Introduction
Earthquakes, the most devastating and uncontrollable natural disasters, involve the relentless shaking of the earth’s surface. According to the National Earthquake Information Center (NEIC) of the United States Geological Survey (USGS), the world experiences approximately half a million earthquakes annually, with many going unnoticed due to their small size and remote locations.1 Earthquakes present extreme challenges for health care professionals working in affected regions. Among these professionals, neurosurgeons face unique psychological stressors when providing emergency care to earthquake victims, operating under severe resource constraints while making critical life-and-death decisions. Despite their pivotal role in disaster response, there remains a significant gap in understanding how this specialized medical group copes with the intense psychological pressures encountered during and after catastrophic seismic events. The coping mechanisms employed by neurosurgeons in these situations represent a crucial area of study with profound implications, as they directly influence individual mental health outcomes, professional burnout rates, quality of patient care during mass casualty events, and the overall effectiveness of emergency medical response systems.
The urgent need for this investigation has become increasingly apparent following recent major earthquakes, such as those in Turkey and Syria in 2023, which demonstrated the devastating impacts on health care systems and personnel. Neurosurgeons working in these disaster zones face distinct challenges, including performing complex emergency procedures without adequate resources or support systems. Current disaster response protocols often lack evidence-based mental health support specifically tailored to the needs of this critical professional group, whose specialized work may require different coping approaches compared to other medical specialties. This study aims to systematically identify and categorize the coping strategies employed by neurosurgeons in earthquake disaster zones, quantify their relationship with psychological resilience indicators, and develop evidence-based recommendations for institutional support systems.
By focusing on this understudied population, the research seeks to provide crucial data that will help protect the mental health of these essential medical professionals and maintain the integrity of emergency neurosurgical services in future disasters. The findings will inform the creation of specialized training programs to enhance coping skills for disaster response scenarios, addressing a vital component of disaster preparedness that has been largely overlooked in both medical literature and emergency planning protocols. Ultimately, this study contributes to strengthening health care systems’ resilience in earthquake-prone regions by supporting the professionals who form the backbone of emergency medical response.2
In recent times, there has been a notable surge in efforts to evaluate the profound effects of earthquakes, recognized as universal sources of stress, on individuals. Research examining the short and long-term impacts of natural disasters has revealed enduring psychological consequences, with conditions such as depression, anxiety disorders, specific phobias, psychosomatic disorders, and post-traumatic stress disorder (PTSD) persisting for extended periods, ranging from 1 to 8 years.Reference Yule, Bolton and Udwin3 Understanding how individuals adapt and cope with the aftermath of natural disasters has become a focal point for researchers.Reference Matthieu and Ivanoff4 This study specifically aims to shed light on the coping mechanisms employed by neurosurgeons actively working in earthquake zones, providing primary treatment to earthquake victims amid the challenging circumstances.
Material and Methods
Coping assessments in the literature typically utilize scales designed for diverse stress situations. However, given the suddenness and extensive scale of earthquakes, conventional scales prove inadequate to evaluate earthquake-induced stress. Moreover, coping strategies vary among groups with distinct functionalities and norms. In light of these considerations, we employed the Coping with Earthquake Stress Questionnaire (CESQ) exclusively for earthquake-related stress within a population sharing similar normal time standards (see Table 1).
Coping with Earthquake Stress Questionnaire (CESQ)
Directions: Below are some statements reflecting the feelings, thoughts, and behaviors used in coping with earthquake stress. You are expected to mark which of these strategies you use in coping with your earthquake-related stress and to what extent. Please read all the items and mark the most appropriate option for you. Thank you for your participation and support in the research.
Scoring: Always 4 points; Mostly 3 points; Sometimes 2 points; Never 1 point.
Scoring is done according to the subdimensions. Higher scores reflect more use of the coping strategy in question. Total score cannot be calculated from the scale.
Subdimensions
Religious Coping: Items 2, 8, 9, 10, and 11 / 5 items in total / Maximum score: 20 – Minimum score: 5
Positive Reappraisal: Items 7, 12, 13, 14, 15, and 16 / 6 items in total / Maximum score: 24 – Minimum score: 6
Seeking Social Support: Items 1, 3, 4, 6, and 7 / 5 items in total (Note: Items 3 and 7 are reverse scored) / Maximum score: 20 – Minimum score: 5
Score of Coping with Earthquake Stress Questionnaire (CESQ) scale and subscale
* Reverse-scored questions.
