The August 1999 Earthquake in Turkey and Posttraumatic Stress

Background

While the 1999 earthquake in Turkey was severe, recovery efforts can be successful because they are informed by clinical and research information collected from previous earthquakes. These previous efforts have helped us to understand that survivors of earthquakes face both the danger of death or physical injury and the loss of their loved ones, homes, possessions, and communities.

The effects of these traumas are immeasurable and long lasting. Survivors are at high risk for behavioral and emotional readjustment problems. Already, psychiatrists in Turkey are reporting high rates of "nervous reactions" and "reactive depression" in the wake of the earthquake.

What specific factors of this quake may contribute to PTSD?

Previous research indicates that a number of factors in this earthquake (as indicated in news reports) increase the likelihood of traumatic stress reactions. These factors include:

• The severity of the earthquake has created extremely high death and injury rates. (Research indicates that disasters involving a high number of deaths are related to higher distress among survivors.)
• Many survivors have been left homeless.
• Homelessness, rains, and a lack of clean water have created high risks for dehydration and infectious diseases.
• Many people are very angry because they feel buildings were constructed poorly. People are also angry because they feel the government did not take proper preparatory actions and has not undertaken proper relief measures.
• The earthquake occurred at 3:00 a.m. local time, waking the majority of people from sleep, and was accompanied by significant aftershocks.
• Survivors felt intense helplessness because they could hear people who were trapped call for help but they were unable to rescue these people from the rubble.

Because of the severity of this disaster, it is estimated that the long-term consequences of this earthquake will affect a large percentage of survivors.

Earthquakes and PTSD

Posttraumatic Stress Disorder occurs in 32% to 60% of the adult survivors and 26% to 95% of the child survivors who have been evaluated after earthquakes. Rather than being a circumscribed event with a defined endpoint, earthquakes tend to produce a series of events that continue to affect people's lives over a prolonged period. Persistent or recurring disruptions from the earthquake substantially contribute to continued mental-health problems.

General psychological distress levels following an earthquake appear to stabilize after about 12 months, but posttraumatic stress reactions do not stabilize until 18 months after the earthquake. In some individuals, there is a high likelihood of permanent psychological symptomatology following earthquake exposure. This is particularly true of those who have the highest level of exposure and the greatest concentration of personal loss and damage associated with the earthquake.

Coping with stress by using avoidance measures (e.g., withdrawal from the situation, isolation, trying to avoid further stressors) appears to contribute to continued distress and posttraumatic stress. Older people and those with a prior history of mental-health problems seem to be at greater risk than others for experiencing posttraumatic stress following an earthquake (1). Also at risk are (1) rescue workers with high levels of catastrophic exposure and (2) individuals who, in reaction to the earthquake, tend to "dissociate," or become "numb," and have a sense of being detached from their emotions and bodily experiences for a prolonged period of time (2).

Previous research in Turkey

A study specific to the Turkish population was conducted in 1993 following the Erzincan earthquake of March 13, 1992, which measured 6.8 on the Richter scale and resulted in 541 people killed, 850 severely injured, and 5,500 buildings collapsed or severely damaged. The study reported high rates of "phobic anxiety" amongst all those interviewed (n = 461). The earthquake emotionally affected nearly all of the survivors. Fear and panic were the most common effects.

About a quarter of the sample studied experienced worry about family members, feelings that life was meaningless, and sadness about the dead and injured. The majority of the survivors stated that these emotional problems still distressed them after sixteen months. The authors of the study noted that females were particularly likely to be distressed. Because women appeared to lead very closed, housebound lives, the researchers suggested that relief workers deliver services via female communities and home visits (3).

The consequences of traumatic stress

Immediate consequences of trauma, affecting the majority of people who experience severe stress, include:

• Emotional symptoms: shock, intense fear, tearfulness, anger, shame, helplessness, nervousness, numbness
• Mental symptoms: confusion, disorientation, unwanted memories, decreased concentration
• Physical symptoms: bodily injury, muscular tension, fatigue, edginess, change in sleep and appetite, gastrointestinal problems, racing heart, bodily aches and pains

Long-term consequences of severe stress can be complex and severe, including marked interpersonal changes such as apathy, anger, and isolation. Long-term consequences can also include psychiatric disorders such as:

• Posttraumatic Stress Disorder (PTSD): Reexperiencing the trauma in memories and dreams, avoiding anything reminiscent of the event, memory loss, emotional numbing, sleep disturbance, anxiety
• Depression: loss of hope, self-worth, motivation, or purpose in life; fatigue; decreased pleasure in previously enjoyed activities; changes in sleep and appetite; suicidal thoughts or actions
• Alcohol and Substance Abuse

Treatment

While the consequences of traumatic stress are severe and complex, treatments are available that significantly reduce symptoms and improve quality of life. See the National Center for PTSD fact sheet on treatment for further information.

Sources

Carr, V.J., Lewin, T.J., Webster, R.A., and Kenardy, J.A. (1997). A synthesis of the findings from the Quake Impact Study: A two-year investigation of the psychosocial sequelae of the 1989 Newcastle earthquake. Social Psychiatry, 32, 123-136.

Marmar, C., Weiss, D., Metzler, T., Delucchi, K., Best, S., and Wentworth, K. (1999). Longitudinal course and predictors of continuing distress following critical incident exposure in emergency services personnel. Journal of Nervous and Mental Disease, 187, 15-22.

Karanci, N.A. & Rustemli, A. (1995). Psychological consequences of the 1992 Erzincan (Turkey) Earthquake. Disasters, 19(1), 8-18.