 (77.6) | 37 (22.4) | 81 (49.1) | 84 (50.9) | |||
| Age (years) | Under 35 | 89 (73.0) | 33 (27.0) | 0.202 | 45 (36.9) | 77 (63.1) | 0.151 |
| 35≥ | 92 (80.0) | 23 (20.0) | 53 (46.1) | 62 (53.9) | |||
| Education | Below university | 38 (70.4) | 16 (29.6) | 0.237 | 24 (44.4) | 30 (55.6) | 0.599 |
| University | 143 (78.1) | 40 (21.9) | 74 (40.4) | 109 (59.6) | |||
| Profession | Other | 117 (73.6) | 42 (26.4) | 0.149 | 61 (38.4) | 98 (61.6) | 0.183 |
| Healthcare worker | 64 (82.1) | 14 (17.9) | 37 (47.4) | 41 (52.6) | |||
| Have experienced an earthquake before | No | 106 (77.9) | 30 (22.1) | 0.509 | 58 (42.6) | 78 (57.4 | 0.638 |
| Yes | 75 (74.3) | 26 (25.7) | 40 (39.6) | 61 (60.4) | |||
| Receiving training about earthquake | No | 63 (87.5) | 9 (12.5) | 0.009 | 36 (50.0) | 36 (50.0) | 0.080 |
| Yes | 118 (72.0) | 46 (28.0) | 62 (37.8) | 102 (62.2) | |||
When factors associated with PTSD were evaluated, it was found that 22.2% of women (n = 16) and 10.3% of men (n = 17) had PTSD. This difference in the prevalence of PTSD in women was statistically significant (p = 0.015). Age, education level, occupation, previous earthquake experience, and earthquake-related training did not show statistically significant effects on the development of PTSD (Table 4).
Table 4.
Factors associated with PTSD
| Presence of PTSD | ||||
|---|---|---|---|---|
| No n (%) |
Yes n (%) |
P value | ||
| Sex | Female | 56 (77.8) | 16 (22.2) | 0.015 |
| Male | 148 (89.7) | 17 (10.3) | ||
| Age (years) | Under 35 | 103 (84.4) | 19 (15.6) | 0.450 |
| 35 ≥ | 101 (87.8) | 14 (12.2) | ||
| Education | Primary school/secondary school/High school | 48 (88.9) | 6 (11.1) | 0.497 |
| University | 156 (85.2) | 27 (14.8) | ||
| Profession | Other | 135 (84.9) | 24 (15.1) | 0.457 |
| Healthcare worker | 69 (88.5) | 9 (11.5) | ||
| Have experienced an earthquake before | No | 118 (86.8) | 18 (13.2) | 0.722 |
| Yes | 86 (85.1) | 15 (14.9) | ||
| Receiving training about earthquake | No | 66 (91.7) | 6 (8.3) | 0.097 |
| Yes | 137 (83.5) | 27 (16.5) | ||
PTSD Post-Traumatic Stress Disorder
In the multivariable logistic regression analysis for anxiety, participants who had not received earthquake-related training had significantly lower odds of anxiety compared with those who had received such training (aOR = 0.35, 95% CI: 0.16–0.76, p = 0.009). No statistically significant associations were found for age, sex, or profession. In the multivariable logistic regression analysis for depression, female participants had significantly higher odds of depression than males (aOR = 3.87, 95% CI: 2.00–7.50, p < 0.001). Participants who had not received earthquake-related training had significantly lower odds of depression compared with those who had received such training (aOR = 0.52, 95% CI: 0.29–0.95, p = 0.034). Non-healthcare workers had significantly higher odds of depression than healthcare workers (aOR = 1.85, 95% CI: 1.01–3.37, p = 0.045). No statistically significant association was found for age. In the model for PTSD, female participants had 2.71-fold higher odds of developing PTSD than male participants (aOR = 2.71, 95% CI: 1.26–5.82; p = 0.011). Age and receiving earthquake-related training were not significantly associated with PTSD development (Table 5).
Table 5.
