The Effect of Depression and Hopelessness Level on Death Anxiety in Earthquake Survivor Students One Year After the Earthquake

Abstract

It is important to reveal the long-term psychological effects of the earthquake in earthquake-exposed individuals. The aim of this study was to determine the levels of depression, hopelessness and death anxiety in students who experienced the earthquake one year after the earthquake and to examine the effects of depression and hopelessness on death anxiety. This is a descriptive and correlational study. Data were collected from 155 Emergency Relief and Disaster Management students who experienced the Kahramanmaras earthquake in Türkiye in 2023. Data were collected using Personal Information Form, Beck Depression Scale, Beck Hopelessness Scale, Thorson-Powell Death Anxiety Scale. In the study, a moderate positive correlation was found, indicating that as levels of depression and hopelessness increased, so did death anxiety (p < .05). Depression and hopelessness explained 18.1% of the variance in death anxiety. Death anxiety was found to be higher in males and in students whose relatives or close friends died.

Keywords

death anxiety depression disaster hopelessness earthquake earthquake victims

Highlights

• One year after the earthquake, students who experienced the earthquake have severe levels of hopelessness, moderate levels of depression and mild levels of death anxiety.

• There is a moderate positive relationship between death anxiety and depression and hopelessness in students who experienced the earthquake.

• Depression and hopelessness together explain 18.1% of death anxiety.

Introduction

Death anxiety is an emotion that people have from birth, continues throughout their lives, and develops as a result of their awareness that they may lose themselves and the world (Canli & Yilmaz, 2024). There is no consensus on what triggers or exacerbates this feeling (Cuvadar & Aksoy, 2024). It is reported that death anxiety is more related to the event or situation experienced (Aksoy et al., 2023). If the traumatic experience is a situation that threatens the life of the person and causes the person to face death, death anxiety can also be triggered. Death anxiety can be even more severe in survivors of any trauma (Yildirim & Guler, 2021). However, death anxiety can be affected by various factors such as developmental and socio-cultural factors, stressful environments and unpredictable conditions (Aksoy et al., 2023; Cuvadar & Aksoy, 2024; McKenzie & Brown, 2017). Earthquake is one of the most important factors that trigger death anxiety. Earthquakes are one of the deadliest disasters that devastate society due to their unpredictable and out-of-control nature, causing great material and moral losses, including death, property damage, and psychological disorders (Cagis et al., 2023). Türkiye is located in an active earthquake zone due to its location (Bahadir & Ucku, 2018). The last devastating earthquake that occurred in Türkiye, which is called the “disaster of the century”, was centered in Kahramanmaras-Pazarcik and Elbistan (Utkucu et al., 2023). The two earthquakes in Türkiye, measuring 7.7 Mw on the Richter scale at 04:17 local time and 7.6 Mw at 13:24 local time, were reported to have affected more than 13 million people in eleven provinces of Türkiye, or 16.4% of Türkiye’s population (DSBO, 2023). Eleven provinces were affected by the earthquake, including the city where this study was conducted. As of June 2023, 50,783 people lost their lives, 115,353 people were injured, 37,984 buildings were destroyed, approximately 215,000 buildings were reported to need urgent demolition, and 1.5 million people were reported to be homeless (DEMP, 2023). This earthquake was recorded as the most severe and deadliest earthquake in Türkiye in more than 80 years (Guler et al., 2024) and the fifth deadliest earthquake of the 21st century in the world (Dal Zilio & Ampuero, 2023). Turkish people, who were exposed to such great losses and suffering, had to cope with the effects of the earthquake and experienced significant difficulties (Birni et al., 2023). In the post-earthquake period, individuals’ perspectives on life and death changed, they felt fear, terror and helplessness (Kocaoglu et al., 2023). It is reported that such a disaster changes individuals’ cognitions and perceptions of death (Cuvadar & Aksoy, 2024) and causes many mental health problems (Birni et al., 2024; Celik, 2023; WHO, 2022). Earthquakes create a heavy burden on individuals and bring psychological problems that spread over a long period of time. It is important to reveal the long-term psychological effects of earthquakes in individuals exposed to earthquakes.

