Loss plus adversity: posttraumatic stress and prolonged grief three years after the 2023 Türkiye earthquakes.

Most mental health research following the 6 February 2023 Kahramanmaraş earthquakes has focused on community samples assessed within the first two years, leaving longer-term trauma- and loss-related psychopathology less well characterized. In this cross-sectional study, 149 adults who directly experienced the earthquakes were assessed at a psychiatry outpatient clinic in the affected region approximately three years after the disaster. Posttraumatic stress, prolonged grief, meaning attributed to loss, and rumination were assessed by self-report, while depression was clinician-rated using the Hamilton Depression Rating Scale. Grief-specific analyses were restricted to 64 participants who had lost a family member or close friend. Overall, 34.9% had elevated depressive symptoms, 23.5% met the screening threshold for posttraumatic stress, and 15.6% of those with a close loss met the algorithmic criteria for probable prolonged grief disorder. Among bereaved participants, those reporting additional earthquake-related adversity had substantially higher posttraumatic stress than those without additional adversity (43.0 vs. 16.7; Hedges g = 1.43, 95% CI [0.93, 1.94]) and greater grief severity (30.5 vs. 18.4; g = 0.97, 95% CI [0.45, 1.48]). Additional adversity remained associated with grief severity after adjustment for posttraumatic stress and depression. By contrast, posttraumatic stress was only modestly higher among participants with bereavement alone than among those with neither bereavement nor additional adversity, and the difference was not statistically significant (g = 0.30, 95% CI [-0.10, 0.69]); however, the confidence interval did not exclude a moderate effect. In secondary analyses, the association between brooding and posttraumatic stress was weaker among bereaved participants, and meaninglessness showed an incremental association with grief beyond posttraumatic stress and depression. Both findings varied across sensitivity analyses and should be regarded as preliminary. Three years after the earthquakes, symptom burden was substantial and was highest when bereavement co-occurred with additional disaster-related adversity.