Evaluation of the demographic characteristics and general health status of earthquake survivors affected by the 2023 Kahramanmaraş earthquake; a section from Gaziantep Nurdağı district

In this study, the earthquake-related knowledge, attitudes, behaviours, general health and psychological status of the earthquake survivors after the earthquake that took place in Nurdağı District of Gaziantep were determined and the factors affecting these were examined.

More than 90% of the survivors stated that they had not experienced an earthquake before and approximately 3% stated that they had received training on evacuation. It was found that injuries occured at a rate of 14.2%, 94.2% of which took place at the time of the first earthquake and in 55% of these, the reason for injury was coming in contact with a falling object. Injuries of the leg and foot were the most frequent type of injury with 44.2%.

In a large number of studies conducted due to lack of post-earthquake trauma assessments, injury models, the characteristics of referrals for earthquake-related injuries and related health incomes have been evaluated [3]. Humans tend to be worried, scared and overwhelmed especially after an earthquake [10]. Such behavioral reactions can make them more vulnerable to injury [20].

In an earthquake-related study conducted in Italy, multiple injuries were found in 52% of the survivors and the injuries found were mostly in the lower extremity [3]. In another study, 89% of referrals to hospital were due to injuries and 66% of these referrals had fractures. Lower extremity and trunk injuries were found to have a more severe course than head and neck injuries [1]. The rate of injury was 5.6% in the survivors of the earthquake that took place in Lushan [21].

After the Wenchuan 2008 earthquake, it was found that 43.3% of the survivors had one injury, while the rest had two or more injuries and most of the injuries were in the lower extremity (22.9%) and the head (30.8%) [22]. After the earthquake that took place in China, injuries were found most frequently in the head and face (28.5%), followed by the head and the lower extremities, while the fractures were mostly in the lower extremity (35.66%), upper extremity (23.37%) and thorax (17.11%) [23]. In a similar study, post-earthquake injury locations in front-line hospital and second-line hospital were found as lower extremities 23.9–29.2%; the head 26.3–11.1% and trunk 32.5–28.6%, respectively [24]. In an earthquake-related study conducted in Turkey, the first three most frequent injuries related with musculoskeletal trauma were found as soft tissue injuries, followed by fractures and contusion injuries [25]. After the Haiti earthquake, rate of injury determined was 66% and the rate of fracture was 47% [26]. In a study, it was shown that stress affected bone metabolism and increased the risk for fractures [27].

While the injury rates in the present study were found to be lower than most studies, injuries were mostly in lower extremities, the trunk and neck region, similar to other studies conducted. While gender, educational level, occupation and the state of having received training on evacuation did not have any effects on injury; age, marital status and being trapped under the debris were found to have effects on injury. Age groups of 21–30, 41–50 and > 50 and being trapped under the debris were found to be important risks for injury.

In a study evaluating earthquake evacuation, it was stated that 52.16% of the survivors left the building running, while 20.29% stayed in the same place. Injury rates were found to be higher in survivors who were trapped under the debris and those who were older than 65 years of age [21]. While the rate of leaving the building was lower in this study, injury rate was found to increase with the increase in age and being trapped under the debris. In literature, the first reactions after the earthquake and fears during the earthquake were found to be correlated with injury. In other words, correlation was shown between individual behavioral characteristics and earthquake-related injury [21].

It was found that 61.05% of the survivors in Lushan had received training on earthquake evacuation and the rate of having received evacuation training was 47.59% in those who were injured and 61.85% in those who were not [21]. The rate of having received earthquake evacuation training was very low in our study, while there was no statistical difference between survivors who had received training and those who had not.

In terms of having losses in the family, it was found that 17.1% of the survivors had lost first degree relatives, while 51.0% had lost their second degree relatives. The rate of survivors whose houses were destroyed or were about to be destroyed was in the majority (53.9%). Mean GHQ-12 score of the survivors was 3.81 ± 2.81 and it was found with GHQ-12 that 51.9% experienced psychological distress. It was found that women, housewives, those who were injured, those who lost their first degree relatives, those who were trapped under the debris and those whose houses were destroyed experienced more psychological distress. At the same time, while mean GHQ-12 scores of the survivors who were younger than 20 years of age, those who were widowed and those who had received education below high school were higher than the mean scores of the survivors in their categories, no statistically significant difference was found.

In the evaluation with logistic regression in terms of psychological stress, being female, having been injured in the earthquake, loss of first-degree relatives, loss of second-degree relatives, having a severely damaged-to be demolished house and having a completely destroyed house were found to be associated with higher psychological stress.

