Two earthquakes occurred on February 6, 2023, at 04.17, with a magnitude of 7.7 Mw, with the epicenter in Pazarcık district of Kahramanmaraş province, and at 13.24, with a magnitude of 7.6 Mw, with the epicenter in Elbistan district of Kahramanmaraş province. The earthquakes were felt strongly in 11 provinces in the Eastern and Southeastern Anatolia Region, causing loss of life and great damage.1 As a result of the magnitude of the earthquake and the destruction it caused, universities across the country started distance education, and state-owned student dormitories were allocated as temporary accommodation centers for individuals affected by the earthquake.
Türkiye is an earthquake region where deaths and destruction can be experienced due to its geological structure. Reference Gönüllü and Gazeteci Tekin19(p134) Earthquakes have the power to deeply affect human life and destroy buildings. Reference Nakajima31(p150) If people are exposed to traumatic disasters, such as earthquakes, fires, and storms, they may experience psychological problems after the disasters. Reference Baloğlu, Harris and Karagözoğlu5(p126) How people react to the traumatic situation they have experienced after traumatic events is an important issue that needs to be addressed. Addressing the issue and determining the reactions to traumatic events is important in terms of being prepared for the events. Reference Tanhan and Kardaş36(p103) Major traumatic events, such as disasters, affect not only those exposed to the disaster but also the societies experiencing the disaster. Disasters disrupt the physical structure and affect the functioning of the society by leaving psychological effects on individuals. Reference Seyle, Widyatmoko and Silver35(p388)
Earthquakes are some of the greatest natural disasters of the age, often striking unexpectedly, threatening lives, and causing large-scale destruction. Reference Dell’OSso, Carmassi and Massimetti14(p59) Earthquakes are natural disasters that cannot be prevented. Although an earthquake cannot be prevented, post-disaster management should be planned well in order to minimize physical and psychological damage. It is important for search and rescue personnel and medical teams to receive special training on the subject. It is also important to focus on those who have experienced trauma in the past as a result of traumatic events. Reference Bilici, Tufan and Turhan8(p18) Exposure to traumatic events throughout life may negatively affect mental health. Stress is part of our daily lives. Psychological resilience is required to cope with stress. It is argued that psychological resilience is a critical factor in recovering from such psychological traumas caused by natural disasters, as it increases the ability to cope with a stressful situation, lead a healthy life, and manage stress. Reference Kc, Gan and Dwirahmadi26(p3) Studies on psychological trauma have increased especially after the Marmara earthquake. The traumas experienced by people affected by the earthquake have been the subject of many studies.Reference Yılmaz38(p69) The shocking aspect of the earthquake is that people suddenly lose their relatives and loved ones. People are not usually exposed to sudden and shocking events in their lives. Therefore, they don’t have the thought of losing their relatives suddenly and are not psychologically prepared for sudden disasters, especially those in which many people lose their lives, as they are sudden life changes. In earthquakes, people lose not only their relatives but also their homes and past memories. Reference Nakajima31(p151)
Posttraumatic stress disorder may develop as a result of many traumatic events, especially after traumas such as earthquakes. Reference Omaç Sönmez, Nazik and Pehlivan32(p2) Natural disasters, such as earthquakes and tsunamis, damage the physical and mental health of those exposed to the disaster. Studies show that adult disaster victims have psychological problems. It was observed that psychiatric disorders, such as post-traumatic stress disorder (PTSD) or major depressive disorder, increased after earthquakes in Italy, China, Southeast Asia, and Türkiye. Reference Kukihara, Yamawaki and Uchiyama27(p525) PTSD is generally recognized as the most common and frequent mental health problem after natural disasters. Reference An, Hu and Zhao2(p104) It is a psychiatric disorder that may occur in people who have experienced (directly or indirectly) or witnessed a traumatic event. It includes symptoms such as avoidance, numbness, and hyperarousal. Post-traumatic stress symptoms are considered the most common negative psychological reactions. Reference Chen, Zhou and Zeng13(p2)
