Earthquake preparedness and earthquake-related anxiety among emergency department patients: a cross-sectional study

To describe earthquake-preparedness behaviors and earthquake-related anxiety responses in emergency department patients and examine associated factors and the relationship between the two composites.

This cross-sectional study included 3,964 adults presenting to an emergency department in an earthquake-prone region between July and December 2025. A structured questionnaire assessed sociodemographic and housing characteristics, 15 binary preparedness behaviors, and five earthquake-related anxiety items. Preparedness was summarized as a behavioral composite (0-15) and anxiety as an exploratory composite (5-25). Nonparametric tests, effect sizes, false discovery rate adjustment, exploratory internal-structure analyses, and multivariable regression were used.

Median preparedness was 9 (IQR, 7-12) and median anxiety was 13 (IQR, 7-18). Knowledge-based behaviors were common, whereas practical measures were less frequent. Most group differences had small effect sizes. Preparedness showed a multidimensional structure, whereas anxiety showed a single-dimension exploratory structure. The inverse correlation was very weak (Spearman's ρ=-0.107; 95 % CI, -0.140 to -0.070). After adjustment, higher anxiety was associated with lower preparedness (B=-0.074; 95 % CI, -0.090 to -0.059), and higher preparedness with lower anxiety (B=-0.241; 95 % CI, -0.289 to -0.193).

Practical preparedness remained incomplete. Preparedness and anxiety were weakly associated; findings are exploratory and should not be interpreted causally or diagnostically.