The Relationship Between Earthquake Induced Trauma, Risk Perception and Substance Use in Southeast Turkey

The Relationship Between Earthquake Induced Trauma, Risk Perception and Substance Use in Southeast Turkey | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 17 January 2025 V1 Latest version Share on The Relationship Between Earthquake Induced Trauma, Risk Perception and Substance Use in Southeast Turkey Authors : Hüseyin ÇAPUK 0000-0003-0542-3152 [email protected] , Fatoş UNCU , and Rukuye AYLAZ Authors Info & Affiliations https://doi.org/10.22541/au.173709915.53963573/v1 267 views 126 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Aim: This study aimed to investigate the correlation between trauma and risk perception resulting from the earthquake in Southeast Turkey and the use of alcohol, tobacco, and illicit drugs. Method: This cross-sectional study was conducted between October and December 2023, utilizing a sample size of 623, determined through the G.Power program with a minimum required sample size for a type-I error rate of α=0.05, a test power of 1-β=0.9, and an effect size of 0.25. Data were collected using surveys. Results: A noteworthy disparity was observed in the affective earthquake risk perception sub-dimension, which was significantly influenced by the motives behind individuals’ experimentation with addictive substances (p<0.05). In comparing the mean total scores of the Trauma Level Determination Scale sub-dimensions, higher total scores were found in relation to sadness and distress, which were identified as reasons for substance use (p<0.05). A statistically significant positive and moderate relationship was established between the Scale for Determining the Level of Post-Earthquake Trauma and the Earthquake Risk Perception Scale, determined through correlation. Conclusion: The study revealed that earthquake risk perceptions and high degrees of trauma significantly influenced individuals’ engagement in addictive substance use following the earthquake event, highlighting the need for targeted interventions and support systems. The Relationship Between Earthquake Induced Trauma, Risk Perception and Substance Use in Southeast Turkey Aim: This study aimed to investigate the correlation between trauma and risk perception resulting from the earthquake in Southeast Turkey and the use of alcohol, tobacco, and illicit drugs. Method: This cross-sectional study was conducted between October and December 2023, utilizing a sample size of 623, determined through the G.Power program with a minimum required sample size for a type-I error rate of α=0.05, a test power of 1-β=0.9, and an effect size of 0.25. Data were collected using surveys. Results: A noteworthy disparity was observed in the affective earthquake risk perception sub-dimension, which was significantly influenced by the motives behind individuals’ experimentation with addictive substances (p<0.05). In comparing the mean total scores of the Trauma Level Determination Scale sub-dimensions, higher total scores were found in relation to sadness and distress, which were identified as reasons for substance use (p<0.05). A statistically significant positive and moderate relationship was established between the Scale for Determining the Level of Post-Earthquake Trauma and the Earthquake Risk Perception Scale, determined through correlation. Conclusion: The study revealed that earthquake risk perceptions and high degrees of trauma significantly influenced individuals’ engagement in addictive substance use following the earthquake event, highlighting the need for targeted interventions and support systems. Keywords: Addictive Substances, Earthquake, Trauma, Risk Perception INTRODUCTION In Turkey, two destructive earthquakes with a magnitude of 7.7 at 04.17 in Pazarcık district of Kahramanmaraş and 7.6 in Elbistan district occurred. On 20 February 2023, a 6.4 magnitude earthquake occurred in Yayladagi, Hatay, Turkey time. The earthquake impacted a total of 11 provinces, resulting in a loss of over 48 thousand lives (Cumhurbaşkanlığı & Strateji ve Bütçe Başkanlığı, 2023). Natural disasters are ecological events in which human beings are helpless, daily life is disrupted and often their own means are not possible to recover (Vildan et al., 2023). The occurrence of natural disasters, including floods, storms, and earthquakes, which are unavoidable phenomena in various regions, has resulted in the degradation of the societal framework. (Heydarpour, Najafi, Janatmakan, & Komasi, 2020). Due to their abrupt, unmanageable, and uncertain nature, earthquakes have the capacity to have an external impact that may potentially yield adverse consequences for individuals (De & Thamarapani, 2022). Similar to other traumatic events, being exposed to natural disasters is recognised to have adverse effects on mental well-being, with post-traumatic stress disorder being the most prevalent outcome (Silwal et al., 2022). Post-Traumatic Stress Disorder (PTSD) can develop following exposure to an extremely threatening or frightening event or series of events (World Health Organization, 2018). Traumatic experiences have negative psychological, social, economic and physiological effects on individuals. After trauma, those affected can often experience fear, anxiety, sleep problems and mood disorders (Çelik, 2023). In studies, exposure to psychological trauma can cause depression, anxiety and stress (Sabuncuoğlu, Çevikaslan, & Berkem, 2003; Uğur, Kartal, Mete, Tamam, & Demirkol, 