Problem Management Plus for improving mental health among earthquake-affected individuals in Türkiye: pilot...

Earthquakes present significant threats to community mental health, yet post-disaster resource limitations and high demand restrict access to care. The 2023 Türkiye-Syria earthquakes affected millions, increasing psychological problems and highlighting the urgent need for scalable interventions.

This study assessed (a) the feasibility of procedures prior to a fully powered randomised controlled trial (RCT) and (b) the potential effectiveness of Problem Management Plus (PM+), a scalable psychological intervention, in reducing common mental health problems among Turkish earthquake survivors.

A two-arm, single-blind pilot RCT was conducted with survivors residing in temporary housing in Türkiye. Participants were randomly allocated (1:1) to PM+ (n = 38) or enhanced care-as-usual (E-CAU; n = 38) and assessed at baseline, 1 week post intervention and at the 1-month follow-up. The primary outcome was depression (Patient Health Questionnaire, PHQ-9); secondary outcomes were self-identified problems (Psychological Outcome Profiles, PSYCHLOPS), functional impairment (World Health Organization Disability Assessment Schedule, WHODAS 2.0), psychological distress (Kessler-10 Psychological Distress Scale, K-10), anxiety (Generalised Anxiety Disorder Scale, GAD-7) and post-traumatic stress (Post-traumatic Stress Disorder Checklist, PCL-5). The trial was prospectively registered (NCT06026306).

Recruitment, retention (74%) and treatment adherence (79%) supported feasibility. At post-assessment, PM+ showed greater reductions than E-CAU across all outcomes: PHQ-9 (adjusted mean difference -5.91, 95% CI -8.23 to -3.58), PSYCHLOPS (-6.94, -8.88 to -5.01), WHODAS 2.0 (-8.77, -12.50 to -5.03), K-10 (-9.66, -13.35 to -5.97), GAD-7 (-4.31, -6.39 to -2.24) and PCL-5 (-18.72, -25.97 to -11.47). At follow-up, improvements remained significant for psychological distress and self-identified problems.

Findings provide preliminary evidence that PM+ is a feasible and potentially effective intervention for alleviating common mental health problems among Turkish earthquake survivors.