Multivariable logistic regression analyses of factors associated with anxiety, depression and PTSD development
| Variables for anxiety LR Model | aOR | 95% CI | p-value |
|---|---|---|---|
| Age | 1.55 | 0.83–2.91 | 0.171 |
| Sex | 1.56 | 0.79.3.07 | 0.200 |
| Receiving training about earthquake | 0.35 | 0.16–0.76 | 0.009 |
| Profession | 1.77 | 0.87–3.60 | 0.118 |
| Variables for depression LR Model | aOR | 95% CI | p-value |
|---|---|---|---|
| Age | 1.53 | 0.88–2.66 | 0.129 |
| Sex | 3.87 | 2.00-7.50 | < 0.001 |
| Receiving training about earthquake | 0.52 | 0.29–0.95 | 0.034 |
| Profession | 1.85 | 1.01–3.37 | 0.045 |
| Variables for PTSD LR Model | aOR | 95% CI | p-value |
|---|---|---|---|
| Age | 1.35 | 0.63–2.88 | 0.445 |
| Sex | 2.71 | 1.26–5.82 | 0.011 |
| Receiving training about earthquake | 0.40 | 0.15–1.03 | 0.059 |
Reference categories: age ≥ 35 years, male sex, having received earthquake-related training, and being healthcare worker. aOR adjusted odds ratio, CI confidence interval, LR Logistic regression, PTSD post-traumatic stress disorder
Discussion
Earthquakes can affect not only those directly experiencing the disaster but also disaster and relief volunteers [26]. Psychological symptoms are frequently observed in relief volunteers [27]. In this study, an assessment was made regarding the mental health of volunteers working in the earthquake-stricken region, which recently experienced major destruction and casualties in our country. According to the results of our study, the frequency of anxiety based on the scale scores of the participants was 23.6%. The frequencies of depression and PTSD were 58.6% and 13.9%, respectively. In a study conducted with individuals working for post-earthquake rehabilitation, PTSD related to the earthquake was shown in over 40% of the participants, and approximately 20% showed depression and anxiety related to the earthquake [28]. Supporting the psychological vulnerability of disaster relief personnel, a study conducted in Türkiye reported a point prevalence of 35.3% for probable PTSD among disaster relief teams [29]. Consistent with the literature, depression, anxiety, and PTSD were common among individuals involved in earthquake and disaster relief activities. The high prevalence of depression, anxiety and PTSD observed in volunteers may be interpreted within the framework of indirect trauma exposure and secondary traumatic stress. Although volunteers were not necessarily direct victims of the earthquake, repeated exposure to injured individuals, bereaved families, distressing scenes, and survivors’ traumatic experiences may have contributed to psychological distress [15]. These findings suggest that volunteers working alongside earthquake survivors may also require access to mental health support and preventive services.
The predominance of depressive symptoms (58.6%) in the present study may reflect psychological processes beyond fear-based trauma responses, including helplessness, emotional exhaustion, or distress related to repeated exposure to others’ suffering [15]. Moral distress or moral injury may represent additional explanatory mechanisms, as these constructs have been associated with depression and other adverse mental health outcomes in helping professionals [30]. The comparatively lower prevalence of PTSD (13.9%) may also suggest that the psychological burden in some volunteers was related more to sustained helping and indirect exposure to suffering than to direct personal life-threat. However, since moral injury, helplessness, burnout, and detailed information on volunteers’ specific duties were not directly assessed in the present study, these explanations should be considered hypothetical.
Understanding factors that may negatively impact mental health is necessary for prioritizing and planning preventive and therapeutic interventions in this field. The rate of participants who had previously experienced an earthquake in our study was 42.6%. Participants with and without a previous earthquake experience did not differ significantly in terms of depression, anxiety, or PTSD symptoms. Previous earthquake exposure alone may be insufficient to explain variations in post-earthquake mental health outcomes. While repeated exposure may increase vulnerability to trauma-related symptoms in some individuals, previous experience may also improve disaster knowledge, preparedness, and coping skills. Consistent with this interpretation, a study conducted in Tehran found that previous earthquake experience was significantly and positively associated with earthquake-related knowledge and preparedness [31].
Previous studies have shown that women are more vulnerable to adverse mental health outcomes following traumatic events and disasters [32, 33]. In the present study, the prevalence of PTSD, anxiety and depression was higher among women; however, the difference was statistically significant for depression and PTSD. Similarly, the multivariable analysis showed that female participants had a higher risk of PTSD and depression. This finding is consistent with previous researches indicating that women may experience a greater psychological burden following earthquakes. A study conducted in Türkiye reported a higher prevalence of earthquake-related anxiety among women [34], while another study reported that the incidence of PTSD was higher among female earthquake survivors in Iran and Pakistan than among their male counterparts [35]. The greater psychological vulnerability observed among women may be partly explained by differences in disaster exposure, caregiving burdens, safety concerns, and unequal access to social and economic resources [36–38]. Volunteer roles and pre-existing mental health conditions may also have contributed to the observed sex differences; however, these factors were not evaluated in the present study. In addition, sex-related differences in symptom reporting or willingness to disclose psychological distress may have influenced self-reported outcomes. Therefore, the higher prevalence of PTSD and depression among women should be interpreted with caution and not attributed solely to greater psychological vulnerability. These findings highlight the importance of considering sex-related differences when planning mental health screening, early intervention, and psychosocial support for volunteers involved in disaster response.