2021), causes chronic traumatic stress problems (Bedirli, 2014) and can be a trigger for alcohol and substance use (Sönmez, 2022). Studies have indicated that people may resort to using substances as a means of dealing with trauma, stress, and emotional distress following natural disasters (Zengin İspir, Danışman, & Sezer Katar, 2023). Following the flood catastrophe in Louisiana in 2016, it was discovered that a significant proportion of male patients admitted to the hospital had substance use disorder, whereas women were admitted with complaints related to depression (Phillippi et al., 2019). Following Hurricane Sandy in the United States of America, there was a noticeable rise in the prevalence of opioid consumption among individuals (McCann-Pineo, Taioli, & Schwartz, 2021). In the aftermath of the 2010 earthquake in Haiti, an increase in psychological distress, suicidal thoughts and alcohol use was observed (Cénat, McIntee, & Blais-Rochette, 2020). A similar pattern was observed in the university student population regarding the consumption of tobacco, alcohol, and substances subsequent to the L’Aquila earthquake. The use of addictive substances is a widespread global public health issue that is present in both developed and developing societies, even under normal conditions. They normally have access to psychotherapy methods and treatment centres for people with addiction. Nevertheless, they are unable to adequately provide this service because of the earthquake-related destruction of the treatment centres and the overcrowding of other medical facilities. In this case, relapse may occur in people who have received treatment or there may be an increase in the use of addictive substances in other groups (Heydarpour et al., 2020). A review of the literature reveals a lack of studies examining the effects of destructive post-earthquake impacts on substance use. Understanding the substance use behaviors of individuals exposed to natural disasters is of critical importance. The information obtained can contribute to disaster emergency preparedness plans. Furthermore, it is believed that these findings can serve as a guide for policymakers and field experts in assisting these vulnerable groups. In this context, the purpose of this study is to identify the connections between the trauma and risk perception resulting from the earthquake in southeastern Turkey and the use of addictive substances. 2. METHODS 2.1. Type of the Study The study was carried out in cross-sectional type. 2.2. Population/Sample of the Study The cross-sectional study was conducted with individuals who experienced the earthquake that affected 11 provinces in the Southeastern Anatolia region of Turkey. It was conducted between October-December 2023 in accordance with the principles of the Declaration of Helsinki. The population of the study consists of a total of 9.207.259 people over the age of eighteen in 11 provinces affected by the earthquake (Cumhurbaşkanlığı & Strateji ve Bütçe Başkanlığı, 2023). The study’s sample size was determined to be 623 using the G.Power programme, based on a minimum required sample size for a type-I error rate of α=0.05, a test power of 1-β=0.9, and an effect size of 0.25. Convenience sampling was employed to reach a total of 623 individuals in the study. The participants for this study were all adults aged 18 years and older. They were administered an online questionnaire through the use of Google Forms. In the study, ”Introductory Information Form”, ”Scale for Determining the Level of Post-Earthquake Trauma” and ”Earthquake Risk Perception Scale” were used as data collection tools. Descriptive Information Form; the personal information form prepared by the researchers by reviewing the literature; gender, age, marital status, education, city of residence, occupation, smoking, alcohol, addictive substance tried for the first time, reason for trying addictive substance, continuing substance use, increase in smoking, alcohol, substance use after the earthquake were examined (Çapuk & Aylaz, 2022; Topal, 2022). Scale for Determining the Level of Post-Earthquake Trauma The scale developed by Tanhan and Kayri (2013) aims to determine the level of trauma experienced by individuals after the earthquake. The scale consists of 20 items and 5 sub-dimensions. The scale features a minimum possible score of 20 and a maximum possible score of 100. An increase in the scale scores signifies a corresponding escalation in the degree of impact caused by the earthquake. The internal consistency coefficient calculated to determine the reliability of the scale was found to be .87 (Tanhan & Kayri, 2013) and .92 in this study. Earthquake Risk Perception Scale Trumbo et al. (2016) initially devised the scale to assess(Trumbo et al., 2016) hurricane risk perception and proposed its applicability to various disaster scenarios. Mızrak et al. translated the scale into Turkish and modified it to suit the context of earthquakes. The internal consistency coefficient of the validity and reliability of the scale was found to be .93. In this study, the internal consistency coefficient calculated to determine its reliability was found to be .92. Ethical Aspects of the Study Before the start of the study, the Ethics Committee of a university Non-Interventional Clinical Research Ethics Committee was applied and permission was obtained from the ethics committee dated 17.10.2023 and numbered 80854. The individuals participating in the study were verbally informed about the study and verbal consent was obtained from the participants. It was agreed that the participants would have complete autonomy in deciding whether or not to participate in the study, that the data gathered from this study would be utilised exclusively for the purposes of the study, and that stringent confidentiality would be maintained. Data Analysis Data were analyzed using the SPSS 22.0 statistical software package. Prior to analysis, normality tests were conducted to assess whether the data met parametric assumptions. Skewness and kurtosis values were examined to evaluate univariate normality. As shown in Table 1, the skewness and kurtosis values fall within the range of ±2.0, indicating that the data exhibit a univariate normal distribution.