Psychological consequences of prolonged shelter residence after the Kahramanmaraş earthquakes: a mixed-methods study

Prolonged displacement following natural disasters poses significant risks to mental health, yet limited research has examined the chronic psychological consequences of long-term residence in temporary shelters. Two years after the 2023 Kahramanmaraş earthquakes, hundreds of thousands of survivors in Türkiye continue to live in container settlements, providing a critical context for examining sustained perceived stress and family dynamics.

This convergent mixed-methods study investigated the relationships between perceived stress, family functioning, and internalizing symptoms among adult earthquake survivors residing in temporary shelters. Quantitative data were collected from 413 participants using the Perceived Stress Scale, Family Assessment Device, and Brief Symptom Inventory. A regression-based mediation analysis with bootstrapping (PROCESS Model 4) was conducted to test whether family functioning mediated the association between perceived stress and psychological distress. In parallel, semi-structured qualitative interviews were conducted with a purposive subsample of 41 participants and analyzed using thematic analysis.

Higher perceived perceived stress was significantly associated with greater internalizing symptoms, including depression, anxiety, and somatization. Family functioning partially mediated this relationship, indicating that prolonged perceived stress adversely affected mental health both directly and indirectly through disruptions in family processes. Qualitative findings corroborated the quantitative results, revealing themes of spatial claustrophobia, erosion of family boundaries, and prolonged uncertainty ("waiting disease") associated with long-term shelter residence.

Prolonged residence in temporary shelters is associated with substantial psychological distress among earthquake survivors, with family functioning representing a key pathway through which perceived stress impacts mental health. These findings underscore the importance of family-centered psychosocial interventions and improved living conditions in long-term disaster recovery efforts.