In addition to sex differences, anxiety was more prevalent among participants who had received earthquake-related training. This finding was also supported by the multivariable analysis, in which participants without earthquake-related training had significantly lower odds of both anxiety and depression. However, in a study conducted in Türkiye, participants who had not received previous disaster-related training had higher depression, anxiety, and stress scores, although the differences were not statistically significant [39]. Our finding may be interpreted from a risk-perception perspective. Disaster training may heighten awareness of the likelihood and potential severity of disaster-related consequences, thereby increasing subjective threat appraisal and, in some individuals, anxiety and depression [40]. However, this interpretation should be considered with caution. Trained volunteers may also have undertaken more demanding roles or experienced greater exposure to distressing scenes during disaster response. Previous studies have shown that disaster volunteers are vulnerable to adverse psychological outcomes and that the severity and duration of exposure to traumatic events are important predictors of mental health problems [18, 39]. In the present study, however, the mechanisms underlying this association could not be determined because variables such as perceived threat, level of preparedness, disaster-related knowledge, volunteer role, and degree of disaster exposure were not assessed. Therefore, this finding should not be interpreted as evidence that earthquake-related training itself increases anxiety. Further studies including detailed measures of training content, preparedness, perceived risk, and disaster exposure are needed to better understand this association. Additionally, our findings suggest that disaster training programs may benefit from integrating psychological preparedness alongside technical content, including guidance regarding emotional responses, and coping strategies.
In addition to the associations observed with earthquake-related training, occupational background was also associated with psychological outcomes. Non-healthcare workers had higher odds of depression compared with healthcare workers. This may be related to differences in disaster preparedness, previous experience, and coping with stressful situations. Previous research has shown that preparedness may influence psychological outcomes among disaster responders [41]. Another research has also identified experience, perceived competence, and effective coping strategies as protective factors for psychological resilience among disaster-exposed workers [42]. Healthcare workers may be more familiar with emergency conditions and working under stress because of their professional background [43]. However, healthcare workers are also vulnerable to psychological distress and negative mental health outcomes after disasters [43, 44]. Therefore, the lower odds of depression among healthcare workers in our study should be interpreted with caution, as differences in training, duties, and level of exposure may have contributed to this finding.
From a public health perspective, the findings of the study highlight the need to consider the mental health of volunteers as an integral component of disaster preparedness and response. Volunteer programs may benefit from pre-deployment orientation, clear role definitions, training in coping and stress management, and access to psychological support during and after disaster response. Particular attention may be needed for subgroups showing higher levels of psychological symptoms. Future disaster preparedness programs should include strategies aimed at strengthening resilience and ensuring sustained psychosocial support.
Limitations and Strengths
The study has several limitations. Participants were recruited through convenience sampling via online communication groups, and the number of individuals who received or viewed the invitation could not be determined; therefore, the response rate could not be calculated. This recruitment approach may have introduced selection bias and may limit the representativeness and generalizability of the findings. Moreover, the findings were based on self-reported information and may therefore be affected by reporting bias. The cross-sectional design causes another limitation since it does not allow causal relationships to be established. Since no pre-earthquake data were available, changes in participants’ psychological status after the earthquake could not be evaluated. Additionally, potentially important occupational and exposure-related variables, including the duration of volunteering, cumulative working hours, specific volunteer activities, direct exposure to dead bodies or severely injured individuals, and detailed previous disaster-response experience, were not assessed. Consequently, the potential effects of these factors on anxiety, depression, and PTSD could not be evaluated. Future studies should include more detailed measures of disaster-related exposure and volunteering characteristics and, where possible, use sampling strategies that allow calculation of participation rates. Despite these limitations, there are several strengths of the study. While studies in the literature mostly focus on the mental health of earthquake victims, our study is strong in evaluating the mental health of volunteers working in the earthquake-stricken area. In addition, the simultaneous evaluation of anxiety, depression, and PTSD in our study contributes to the literature from a broad perspective.