(George & Mallery, 2010). Number, mean, percentage distributions and parametric tests (Student t test, ANOVA) were used with data showing normal distribution. Correlation analysis was used to evaluate the relationship between the scales. P<0.05 was accepted as significance level. The mean total scores obtained by the participants on the Earthquake Risk Perception Scale are 33.13±7.53, as shown in Table 1. Additionally, the mean total scores for the sub-dimensions of the scale are as follows: 15.62±4.65 for the affective dimension and 17.52±3.58 for the cognitive dimension. The mean total scores of the participants from the Scale for Determining the Level of Post-Earthquake Trauma were 59.60±19.18, and the mean total scores from the sub-dimensions of the Scale for Determining the Level of Post-Earthquake Trauma were 10.79±4.80 for Behavioural Problems, 14.98±6.54 for Excitement Limitation, 9.99±2.56 for Affective, 15.17±4.76 for Cognitive Configuration, and 28.67±4.36 for Sleeping Problems. The comparison of the total mean score of the Earthquake Risk Perception scale and its sub-dimensions with the variables related to the participants’ addictive substance use in Table 2 suggests that a statistically significant difference was found in the affective earthquake risk perception sub-dimension due to the participants’ addictive substance trial (p<0.05). In the further analysis (Tukey Test); those who tried addictive substances because of sadness and distress had higher affective earthquake risk perceptions significant difference was found between the substance that the participants tried for the first time and the affective sub-dimension of the PTSD (p<0.05). In the further analysis (Tukey Test); those who tried amphetamine and its derivatives had higher trauma levels in the affective sub-dimension. A statistically significant difference was found between the reasons for substance experimentation of the participants and the total score and behavioral problems, excitement limitation, and sleep problems sub-dimensions of the PTSD (p<0.05). In the further analysis (Tukey Test); those who tried the substance due to sadness and distress had higher trauma levels in the sub-dimensions of behavioral problems, excitability, and sleep problems. A statistically significant difference was found between the increase in substance use of the participants after the earthquake and the excitability and sleep problems sub-dimensions of the PTSD (p<0.05). In the further analysis (Tukey Test); those who had an increase in substance use after the earthquake had higher levels of trauma in the sub-dimensions of excitability and sleep problems. Table 4 shows that there is a statistically significant positive and moderate relationship between the Scale for Determining the Level of Post-Earthquake Trauma and the Earthquake Risk Perception Scale (r=.657**, 0.00). Discussion The effects of natural disasters on communities and individuals are profound, encompassing destructive impacts such as infrastructure damage, loss of life, psychological distress, and physical injuries. During and after these events, factors such as trauma and stress, disruption of social support networks, the availability of substances, and limited access to mental health services all contribute to the development of substance use disorders. This article aims to highlight the relationship between addictive substances and natural disasters. Notably, there is a lack of studies in Turkey examining the effects of substance use disorders following the earthquakes of February 6, 2023, and previous significant seismic events (Zengin İspir et al., 2023). This study was conducted to investigate the relationship between trauma and risk perception induced by the earthquake in southeastern Turkey and the use of addictive substances. The mean score of participants on the Earthquake Risk Perception Scale was 33.13 ± 7.53, while the mean total score on the Scale for Determining the Level of Post-Earthquake Trauma was 59.60 ± 19.18 (Table 1). Risk perception reflects the public’s subjective judgment regarding the likelihood of a hazard and the severity of its potential consequences. Exposure to a disaster heightens risk perception by increasing individuals’ awareness of their vulnerability (Terpstra, 2011). Many studies have found a proportional relationship between disaster experience and risk perception (Ho, Shaw, Lin, & Chiu, 2008; Kung & Chen, 2012; Wachinger, Renn, Begg, & Kuhlicke, 2013). In our study, individuals’ Earthquake experience increases their risk perception (Table 1). Studies show that post-traumatic stress disorder (PTSD), a trauma-related mental disorder, is the most common psychiatric disorder among earthquake survivors. In an epidemiological study of residents exposed to the devastating Spitak earthquake in Armenia, the rate of PTSD was 49.6% two years after exposure (Armenian et al., 2000). Two subsequent extensive investigations, carried out 14 and 20 months following the catastrophic 1999 Marmara earthquake in Turkey, revealed that the prevalence of post-traumatic stress disorder (PTSD) among individuals residing in the epicentre was 23% and 39% respectively (Salcioglu, Basoglu, & Livanou, 2003). The mean trauma level obtained in our study is in parallel with the studies (Table 1). In our study, the comparison of the overall mean scores of the Earthquake Risk Perception scale and its sub-dimensions with variables related to participants’ addictive substance use revealed a statistically significant difference in the affective earthquake risk perception sub-dimension based on participants’ experiences with addictive substances (p < 0.05). Further analyses using the Tukey Test indicated that individuals who experimented with addictive substances due to feelings of sadness and distress exhibited higher affective earthquake risk perceptions (see Table 2). Additionally, when examining the mean total scores of the sub-dimensions of the Trauma Level Determination Scale in relation to participants’ addictive substance use, it was found that the total scores and sub-dimensions of trauma level including behavioral problems, excitement limitation, affective issues, and sleep disturbances were significantly elevated due to experiences of sadness and distress associated with substance use (Table 3). Following a natural disaster, individuals often experience feelings of grief, anxiety, and anguish stemming from the loss of loved ones, the destruction of possessions, and the disruption of their daily lives. Such emotional responses can contribute to the onset of substance abuse. Previous studies have indicated a strong correlation between exposure to disasters and an increased likelihood of developing anxiety, depression, Post-Traumatic Stress Disorder (PTSD), and substance abuse, with these conditions potentially persisting for an extended period following such traumatic events (Lowe, Sampson, Gruebner, & Galea, 2015; Pouget, Sandoval, Nikolopoulos, & Friedman, 2015; Schwartz, Gillezeau, Liu, Lieberman-Cribbin, & Taioli, 2017). A statistically significant positive and moderate relationship was identified between the Scale for Determining the Level of Post-Earthquake Trauma and the Earthquake Risk Perception Scale (r = .657**, p < 0.01). Earthquakes, as highly destructive natural disasters, not only lead to considerable casualties and extensive property damage but also impose lasting psychological and physiological effects on survivors. As a result, post-disaster mental health and especially PTSD have become the focus of significant recent study. Some studies have found that risk or threat perception may be an indicator of poor mental health after a disaster (Başoğlu, Salcioğlu, & Livanou, 2002; Feder et al., 2013; Salcioglu, Basoglu, & Livanou, 2007; Xu, Dai, Rao, & Xie, 2016). Earthquake exposure affects survivors’ perception of risk, leading to emotional and psychological responses such as fear, helplessness, sadness, grief, anxiety, depression and loss of confidence. A substantial inverse correlation has been identified in studies between earthquake exposure and PTSD. Xu and Song discovered in their study of PTSD among survivors of the Wenchuan earthquake that above-average exposure predicted a greater prevalence of PTSD (Başoğlu et al., 2002; Feder et al., 2013; Salcioglu et al., 2007; Xu et al., 2016; Xu & Song, 2011) . Carson et al. also show that exposure to injuries or death can lead to a higher degree of PTSD (Carson et al., 2000). The findings of our study provide new evidence that disaster risk perception is related to posttraumatic stress disorder, as proven in previous studies (Table 4). Conclusion and Recommendations The findings of this study indicate that individuals who have personally experienced an earthquake tend to exhibit an elevated perception of danger. In comparing the mean total scores of the sub-dimensions of the Trauma Level Determination Scale, it was found that both the total scores and sub-dimensions (behavioral problems, emotional regulation, affective issues, and sleep disturbances) were significantly higher due to feelings of sadness and distress, which were identified as contributing factors to substance use. A statistically significant positive and moderate relationship was observed between the Scale for Determining the Level of Post-Earthquake Trauma and the Earthquake Risk Perception Scale. The study revealed that heightened earthquake risk perceptions and significant trauma levels experienced by individuals are critical factors influencing their engagement in addictive substance use following an earthquake event. To mitigate substance use among those affected by the earthquake, it is recommended to provide psychosocial support, limit access to addictive substances, and offer training to healthcare workers and emergency response teams. Additionally, increasing social activities, sports opportunities, hobby development, and job prospects for earthquake survivors is advised. Data availability statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Acknowledgments: We thank the individuals who participated in the study. Funding: This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. 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