Developed by Yöndem et al., the CESQ is the sole scale in the literature specifically designed to assess individuals’ coping mechanisms in response to earthquake stress.Reference Yöndem5 The questionnaire comprises 16 questions categorized into 3 subdimensions: Religious Coping (items 1-5), Positive Reappraisal (items 6-11), and Seeking Social Support (items 12-16). Respondents rate their responses on a 4-point Likert-type scale (1 = Never to 4 = Always). The total score ranges from 16 to 64. In the Seeking Social Support subscale, 2 items are reverse-scored (item 14 and item 15), reflecting the reluctance to seek social support. The higher the score in each subdimension—Religious Coping, Positive Reappraisal, and Seeking Social Support—the more the individual employs that particular coping strategy, with lower scores indicating less utilization.
To validate the CESQ, Yöndem and Eren conducted exploratory and confirmatory factor analyses. Both analyses demonstrated that the 16-item questionnaire comprises 3 factors. Internal Consistency reliability coefficients, measured through Cronbach’s alpha, were found to be satisfactory: α = .85 for Religious Coping, α = .69 for Positive Reappraisal, and α = .74 for Seeking Social Support.Reference Yöndem5
In this study, we administered the CESQ to neurosurgeons who experienced the earthquake, voluntarily traveled to the affected region, and provided primary care to earthquake victims. Given the high mortality and morbidity potential associated with neurosurgical care for cerebral hemorrhages or spinal fractures resulting from earthquake trauma, our focus was to discern variations in coping methods among neurosurgeons postearthquake.
Statistical Analysis
Data analysis employed IBM SPSS 25.0 (Armonk, NY: IBM Corp.). Descriptive statistical methods, including frequency, percentage, mean, standard deviation, median, and interquartile range, were utilized. The chi-square (χ2) test compared qualitative data. Normality of the distribution was assessed using the Kolmogorov-Smirnov test, skewness, kurtosis, and graphical methods (histogram, Q-Q Plot, Stem and Leaf, Boxplot). For quantitative data with normal distribution, Independent Samples t-test or One-Way Anova was employed. In cases of differences in multiple comparisons, Bonferroni correction facilitated post hoc analysis. The relationship between variables was assessed through the Pearson correlation test. The significance level was set at α = 0.05. A power analysis was conducted using G*Power 3.1.9.7, yielding a sample size (n) of 64, effect size (r) of 0.398, R2 of 0.158, α of 0.05, and a power of 91%.
Results
Following the Kahramanmaraş earthquake on February 6, a total of 64 neurosurgeons actively engaged in earthquake relief participated in the CESQ Scale. Among the participants, 5 (7.8%) experienced the February 6 earthquake, while 8 (12.5%) had encountered a previous earthquake. Regarding neurosurgical experience, 32 (50%) had 1-5 years, 21 (32.8%) had 5-10 years, and 11 (17.2%) had more than 10 years of experience. Figure 1 illustrates participants’ responses to survey questions.
Responses to Coping with Earthquake Stress Questionnaire (CESQ).
In comparing CESQ scale and subscale scores based on participant characteristics, no statistically significant differences (P >0.05) emerged in overall and subscale scores across all questions. Professional experience and prior earthquake exposure did not alter the coping strategies of neurosurgeons. Participants’ scores across subdimensions are presented in Figure 2 and Table 2.
Scores of subdimensions.
Exploring relationships between subdimension scores in the DBS scale, a positive correlation surfaced between the “Religious Coping” and “Positive Reappraisal” subdimensions (r = 0.398), proving statistically significant (P <0.05). However, other relationships were not statistically significant (P >0.05). Refer to Figure 3 for a detailed depiction of subdimension relationships.
Relationships between CESQ Subscale Scores.
Discussion
The catastrophic February 6 Kahramanmaraş earthquake caused unprecedented devastation, resulting in significant mortality, permanent disabilities, and profound psychological trauma among survivors. Our findings reveal critical insights into how neurosurgeons coped with these extraordinary circumstances, contributing to the growing literature on disaster medicine and occupational mental health.
The predominance of positive reappraisal as a coping strategy among neurosurgeons (mean score 3.0 ± 0.6) aligns with findings from studies of other high-stress medical professions,Reference Smith, Heimisson and Bourne6 suggesting this cognitive strategy may be particularly adaptive in health care disaster response. Contrary to our hypothesis, this coping mechanism showed no significant correlation with professional experience (P >0.05), indicating that resilience in disaster situations may develop independently of clinical tenure. This finding parallels observations in heat wave adaptation research,Reference Jones, Pascale and Wanigarathna7 where both novice and experienced professionals demonstrated similar adaptive capacities when facing novel extreme events.