Conclusion
In this study, anxiety, depression, and PTSD symptoms were found in 23.6%, 58.6%, and 13.9% of the volunteers, respectively, with depression being the most common mental health problem. Female sex was associated with higher odds of both PTSD and depression, while non-healthcare workers had higher odds of depression and participants without earthquake-related training had lower odds of anxiety and depression. These findings suggest that the mental health needs of volunteers should also be considered alongside those of disaster-affected individuals. Although no causal inferences can be drawn because of the cross-sectional design, our findings support the consideration of basic psychological screening, access to psychosocial support, and referral services for volunteers with mental health symptoms, particularly for potentially vulnerable subgroups such as women. Longitudinal studies are needed to confirm these associations, identify other related factors, and examine changes in mental health over time.
Acknowledgements
This study used the generative AI tool ChatGPT (OpenAI, version GPT-5.1) solely for language editing and improving the clarity of the manuscript. No content, interpretation, analysis, or scientific conclusions were generated by the AI.
Authors' contributions
MA—conceptualism, writing and editing of this paper, completed follow-up data collection; MAS— conceptualism, writing and editing of this paper, completed follow-up data collection; ZMA— conceptualism, writing and editing of this paper, data analysis.
Funding
No funding was received fort his study.
Data availability
The dataset generated and/or analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Ethics committee approval was obtained from Istanbul Medipol University (date: 16.03.2023, protocol code: 239). Written informed consent was obtained from all participants prior to their participation in the study. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.World Health Organization. Earthquakes. WHO Health Topics. Available from: WHO website. Accessed July 28, 2026.
- 2.Nagata K, Tateishi S, Mori K. A literature review of the health effects of workers responding to the Great East Japan Earthquake. Environ Occup Health Pract. 2020;2(1):1–9. 10.1539/eohp.2020-0005-RA. [DOI] [Google Scholar]
- 3.Jahangiri K, Yousefi K, Mozafari A, Sahebi A. The Prevalence of Suicidal Ideation after the Earthquake: A Systematic Review and Meta-Analysis. Iran J Public Health. 2020;49(12):2330–8. 10.18502/ijph.v49i12.4815. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Sönmez D, Hocaoglu C. Post-Traumatic Stress Disorder After Natural Disasters: A Review. Duzce Med J. 2023;25(2):103–14. 10.18678/dtfd.1277673. [DOI] [Google Scholar]
- 5.Hassija CM, Gray MJ. Behavioral interventions for trauma and posttraumatic stress disorder. Int J Behav Consult Ther. 2007;3(2):166–75. 10.1037/h0100797. [DOI] [Google Scholar]
- 6.Pacella ML, Hruska B, Delahanty DL. The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. J Anxiety Disord. 2013;27(1):33–46. 10.1016/j.janxdis.2012.08.004. [DOI] [PubMed] [Google Scholar]
- 7.Ressler KJ, Berretta S, Bolshakov VY, et al. Post-traumatic stress disorder: clinical and translational neuroscience from cells to circuits. Nat Rev Neurol. 2022;18(5):273–88. 10.1038/s41582-022-00635-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Heanoy EZ, Brown NR. Impact of Natural Disasters on Mental Health: Evidence and Implications. Healthc (Basel). 2024;12(18):1812. 10.3390/healthcare12181812. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Afifi WA, Felix ED, Afifi TD. The impact of uncertainty and communal coping on mental health following natural disasters. Anxiety Stress Coping. 2012;25:329–47. 10.1080/10615806.2011.603048. [DOI] [PubMed] [Google Scholar]
- 10.Önder E, Tural Ü, Aker T, Kılıç C, Erdoğan B. Prevalence of psychiatric disorders three years after the 1999 earthquake in Turkey: Marmara Earthquake Survey (MES). Soc Psychiatry Psychiatr Epidemiol. 2006;41(11):868–74. 10.1007/s00127-006-0107-6. [DOI] [PubMed] [Google Scholar]
- 11.Cénat JM, McIntee SE, Blais-Rochette C. Symptoms of posttraumatic stress disorder, depression, anxiety and other mental health problems following the 2010 earthquake in Haiti: A systematic review and meta-analysis. J Affect Disord. 2020;273:55–85. 10.1016/j.jad.2020.04.046. [DOI] [PubMed] [Google Scholar]
- 12.Ulusoy S, Celik Z, Guleryuz A, Esgibag HC, Yavuz KF. Prevalence and Risk Factors of PTSD, Depression, and Grief Among Survivors of 2023 Türkiye Earthquake. J Nerv Ment Dis. 2024;212(10):541–8. 10.1097/NMD.0000000000001803. [DOI] [PubMed] [Google Scholar]
- 13.Republic of Türkiye Ministry of Interior, Disaster and Emergency Management Presidency (AFAD). Kahramanmaraş’ta meydana gelen depremler hakkında. 2023. Available from: https://www.afad.gov.tr/kahramanmarasta-meydana-gelen-depremler-hk-34. Accessed July 23, 2025.