Due to the frequency of natural disasters and the great suffering experienced, many efforts have been made to analyze the aftermath of disasters in terms of mortality, morbidity, physical disability, psychological trauma, and post-disaster psychological and social adaptation. Numerous studies have evaluated the extent of psychological trauma and severity of psychiatric symptoms after earthquakes and their associated risk factors among groups of survivors. Reference Farooqui, Quadri and Suriya17(p136) Various studies show that people exposed to extreme traumatic events, such as disasters, are at risk of suffering from psychological problems such as depression, anxiety, PTSD, and other unspecified forms of stress. Reference Kc, Gan and Dwirahmadi26(p2) Irritability, outbursts of anger, feeling excluded, avoiding emotions and thoughts related to the trauma, and avoiding activities and memories that remind of the trauma are emotional states seen after trauma. Reference An, Hu and Zhao2(p107) Some studies indicate that psychiatric disorders and problems increase after an earthquake or trauma. It has been observed that the prevalence of PTSD varies by country. For example, in the 1988 Armenian earthquake, 67% of the population was traumatized, while this rate was reported to be 24% in the Chinese earthquake. Reference Omaç Sönmez, Nazik and Pehlivan32p(2)
Many findings such as loss of life, injury, transportation and communication problems, power failure, loss of economic value of houses, psychological deterioration, and theft are encountered after earthquakes. Reference Öztürk34(p312) The first priority after an earthquake is to rescue those trapped under the debris. Then, physical injuries are treated, accommodation is provided, and food and beverage needs are met. Reference Nakajima31(p150) It is important to give those exposed to the earthquake the opportunity to freely express their feelings and experiences after the earthquake. It is also important to help them relax mentally and physically and to help solve their psychological and emotional problems. People who experienced an earthquake should not be forced to talk about the disaster afterwards; they should be allowed to talk whenever they want. When talking to people who were exposed to an earthquake, behaviors and attitudes that belittle the event, feelings, and thoughts should be avoided. Although the trauma caused by exposure to an earthquake affects people’s lives, the effort made to recover is important. Reference Nakajima31(p152) An earthquake is a traumatic event. Determining who is affected by this traumatic event and who is resistant to trauma will enable the next generation to be more resistant and conscious amongst earthquakes. Reference Canel, Balcı, Temizer and Serbestoğlu10(p492)
Methods
Survey design, a quantitative research method, was used in the study. The data were collected using a cross-sectional survey approach. The aim of survey design is to try to describe an already existing situation. Cross-sectional studies, in which the variables to be described are measured at a single time, are a type of survey research.Reference Büyüköztürk and Kılıç Çakmak9
Aim of the Study
The study aimed to examine the post-earthquake trauma levels of the guests who were affected by the earthquakes of February 6, 2023 and left their cities and temporarily accommodated in the dormitories, affiliated with the General Directorate of Credit and Dormitories of the Ministry of Youth and Sports in Konya, in terms of various variables. The research questions determined to be in line with the aim of the study are as follows:
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1. Do the post-earthquake trauma levels of individuals affected by the earthquake differ according to gender, age, marital status, education level, employment status before the earthquake, city of residence, and chronic disease status?
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2. Do the post-earthquake trauma levels of individuals affected by the earthquake differ according to the variables of temporary accomodation period, home damage, being trapped under debris, injury, participation in debris search activities, death of family member, loss of relatives, neighbors and friends, and receiving psychological support?
The dependent variable of this study is the level of post-earthquake trauma. Independent variables are gender, age, marital status, education level, employment status before the earthquake, city of residence, chronic disease status, variables of temporary accomodation period, home damage, being trapped under debris, injury, participation in debris search activities, death of family member, loss of relatives, neighbors and friends, and receiving psychological support.
Data Collection Tools
The data were collected with a personal information form containing questions regarding the independent variables of the study and a survey form containing scale questions to measure post-earthquake trauma levels, which is the dependent variable.
Personal information form
The form prepared by the researchers includes questions regarding the independent variables of the study and aims to describe the characteristics of the participants.
Post-earthquake Trauma Level Determination Scale (PETLDS)
The PETLDS was developed by Tanhan and Kayri.Reference Tanhan and Kayri37 The scale consists of 20 items. The scale items prepared in Likert type have 5 options: “not at all suitable for me,” “somewhat suitable for me,” “moderately suitable for me,” “very suitable for me,” and “completely suitable for me.” There are no reverse items in the scale. The lowest score that can be obtained from the scale is 20, while the highest score is 100. The increase in the scores obtained from the scale indicates that the level of being affected by the earthquake also increases. Cronbach’s α coefficient was found to be 0.87 for the total items of the scale. In this study, it was found to be 0.92.