Depression is one of the common mental health problems following earthquakes (Ilhan et al., 2023; Keya et al., 2023). Depression is characterized by disorders in emotional, cognitive and behavioral processes (American Psychiatric Association, 2022). Disaster survivors may experience a wide range of problems including restlessness, fear, hopelessness, helplessness, insomnia, grief, anxiety disorder, shock, depression and posttraumatic stress disorder (Kocoglu et al., 2023; Novia et al., 2020). In the study conducted by Kamaledini and Azkia (2021), individuals mentioned that they experienced extreme sadness, guilt, anger, hopelessness, depression and anticipation of death for the future during and after the earthquake. A recent systematic review and meta-analysis by Keya et al. (2023) reported that anxiety and depression are the most common mental health problems attributed to disasters. However, it is reported that symptoms of depression persist even years later (Cénat et al., 2020) and death anxiety may be associated with depression. It was found that death anxiety increased as the level of depression increased (Gurbuz & Yorulmaz, 2024; Koc & Basgol, 2022).

Another situation that affects individuals psychologically negatively after the earthquake is the feeling of hopelessness (Amiri & Jahanitabesh, 2022). Hopelessness can be defined as a negative feeling that occurs when an individual believes that his/her situation will not improve physically, spiritually and socially. The helplessness experienced as a result of the earthquake may cause anxiety levels to increase and individuals to become restless, unhappy and hopeless (Kaya & Bayram, 2024). It can be argued that individuals experience future anxiety due to the economic crisis caused by the earthquake, while the uncertainty in their expectations for the future and the loss of motivation for future plans cause hopelessness. Accordingly, it is thought that these negative expectations, feelings and loss of motivation towards the future may increase death anxiety. However, hopelessness is a prominent feature of depressive symptoms, and hopelessness can create a basis for depression (Turkgil, 2021).

The fact that some people who experience the same traumatic event experience psychological symptoms while others do not has been the focus of research (Ekmekci-Ertek & Ilhan, 2023). The struggle of individuals who cannot recover from the shock, who try to make sense of it, who cannot digest the pain of losing their relatives is more intense. The power of individuals to recover quickly from difficult and negative life events and return to their normal lives is defined as resilience (Aydın & Aytac, 2023). Individuals’ coping with psychological problems after disasters and their ability to look at life positively vary according to cognitive efforts, cultural factors including religious coping elements and social support, and individuals’ psychological resilience (Sonmez, 2022). In the systematic review study conducted by Gurbuz and Yorulmaz (2024), it was reported that perception of death, psychological problems and coping with them vary according to countries and cultures, and cultural differences may affect the level of death anxiety. Oker et al. (2019) reported that death anxiety was associated with depression and anxiety syndromes and Turkish participants had higher levels of death anxiety, depression and anxiety symptoms compared to Norwegian participants. Understanding cultural differences in increasing individuals’ post-earthquake resilience will be important in developing appropriate interventions for high levels of death anxiety, depression and hopelessness.

It is clear that Türkiye is located in the Alpine-Himalayan earthquake zone and therefore will have to cope with earthquakes. Earthquake survivor students may be in the risky group in terms of mental illnesses due to the damages caused by earthquakes. The psychological state of students after earthquakes is important; educators should take this seriously (Telli & Altun, 2023). When the literature is examined, it is reported that mental health deteriorates more with disasters and stress (Akay et al., 2024), death anxiety, depression (Pan et al., 2015), hopelessness (Sonmez & Turk Delibalta, 2023), anxiety (Kocoglu et al., 2023) and post-traumatic stress disorder (Sarman & Tuncay, 2024) may be observed in individuals after earthquakes. Studies have examined the relationship between death anxiety in disasters and variables such as psychological resilience, earthquake anxiety (Canli & Yilmaz, 2024), depression and anxiety (Gurbuz & Yorulmaz, 2024), posttraumatic stress disorder and insomnia (Ciftci et al., 2024). However, the lack of a study on the effect of depression and hopelessness levels on death anxiety in earthquake survivors emphasizes the originality and importance of this study. In the literature, studies examining the post-earthquake death anxiety of earthquake survivors are limited (Akturk & Yenigun, 2024).