- 14.Bıçakçı AB, Okumuş FEE. Depremin psikolojik etkileri ve yardım çalışanları. Avrasya Dosyası. 2023;14(1):206–36. [Google Scholar]
- 15.Greinacher A, Derezza-Greeven C, Herzog W, Nikendei C. Secondary traumatization in first responders: a systematic review. Eur J Psychotraumatol. 2019;10(1):1562840. 10.1080/20008198.2018.1562840. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Brooks SK, Dunn R, Amlôt R, Greenberg N, Rubin GJ. Social and occupational factors associated with psychological distress and disorder among disaster responders: a systematic review. BMC Psychol. 2016;4:18. 10.1186/s40359-016-0120-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Thormar SB, Sijbrandij M, Gersons BPR, van de Schoot R, Juen B, Karlsson T, Olff M. PTSD symptom trajectories in disaster volunteers: The role of self-efficacy, social acknowledgement, and tasks carried out. J Trauma Stress. 2016;29(1):17–25. 10.1002/jts.22073. [DOI] [PubMed] [Google Scholar]
- 18.Thormar SB, Gersons BP, Juen B, Marschang A, Djakababa MN, Olff M. The mental health impact of volunteering in a disaster setting: a review. J Nerv Ment Dis. 2010;198(8):529–38. 10.1097/NMD.0b013e3181ea1fa9. [DOI] [PubMed] [Google Scholar]
- 19.Çınaroğlu M, Yılmazer E, Noyan Ahlatcıoğlu E, Ülker SV, Hızlı Sayar G. Psychological impact of the 2023 Kahramanmaraş earthquakes: a systematic review and meta-analysis of PTSD, depression, and anxiety among Turkish adults. Front Public Health. 2025;13:1664212. 10.3389/fpubh.2025.1664212. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. 10.1001/archinte.166.10.1092. [DOI] [PubMed] [Google Scholar]
- 21.Konkan R, Şenormancı Ö, Güçlü O, Aydın E, Sungur MZ. Yaygın Anksiyete Bozukluğu-7 (YAB-7) Testi Türkçe uyarlaması, geçerlik ve güvenirliği. Noropsikiyatri Arşivi. 2013;50(1):53–9. 10.4274/npa.y6308. [DOI] [Google Scholar]
- 22.Radloff LS, The CES-D, Scale. A Self-Report Depression Scale for Research in the General Population. Appl Psychol Meas. 1977;1(3):385–401. 10.1177/014662167700100306. [DOI] [Google Scholar]
- 23.Tatar A, Saltukoğlu G. CES-Depresyon Ölçeği’nin doğrulayıcı faktör analizi ve madde cevap kuramı kullanımı ile Türkçe’ye uyarlanması ve psikometrik özelliklerinin incelenmesi. Klinik Psikofarmakoloji Bülteni. 2010;20(3):213–27. [Google Scholar]
- 24.Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5) – Standard [Measurement instrument] 2013. Available from https://www.ptsd.va.gov/.
