Supplementary file 4_Effectiveness of psychological interventions for adult survivors of the 2023 Kahramanmaraş earthquakes: a systematic review and meta-analysis.docx

BackgroundThe February 6, 2023 Kahramanmaraş earthquakes were among the most devastating disasters in Türkiye’s history, leaving millions affected and exposing survivors to elevated risks of post-traumatic stress disorder (PTSD), depression, and anxiety. While numerous psychological interventions have been deployed in the aftermath, their effectiveness for this population has not been systematically evaluated.
ObjectiveThis study synthesized evidence on the effectiveness of psychological interventions delivered to adult survivors of the Kahramanmaraş earthquakes, with a focus on PTSD, depression, and anxiety outcomes.
MethodsA systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251102991). Eligible studies were randomized or quasi-experimental trials assessing structured psychological interventions (e.g., trauma-focused cognitive behavioral therapy [TF-CBT], psychoeducation, spiritually integrated approaches, telepsychiatry, and virtual reality–based programs) among earthquake-exposed adults. Primary outcomes were PTSD, depression, and anxiety, measured with validated instruments. Random-effects models were used to pool effect sizes.
ResultsNine peer-reviewed studies (N = 435 participants) were identified. Interventions included TF-CBT, Islamic TF-CBT, spiritually oriented logotherapy, VR-based trauma therapy, CBT-based psychoeducation, and telepsychiatry. Meta-analyses indicated large pooled effects favoring interventions: PTSD (Hedges’ g = −2.6, 95% CI [−4.0, −1.3]), depression (g = −1.27, 95% CI [−1.73, −0.81]), and anxiety (g = −1.18, 95% CI [−1.55, −0.82]). Benefits were consistent across individual, group, and online formats. Culturally adapted approaches appeared to produce meaningful improvements, although the evidence is limited. Follow-up assessments across studies ranged widely (1–12 months). Short-term follow-up data (1–3 months) generally indicated maintained symptom reductions, whereas evidence from longer-term follow-up (6–12 months) was limited to a small number of studies and should therefore be interpreted cautiously.
ConclusionStructured psychological interventions–especially trauma-focused CBT, culturally adapted therapies, and psychoeducation–significantly alleviated PTSD, depression, and anxiety among adult survivors of the Kahramanmaraş earthquakes. Group-based and telehealth modalities proved feasible and effective, expanding access when in-person services were disrupted. Despite promising results, evidence remains limited by small sample sizes, heterogeneity, and short follow-up. Future research should address long-term outcomes, functional recovery, and broader populations, including children and first responders.
Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251102991, identifier CRD42025837569