Interestingly, early-career neurosurgeons (1-5 years of experience) showed a greater tendency to seek social support compared to their senior colleagues, though this difference did not reach statistical significance. This pattern mirrors findings from studies of emotional intelligence in medical staff,Reference Chen, Tang and Xiong8 where junior professionals relied more heavily on peer networks during crises. The overall reluctance to seek professional psychological support, however, highlights a critical gap in mental health resources for this population—a concern also noted in medical tourism research regarding health care workers in high-stress environments.Reference Liao, Lee and Wang9
The observed interplay between religious coping and positive reappraisal may reflect Turkey’s cultural context, where spiritual beliefs often inform cognitive coping strategies. This dynamic warrants further investigation with larger, multinational samples to disentangle cultural from professional influences. Notably, neurosurgeons demonstrated attenuated psychological reactions to mortality events compared to the general population, consistent with their routine exposure to life-and-death decisions.
The findings of this study carry significant practical implications that warrant urgent attention. First, they underscore the need for differentiated institutional support programs that address the distinct coping needs of neurosurgeons at various career stages, particularly targeting early-career professionals who may benefit most from structured peer support systems. Second, the results highlight the necessity of developing culturally sensitive mental health interventions tailored specifically for medical first responders, acknowledging both their professional realities and regional belief systems. Third, these insights should inform the design of comprehensive disaster preparedness training programs that integrate evidence-based resilience-building strategies alongside clinical response protocols. Looking ahead, future research must adopt longitudinal designs to track coping strategy evolution over time while expanding cross-cultural comparisons—a critical endeavor given the rising frequency of climate-related disasters and the increasing mobility of medical professionals worldwide. Together, these directions promise to strengthen both our theoretical understanding of medical professionals’ disaster coping mechanisms and our practical capacity to support those on the frontlines of emergency response.
Conclusion
This study reveals that neurosurgeons facing earthquake-related stress primarily utilize positive reappraisal as their dominant coping mechanism, a finding that likely reflects their professional acclimatization to high-stress, life-threatening situations. While this adaptive strategy appears consistent across all career stages, our data suggests early-career neurosurgeons may benefit particularly from enhanced social support systems, highlighting an important area for institutional intervention.
The study’s limitations—including its single-region focus and cross-sectional design—simultaneously outline clear pathways for future research. Most urgently needed are multinational longitudinal studies that can: (1) track coping strategy evolution across disaster phases, (2) distinguish between professional and cultural influences on stress responses, and (3) validate the CESQ across diverse health care systems. Such research should employ mixed-methods approaches, combining quantitative measures with qualitative insights into neurosurgeons’ lived experiences during crises.
Practically, these findings call for immediate action in 3 domains: First, the development of targeted resilience programs, including peer-mentoring systems for early-career neurosurgeons and crisis simulation training for entire teams. Second, health care institutions must prioritize accessible, stigma-free mental health resources tailored to surgeons’ unique professional culture. Third, disaster preparedness protocols should incorporate evidence-based psychological support strategies alongside traditional medical response training.
By addressing these research and implementation priorities, we can both advance our scientific understanding of medical professionals’ disaster coping mechanisms and tangibly improve support systems for those who shoulder the immense responsibility of maintaining health care services during catastrophic events. This dual progress remains essential as climate change and urbanization increase global exposure to natural disasters.
Limitations
While this study offers valuable insights into neurosurgeons’ coping mechanisms during earthquakes, several limitations must be acknowledged. The sample of 64 neurosurgeons from a single Turkish region may limit generalizability to other contexts, despite providing adequate statistical power. Our cross-sectional design using self-reported CESQ data captures only immediate postdisaster responses, potentially affected by recall bias, without assessing longitudinal coping pattern evolution. The prominent religious coping observed likely reflects Turkey’s cultural context, suggesting findings may not transfer to secular settings. Additionally, we could not account for potential confounders like personal trauma history or institutional support systems. Future research should employ multicenter longitudinal designs across diverse cultures, incorporate mixed methodologies, and examine institutional support structures to better understand coping strategy development. Comparative studies across medical specialties could clarify profession-specific patterns, while intervention studies could translate findings into practical support programs. Despite these limitations, our work establishes an important foundation for understanding neurosurgeons’ disaster coping strategies, with meaningful implications for health care policy and disaster preparedness initiatives aimed at supporting frontline medical responders during catastrophic events. The findings highlight both the resilience of this critical professional group and the need for tailored mental health support systems in disaster response planning.
Author contribution
Conceptualization: GG and ZD; Investigation: GG; Project administration: GG, ZD, and EC; Resources: EÇ; Writing—original draft: GG, EÇ, and ZD; Writing—review and editing: EÇ and ZD.
Competing interests
The author(s) declare none.