- 25.Boysan M, Ozdemir G, Ozdemir O, Selvi Y, Yılmaz E, Kaya N. Psychometric properties of the Turkish version of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5). Psychiatry Clin Psychopharmacol. 2017;27(3):306–16. 10.1080/24750573.2017.1342769. [DOI] [Google Scholar]
- 26.Işıklı S, Tüzün Z. Afetlerin Akut Dönem Psikolojik Etkilerine Yönelik Psikososyal Müdahale Yaklaşımları. Türkiye Klinikleri J Psychology-Special Top. 2017;2(3):180–8. [Google Scholar]
- 27.Kang P, Lv Y, Hao L, et al. Psychological consequences and quality of life among medical rescuers who responded to the 2010 Yushu earthquake: A neglected problem. Psychiatry Res. 2015;230(2):517–23. 10.1016/j.psychres.2015.09.047. [DOI] [PubMed] [Google Scholar]
- 28.Ehring T, Razik S, Emmelkamp PM. Prevalence and predictors of posttraumatic stress disorder, anxiety, depression, and burnout in Pakistani earthquake recovery workers. Psychiatry Res. 2011;185(1–2):161–6. 10.1016/j.psychres.2009.10.018. [DOI] [PubMed] [Google Scholar]
- 29.Iseri A, Baltaci R. Psychological Impact of Disaster Relief Operations: A Study Following Consecutive Earthquakes in Turkey. Disaster Med Public Health Prep. 2024;18:e128. 10.1017/dmp.2024.134. [DOI] [PubMed] [Google Scholar]
- 30.Coimbra BM, Zylberstajn C, van Zuiden M, et al. Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis. Eur J Psychotraumatol. 2023;15(1):2299659. 10.1080/20008066.2023.2299659. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Ostad Taghizadeh A, Hosseini M, Navidi I, Mahaki AA, Ammari H, Ardalan A, Knowledge. Attitude and Practice of Tehran’s Inhabitants for an Earthquake and Related Determinants. PLoS Curr. 2012;4:e4fbbbe1668eef. [DOI] [PMC free article] [PubMed]
- 32.Gök A, Yılmaz Koğar E. A meta-analysis study on gender differences in psychological resilience levels. Cyprus Turkish J Psychiatry Psychol. 2021;3(2):132–43. 10.35365/ctjpp.21.2.15. [DOI] [Google Scholar]
- 33.Afifi M. Gender differences in mental health. Singap Med J. 2007;48(5):385–91. [PubMed] [Google Scholar]
- 34.Zortuk O, Bedel C, Selvi F. Emergency service workers’ earthquake anxiety and evaluation of factors affecting earthquake anxiety. J Prev Complement Med. 2024;3(2):81–6. 10.22034/jpcm.2024.473122.1178. [DOI] [Google Scholar]
- 35.Hosseinnejad M, Yazdi-Feyzabadi V, Hajebi A, et al. Prevalence of Posttraumatic Stress Disorder Following the Earthquake in Iran and Pakistan: A Systematic Review and Meta-Analysis. Disaster Med Public Health Prep. 2022;16(2):801–8. 10.1017/dmp.2020.411. [DOI] [PubMed] [Google Scholar]
- 36.Shooshtari S, Abedi MR, Bahrami M, Samouei R. The mental health needs of women in natural disasters: A qualitative study with a preventive approach. J Family Med Prim Care. 2018;7(4):678–83. 10.4103/jfmpc.jfmpc_333_17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Juran L, Trivedi J. Women, gender norms, and natural disasters in Bangladesh. Geogr Rev. 2015;105(4):601–11. 10.1111/j.1931-0846.2015.12089.x. [DOI] [Google Scholar]
- 38.Fothergill A. Gender, risk, and disaster. Int J Mass Emerg Disasters. 1996;14(1):33–56. 10.1177/028072709601400103. [DOI] [Google Scholar]
- 39.Bekiroglu S, Attepe Özden S, Çakmak E. Post-traumatic stress, depression, and anxiety levels in Turkish rescue workers after the 2023 Kahramanmaraş earthquakes. Geopsychiatry. 2026;3:100076. 10.1016/j.geopsy.2026.100076. [DOI] [Google Scholar]
- 40.Gendeshmin SB, Rostamzadeh S, Dowlati M. Evaluation of disaster risk perception and influencing factors among hospital personnel using structural equation modeling. Sci Rep. 2025;15(1):12780. 10.1038/s41598-025-97747-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.James LE, Welton-Mitchell C, Noel JR, James AS. Integrating mental health and disaster preparedness in intervention: a randomized controlled trial with earthquake and flood-affected communities in Haiti. Psychol Med. 2020;50(2):342–52. 10.1017/S0033291719000163. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Brooks S, Amlôt R, Rubin GJ, Greenberg N. Psychological resilience and post-traumatic growth in disaster-exposed organisations: overview of the literature. BMJ Mil Health. 2020;166(1):52–6. 10.1136/jramc-2017-000876. [DOI] [PubMed] [Google Scholar]
- 43.Sehlikoglu S, Yilmaz Karaman IG, Kacar Y, C., Canakci ME. Earthquake and mental health of healthcare workers: A systematic review. Turkish J Clin Psychiatry. 2023;26:309–18. 10.5505/kpd.2023.70845. [DOI] [Google Scholar]
- 44.Naushad VA, Bierens JJ, Nishan KP, et al. A Systematic Review of the Impact of Disaster on the Mental Health of Medical Responders. Prehosp Disaster Med. 2019;34(6):632–43. 10.1017/S1049023X19004874. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The dataset generated and/or analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request.