In a study conducted on earthquake survivors, it was found that 40.1% of the survivors had post traumatic stress disorder 1 year after the earthquake, while a meta-analysis report found post-traumatic stress disorder with a rate of 29% in the 9-month period following the earthquake among 76,101 individuals [7]. In Bam province of Iran, psychological distress was measured with GHQ-12 and mental problems were found with a rate of 58%. More severe psychological distress was reported in individuals who were older, females, individuals with lower educational level, divorced or widowed and unemployed participants and participants who lost more family members in the earthquake [6]. In adolescent survivors who were affected by the Wenchuan earthquake, PTSD prevalence was found as 5.7% and injury prevalence was found as 8.8%, as measured by various scales. Positive risk factors of PTSD include losing house and property, being injured, death of family members and witnessing death, while negative risk factors are social support and physical exercise [28]. In another study, delayed-onset PTSD symptoms prevalance was found as 9.7% as a result of 7-year long follow up in 340 survivors. While being injured during the earthquake, being unemployed and social support were found to be significant for PTSD symptoms in univariate analysis; unemployment was found to be a risk factor and social support was found to be a protective factor for PTSD symptoms in multivariate analysis [7]. In the literature, psychological stress was found to be 15.4% with the Professional quality of life (ProQOL) scale as a result of seven years of follow-up after earthquake [29]. The relationship between age and posttraumatic stress was evaluated in survivors of Sichuan earthquake and PTSD and general psychiatric morbidity were found to be more frequent in elders when compared with young individuals. Significant correlations were found between PTSD development and risk factors of being old, having been in serious danger, loss of family members and guilt related with one’s death or injury [30]. In a study, GHQ-12 scores were found to be significantly higher at most stressful times and even five months after the earthquake. It was shown that increase in age had an effect on GHQ-12 scores of the subjects [16].

It was also found that in addition to total GHQ score, advanced age also had an effect on the impaired recovery of factor ‘social dysfunction’ score [17]. In the assessment of the psychologies of survivors with different scales, the prevalence of PTSD was found as 40.1%. Being a woman, having a low level of income and a low level of perceived social support were found to be risk factors associated with anxiety, depression and PTSD [31].

In the first month following the L’Aquila earthquake, risk factors of patients diagnosed with PTSD were examined. The fear of having aftershocks all the time and impairment of working memory backward were found to be risk factors [32]. After the earthquake that occurred in Italy, PTSD prevalence was found as 14.5% and male gender, age under 55 years, and better school education were found to be protective factors for PTSD [33]. In another study, PTSD prevalence was found as 9.2% with PTSD checklist-civilian version questionnaire. Multiple logistic regression analysis showed females, elders, farmers and those who lost a family member were riskier for PTSD development [34].

When the effect of earthquake on adolescents was evaluated, while economic loss, separation from parents, and worrying about future aftershocks were risk factors for PTSD, good social relationships and positive news were protective factors [35, 36].

The present study and similar studies evaluated PTSD prevalence and the affecting factors. PTSD prevalence has often been found with GHQ-12 and sometimes by using different scales. Similar to the results of our study, it has been found that female gender, being a housewife, being trapped under the debris, being injured in the earthquake and loss of relatives have significant effects on psychological distress, while unlike our study it was found that having low income, being widowed, unemployed and older increased stress. Also better education, doing exercise after the earthquake and receiving social health were protective factors for PTSD.

As a conclusion, injuries were mostly in the lower extremity, trunk and neck area in the present study and increased age and being trapped under the debris were important risks for injury. It was found that more than half of the survivors had psychological distress, while female gender, being injured in the earthquake, and losing a first degree relative had higher psychological distress, while loss of first and second degree, having a severely damaged house and having a completely destroyed house were associated with higher levels of psychological distress.

Some limitations are present in this study on earthquake survivors. The first of these was that while the earthquake was seen in a much larger region, the study was conducted only in Nurdağı and the participants were earthquake victims residing in Nurdağı. However, it must be noted that the Nurdağı District was one of the residential places where the earthquake was experienced most severely. The study was obtained from the results of a survey conducted 2 months after the earthquake, and the psychological states of the survivors were evaluated with the GHQ-12 scale. This scale is a method used to measure mental health in general, and no different method has been used to evaluate this situation. In this study, the mental health of the survivors was evaluated shortly after the earthquake, and the long-term effect of the earthquake on mental health was not examined. Furthermore, the study group only consisted of earthquake survivors and a control group to compare the effects of the earthquake was not included in the study.

In this study, the general and mental health of earthquake victims was examined and its interaction with different factors was shown, and in this respect it will make a significant contribution to the literature. Since the first-reaction after an earthquake carries vital importance in the prevention of injuries, sharing experiences and educational information related to earthquakes may prevent injuries; keeping in mind that psychological counseling after an earthquake can reduce the negative effects on mental health, it is necessary and essential that such forms of support be provided.