Psychiatric outcomes after primary and secondary earthquake exposure: effects of loss, media, and treatment.

Introduction: Earthquakes can cause substantial psychiatric morbidity including Post-Traumatic Stress Disorder (PTSD). While direct exposure effects are well known less is understood about relapse after indirect exposure. Following the 2023 Kahramanmaraş earthquakes clinicians observed renewed distress among survivors of the 2020 Aegean Sea earthquake. Understanding how media exposure individual factors contribute to symptom reactivation is important for post-disaster care. This study investigated factors linked to PTSD symptom relapse after repeated disaster exposure. Method: This prospective quantitative study (February 2023-February 2024) recruited patients from a psychiatry outpatient clinic following the Kahramanmaraş earthquakes. Individuals with earthquake-related complaints who had also experienced the 2020 Aegean Sea earthquake were enrolled. Post-traumatic stress symptoms were assessed using the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5) at baseline and at 1, 3, 6, 9, and 12 months. Resilience was measured using the Resilience Scale for Adults (RSA) at baseline. Sociodemographic and clinical variables, including prior psychiatric treatment and media exposure type, were recorded. Multivariate analysis of variance was used to examine longitudinal symptom trajectories and predictors. Results: The study included 87 participants (mean age = 48.8 ± 12.5yrs), the majority were female (85%). Following the Aegean Sea earthquake, 45% of participants received psychiatric treatment, with loss experience being the only significant predictor of treatment seeking (χ² = 14.90, p <.001). After the Kahramanmaraş earthquakes, 74.7% received psychiatric treatment. A significant effect of time on PCL-5 symptom severity across the 12-month follow-up (Pillais Trace = .40, F = 7.32, p <.001). Age and resilience were independently associated with PTSD severity, with resilience showing the strongest effect (F = 40.24, p <.001). Higher PCL-5 scores among those primarily exposed to traditional media (F = 5.11, p = .027), symptom trajectories did not differ over time. Conclusion: This study shows that indirect exposure to large-scale disasters can shape symptom trajectories in previously affected individuals. Resilience served as a protective factor, while prior treatment indicated both vulnerability and adaptive potential. Media exposure type also influenced symptom severity. These results highlight the value of assessing resilience, treatment history, and media use in trauma-informed care after repeated disaster exposure.