Population and Sample
The population of the study consists of adult individuals who were affected by the February 6, 2023 earthquakes and temporarily accommodated in dormitories affiliated with the Ministry of Youth and Sports Credit and Dormitories Institution in Konya province. On the date the research permission was obtained, it was learned that the number of adult individuals staying in the dormitories of Credit and Dormitories Institution in Konya was 2079 people. 334 people reached through the method known as convenience sampling constitute the sample of the study. According to the sample calculation formula n=(t*S/d)2/[1+(t*S/d)2/N], n=[(1,96*0,5)/0,05]2/[[1+[(1,96*0,5)/0,05]2/2.079]=324 people provide sufficient sample size.Reference Büyüköztürk and Kılıç Çakmak9
Table 1 shows the demographic and pre-earthquake information of the participants. Of the participants, 62% are female, 38% are male, 56.3% are married, 32.9% are single, 39.5% are 18-30 years of age, 35% are 31-46 years of age, and 25.4% are 47 years of age or older. When the educational level of the participants is analyzed, it is seen that 31.2% of the participants have primary school education or below, 15.3% have secondary school education, 29.9% have high school education, and 23.7% have university education or above. It is seen that 57.5% of the participants live in Hatay and 42.5% of them live in other cities affected by the earthquake. While 67.4% of the participants had a job before, 32.6% did not work. 76% of the participants do not have a chronic disease, while 24% have a chronic disease. The minimum duration of accommodation of participants in the dormitories is 1 week and the maximum is 24 weeks. The average duration of accommodation is 13.27 weeks.
Descriptive information of participants
Table 2 provides descriptive information about some of the situations experienced by the participants during the February 6, 2023 earthquakes. Accordingly, 88.6% of the participants’ houses were damaged in the earthquake, while 11.4% of the participants’ houses were not damaged. 9% of the participants were trapped under debris during the earthquake, and 91% did not experience such a situation. 17.7% of the participants were injured due to the earthquake and 82.3% were not injured. 15.9% of the participants participated in the debris search activities, while 84.1% did not. 17.1% of the participants had a family member who died in the earthquake, 82.9% of them did not lose a family member. 88.6% of the participants’ relatives, neighbors, or friends other than family members died. The rate of those who did not experience any loss is 11.4%. 16.5% of the participants stated that they received psychological support after the earthquake, and 83.5% stated that they did not receive psychological support.
Descriptive information of the participants regarding the February 6, 2023 Earthquakes
Data Collection and Analysis
The research was found ethically appropriate by the decision of Selçuk University Faculty of Letters Scientific Ethics Evaluation Board dated April 4, 2023 and numbered 2023/011. In addition, the permission from the Ministry of Youth and Sports dated June 25, 2023 and numbered E.36592570-604.02-5122488 was obtained in order to conduct the survey in the dormitories. The data were collected between June 25, 2023 and July 31, 2023, following the approval of the Ministry. The data of a total of 334 volunteer participants were entered into the SPSS 26 program for analysis. As a result of the normal distribution analysis, it was seen that the data deviated from the normal distribution for some subcategories. For this reason, nonparametric tests were preferred for data analysis. Frequency and descriptive analyses were conducted to describe demographic information. Mann-Whitney U and Kruskal Wallis-H tests were used to analyze the relationships between the scale and variables.
Results
When Table 3 was examined, no significant difference was found between the PETLDS total score and the participants’ gender, working status before the earthquake, having a chronic disease, marital status, and education level (P > 0.05). The individuals participating in the study lived in 10 different cities before the earthquake. However, most of the participants were living in Hatay. For the analysis, city categories were regrouped as Hatay and other. According to the Mann Whitney U test results, the post-earthquake trauma levels of the participants living in Hatay before the earthquake were found to be statistically higher than those living in other cities (U = 11793.000, P = 0.035). In addition, post-earthquake trauma levels of participants aged 31-46 were higher than participants aged 47 and over (x 2 = 9677, P = 0.008).
The relationship between sociodemographic characteristics of the participants and their post-earthquake trauma levels
*P<0.05, **P<0.01
When Table 4 was analyzed, no significant relationship was found between the post-earthquake trauma levels of the individuals affected by the earthquake and the duration of accomodation, home damage, and debris search (P > 0.05). The post-earthquake trauma levels of the participants who stated that they were trapped under debris due to the earthquake were significantly higher than the participants who were not trapped under debris (U = 3368.000, P = 0.018). Similarly, the post-earthquake trauma levels of the participants who stated that they were injured due to the earthquake were higher than the participants who stated that they were not injured (U = 5565,000, P = 0.000). The trauma levels of the participants who lost a family member in the earthquake were found to be higher than those who did not lose a family member (U =6110.500, p= 0,007). Similarly, the trauma levels of those who lost relatives, friends or neighbours other than family members were significantly higher than those who did not experience loss (U = 4346.500, P = 0.023). Finally, it was found that the post-earthquake trauma levels of the participants who received psychological support after the earthquake were higher than the participants who did not receive support (U = 5883.500, P = 0.006).
The relationship between participants’ post-earthquake status and post-earthquake trauma level
*P<0.05, **P<0.01, ***P<0.001
Discussion
Based on the findings of the study, it was found that the level of post-earthquake trauma did not change according to gender. In another study conducted in Nepal, no gender-based differences were found in terms of posttraumatic stress and posttraumatic growth among individuals affected by the earthquake.Reference Muldoon, Acharya and Jay30 Similarly, in a study conducted with individuals affected by the earthquake, it was observed that there was no significant relationship between posttraumatic stress and gender.Reference Hacıoğlu, Aker and Kutlar22 Similarly, in a study conducted with individuals who experienced the Elâzığ earthquake, no statistically significant relationship was observed between gender and post-earthquake trauma.Reference Gülmez20 In addition, it was observed that there was no statistically significant difference between the PTSD scores of individuals who experienced the Gölcük earthquake in their childhood according to their gender.Reference Baytar6 Contrary to the findings obtained in this study, various studies conducted on individuals with traumatic past such as fire and earthquake showed that being a woman significantly increased the risk of developing PTSD.Reference Cankardaş and Sofuoğlu11, Reference Farooqui, Quadri and Suriya17, Reference Fernández, Estario and Enders18 In a study conducted with male and female students who experienced the Van earthquake, the Traumatic Stress Symptom Scale score of female students was higher than male students.Reference Kurt and Gülbahçe28 Similarly, in some studies, it was observed that there was a significant difference between gender and post-earthquake trauma.Reference Demirbaş Kurtoğlu15, Reference Önder33
In our study, no significant results were found between the marital status of the people who experienced the earthquake and their post-earthquake trauma status. In addition to studies reporting that being married before the earthquake reduces the risk of PTSD only in women,Reference Cerdá, Paczkowski and Galea12 a study conducted with people who experienced the Izmir earthquake in our country showed that the post-traumatic stress levels of the participants were higher than those whose marital status was single.Reference Önder33 In addition, many studies have shown that there is no significant difference between marital status and post-earthquake trauma.Reference Baytar6, Reference Demirbaş Kurtoğlu15, Reference Güven21
When the relationship between age and post-earthquake trauma status was examined, it was found that the post-earthquake trauma level scores of individuals aged 35-46 were significantly higher than those of participants aged 47 and over. Similar results were found in another study conducted with people who experienced the February 6 earthquake.Reference Karaarslan, Yavuz and Özdemir23 Contrary to similar results, there are also studies indicating that there is no significant change when trauma status is evaluated according to age ranges.Reference Baytar6
It is reported that high education level is a protective factor in terms of post-earthquake PTSD.Reference Fernández, Estario and Enders18 Being educated may provide the person with knowledge about what to do when faced with an earthquake. However, it has been shown that experiencing the earthquake unexpectedly is not related to education level. In this study, it was observed that there was no significant relationship between post-earthquake trauma and education level. In a study conducted with people who experienced the Gölcük earthquake, it was also observed that there was no significant difference between gender and post-earthquake trauma.Reference Baytar6 There are other studies stating that there is no relationship between post-earthquake trauma and educational level.Reference Güven21, Reference Önder33
Although the situation of being affected by the earthquake was tried to be evaluated on a city-specific basis, data could not be obtained from all provinces that experienced the earthquake. It was observed that the majority of the participants were from Hatay province. When the group living in Hatay province was compared with the group living in other provinces, it was concluded that the post-earthquake trauma level was higher in those living in Hatay province. It is known that the provinces most affected by the first earthquake on February 6 were Kahramanmaraş and Hatay.1 Although Hatay was not the epicentre of the earthquake, it is thought that the great destruction that occurred in Hatay may have an impact on the post-earthquake trauma. When the national literature is examined, it is seen that there are no data on the subject. The reason for this may be due to the fact that the studies on earthquakes are mostly conducted in a single city. Another reason is that throughout the history of Türkiye, so many provinces were not affected at the same time in a single earthquake. Generally, only a single province was affected and, therefore, the studies were carried out around a single province. Therefore, no comparative trauma situation of the cities was found.