It is important to evaluate whether students who have experienced an earthquake and especially those studying in health fields have mental health problems before starting their professional journey and to provide guidance (Tahernejad et al., 2023). For this reason, it is of utmost importance to address the medium and long-term psychological effects of earthquakes, taking into account the possibility of affecting future generations. Therefore, the present study was conducted to determine the levels of depression, hopelessness and death anxiety in students who experienced the earthquake one year after the earthquake and to examine the effects of depression and hopelessness on death anxiety.

Research Questions

(1) What are the levels of depression, hopelessness and death anxiety in earthquake survivor students?

(2) Is there a relationship between depression, hopelessness and death anxiety in earthquake survivor students?

(3) What are the effects of depression and hopelessness levels on death anxiety levels?

Methods

Design and Sample of Study

This study is a descriptive and correlational study. The population of the study consisted of students enrolled in the Department of Emergency Aid and Disaster Management at Hatay Mustafa Kemal University in the 2023-2024 academic year who met the inclusion criteria (N = 192). The sample size was determined using the formula n = N.t².p.q/d²(N-1)+t².p.q (Kilic, 2012). In the formula, N is the number of individuals in the population; n is the number of individuals to be sampled; p is the frequency of occurrence of the event to be studied; q is the frequency of non-occurrence of the event to be studied (1-p); t is the theoretical value found in the t-table at certain degrees of freedom and at the determined level of error; and d is the desired ± deviation according to the frequency of occurrence of the event. With alpha = .05, 95% confidence level, t = 1.96, it was estimated that at least 129 students should be reached. Accordingly, a total of 155 students were included in the study and 80.7% of the population was reached. The dependent variable of the study is the level of death anxiety. The independent variables of the study were gender, grade level, where the family lived, loss of relatives/friends in the earthquake, experiencing financial loss in the earthquake, receiving training on disasters before the earthquake, preparing a disaster kit after the earthquake, depression and hopelessness level.

Inclusion criteria for the study: Having experienced the February 6, 2023 Kahramanmaras-centered earthquake, being a student of the Department of Emergency Aid and Disaster Management. Exclusion criteria for the study: Being visually and hearing impaired, being diagnosed with a psychiatric disorder.

Participant

A total of 155 Turkish university students (56 males and 99 females) with a mean age of 21.49 ± 1.71 years participated in this study. The majority of the participants were in their second year of study, their families resided in the earthquake zone, and they had received education on disasters before the earthquake. Of the participants, 30.3% had lost a relative in the earthquake and 51.6% had experienced financial loss (Table 1).

Table 1.

The Distribution of the Characteristics of the Participants (n = 155).

Variables	Mean ± SD	Min–Max
Age	21.49 ± 1.71	18–32
	n (%)
Gender
Female	99 (63.9)
Male	56 (36.1)
Class
1st grade	22 (14.2)
2nd grade	52 (33.5)
3rd grade	36 (23.2)
4th grade	45 (29.1)
City where the family lives
Earthquake zone^a	127 (81.9)
Outside the earthquake zone	28 (18.1)
Loss of relatives/friends in earthquake
Yes	47 (30.3)
No	108 (69.7)
Experiencing material/monetary loss in an earthquake
Yes	80 (51.6)
No	75 (48.4)
Receiving training on pre-earthquake disasters^b
Yes	134 (86.5)
No	21 (13.5)
Preparing a disaster bag after an earthquake
Yes	60 (38.7)
No	95 (61.3)
Death anxiety
Very low (0–25 points)	12 (7.7)
Mild (26–50 points)	88 (56.8)
Medium (51–75 points)	43 (27.7)
Very high (76–100 points)	12 (7.7)

^aEarthquake zone: Kahramanmaras, Hatay, Gaziantep, Osmaniye, Malatya, Adana, Diyarbakır, