Traumatic stress and eating-related behaviours after the 6 February 2023 Kahramanmaraş earthquakes: a cross-sectional...

Large earthquakes may be associated with traumatic stress and eating-related outcomes, but evidence from Turkey remains limited. This study examined the associations between direct earthquake exposure, post-earthquake traumatic stress, and eating-related outcomes approximately two years after the 6 February 2023 Kahramanmaraş-centred earthquakes.

This cross-sectional comparative online survey was conducted in Turkey between March and June 2025. Adults were classified as directly exposed (n = 602) or comparison (n = 615) based on residence in the 11 affected provinces and self-reported earthquake experience. Participants completed the Post-Earthquake Trauma Level Determination Scale (PETLDS), Salzburg Emotional Eating Scale (SEES), Mindful Eating Questionnaire (MEQ), and SCOFF eating disorder screening tool, together with sociodemographic and self-reported anthropometric measures. Adjusted group differences were estimated using multivariable regression models controlling for age, BMI, gender, marital status, education, employment, income status, and earthquake-related loss. Additional adjusted models examined whether PETLDS total score was independently associated with eating-related outcomes.

Direct exposure was strongly associated with higher traumatic stress (PETLDS total: B = 12.30, 95%CI 10.66 to 13.94; p < 0.001) and with higher scores on most PETLDS subscales, whereas the PETLDS emotional subscale was higher in the comparison group (B=-1.09, 95%CI -1.37 to -0.81; p < 0.001). Direct exposure was not independently associated with SEES total score (p = 0.153), MEQ total score (p = 0.584), or a positive SCOFF screen (OR = 1.286, 95%CI 0.969 to 1.706; p = 0.081), although small exploratory subscale differences were observed. In additional adjusted models, higher PETLDS total score was associated with lower MEQ total score and greater odds of a positive SCOFF screen (both p < 0.001), but not with SEES total score.

Direct exposure was strongly associated with traumatic stress, whereas eating-related associations were limited. Traumatic stress severity was more clearly associated with lower mindful eating and higher eating disorder risk screening positivity, supporting trauma-informed post-disaster care and nutritional screening in highly stressed individuals.