There was no significant difference between the previous employment and trauma levels of individuals affected by the earthquake. The same results were observed in another study conducted with people who experienced the same earthquake on the same date.Reference Demirbaş Kurtoğlu15 This means that the employment status of the person, whether he/she was working or not, did not change the rate of being affected by the earthquake. Disease status is an important issue that needs to be paid more attention to in case of disasters such as earthquakes. Exposure to a natural disaster such as an earthquake negatively affects life, especially for those with chronic diseases. This study showed that there was no significant relationship between not having a chronic disease and post-earthquake trauma levels. In a similar study conducted with individuals who experienced the earthquake, it was observed that the number of chronic diseases did not affect the level of physical and mental health quality of life.Reference Karayurt, Dicle and Malak24
It was observed that there was no relationship between whether the home was damaged in the earthquake or not and post-earthquake trauma. In another study conducted with people who experienced the February 6 earthquake, it was observed that the scale score was significantly higher in those whose homes were destroyed after the earthquake compared to individuals in other situations.Reference Demirbaş Kurtoğlu15 Similarly, in a study conducted with people who experienced the 2020 Elâzığ earthquake, a significant relationship was found between home damage and trauma.Reference Gülmez20 However, in some studies conducted with people who experienced the earthquake and and had their homes damaged, it was found that there was no relationship between trauma and home damage.Reference Atılgan4, Reference Bilici, Tufan and Turhan8, Reference Dizer16, Reference Kurt29 The relationship between home damage and PTSD may vary depending on the history of previous violent trauma, but home damage during an earthquake is a high risk factor for major depressive disorder.Reference Cerdá, Paczkowski and Galea12
It was found that the post-earthquake trauma levels of the participants who were trapped under debris in the earthquake were higher than those who were not under debris. In the study conducted after the 2010 Haiti earthquake, it was reported that participants who were trapped under debris and had a history of violent trauma were more likely to exhibit PTSD than those who were trapped under debris but did not have a history of violent trauma.Reference Cerdá, Paczkowski and Galea12 A statistically significant difference was found between Traumatic Stress Symptom Scale scores according to the situation of being trapped under debris in the Van earthquake.Reference Kurt and Gülbahçe28 In another study conducted by Kurt, it was concluded that the mean scores of Traumatic Stress Symptom Scale and Trait Anxiety Scale of the students who were under debris in the Van earthquake were higher than the students who were not trapped under debris.Reference Kurt29 Similar results were found in other studies on the subject.Reference Güven21, Reference Önder33
Significant results were found between the participants’ injury status in the earthquake and the level of post-earthquake trauma in favour of those who experienced injury. Personal injury in the earthquake was associated with a higher risk of PTSD, and this relationship was higher especially in men.Reference Cerdá, Paczkowski and Galea12 In another study conducted with individuals affected by the earthquake, it was observed that the participants who were injured in the earthquake had higher re-experiencing subscale scores than the participants who were not injured in the earthquake.Reference Önder33 In the study conducted with earthquake victims who experienced the 2020 Elâzığ earthquake, a highly significant relationship was found between the presence or absence of PTSD and witnessing someone’s death or injury in the earthquake.Reference Gülmez20
It was observed that there was no significant relationship between the participation in post-earthquake debris search and rescue activities and post-earthquake trauma levels of individuals affected by the earthquake. Similarly, in a study conducted with people who experienced the earthquake, no significant difference was found between participation in debris rescue activities and post-traumatic positive development score.Reference Güven21 In the February 6 earthquake, the number of individuals who experienced the earthquake and participated in debris search and rescue activities was quite high. The fact that the earthquake occurred in 11 provinces at the same time and that there were not enough people to carry out search and rescue activities can be considered as the biggest factors for people to participate in search and rescue activities. Based on the data, it is seen that there is no relationship between participating in search and rescue activities and PTSD, which is supported by other studies.Reference Demirbaş Kurtoğlu15, Reference Gülmez20
It was found that the post-earthquake trauma levels of the participants who experienced the loss of family members in the earthquake was significantly higher than the participants who did not experience the loss of family members. In a study conducted with women, it was found that even being separated from family members after the earthquake significantly increased the risk of depression and anxiety.Reference Anwar, Mpofu and Matthews3 In a study conducted with students who experienced the Van earthquake, it was observed that students who lost their relatives in the earthquake had higher mean scores on the Traumatic Stress Symptom Scale than those who did not.Reference Kurt and Gülbahçe28 In another study conducted after the same earthquake, loss of family members was found to be an important predictor of PTSD diagnosis. It is possible to find similar data in a study conducted with those who experienced the Düzce earthquake.Reference Bedirli7
The post-earthquake trauma levels of participants who lost relatives, neighbors, or friends other than family members in the earthquake were found to be significantly higher than those who did not lose these relatives. In a study, it was reported that women who witnessed the death of a friend, neighbor, or relative were twice as likely to experience anxiety.Reference Anwar, Mpofu and Matthews3 Although the importance of social support is emphasized in such mass traumas, social support resources may also be lost for many people in developing countries where post-earthquake losses are high.Reference Muldoon, Acharya and Jay30 It was also reported that the loss of friends or relatives had an effect on the rate and severity of PTSD in the adolescent group.Reference Dell’OSso, Carmassi and Massimetti14
In this study, it was found that the post-earthquake trauma levels of the participants who stated that they received psychological support after the earthquake were significantly higher than those who stated that they did not receive psychological support. Similar results were found in some other studies. In a study, it was observed that the PTSD, re-experiencing, avoidance, and extreme startle subscale scores of participants who received psychological support due to the earthquake were higher than those of participants who did not receive psychological support due to the earthquake.Reference Önder33 In a study conducted with the participants who experienced the 2020 Elazığ earthquake, it was observed that the relationship between receiving psychological support and PTSD was statistically significant.Reference Gülmez20 In a study conducted with university students who experienced the Van earthquake, it was observed that 98.4% of the participants did not receive any psychological support in the post-earthquake period.Reference Kardaş and Tanhan25 In this study, the majority of participants stated that they did not receive psychological support. When all these factors are evaluated together, it is thought that the participants with higher post-earthquake trauma level felt the need to receive psychological support more, so the post-earthquake trauma levels of this group may have been higher.
Limitations
This study was not conducted with all individuals affected by the February 6, 2023 earthquake. The study group consists only of volunteer participants in temporary accommodation centers in Konya province after the earthquakes. Because the majority of these participants came from Hatay province and the earthquake took place in a wide geography covering 11 provinces, the results regarding the city lived in before the earthquake should be approached with caution.
Conclusion
This study aimed to reveal the relationship between the post-earthquake trauma levels of individuals affected by the earthquakes on February 6, 2023 and various variables. These variables were analyzed in 2 categories as pre-earthquake situation and during or after the earthquake, that is, earthquake-related situations. Regarding the pre-earthquake situation, no significant relationship was found between the gender, marital status, education level, working status, and chronic disease status of the individuals affected by the February 6, 2023 earthquakes and their post-earthquake trauma levels. However, it was observed that those living in Hatay province before the earthquake had a higher level of post-earthquake trauma than those living in other provinces, and those in the 31-46 age group had a higher level of post-earthquake trauma than those in the 47 and over age group. Among the post-earthquake variables, no relationship was found between the duration of temporary accommodation in the student dormitory, home damage, and participation in the debris search activity and the level of post-earthquake trauma. However, it was found that the level of post-earthquake trauma was higher in those who were trapped under the debris than in those who were not; in those who were injured due to earthquakes than in those who were not; in those who lost family members than in those who did not; in those who lost relatives, friends, or neighbors other than family members than in those who did not; and in those who received psychological support after the earthquake than in those who did not. It is expected that the results of the study will contribute to the literature and provide a basis for further research. In addition, it is thought that the results will be beneficial in prioritizing the groups with high post-earthquake trauma levels in psychosocial support services provided after the earthquake.
Acknowledgements
Our sincere thanks to the earthquake survivors who have volunteered to be part of our study.
Author contrubition
Research idea MÖB, Research design, ÇSK, Data Collection, ŞB, Data Analysis, ÇSK Article writing, MÖB, ÇSK Critical review, ŞB, and all authors reviewed the final manuscript.
Competing interests
All authors declare that they have no competing interests.
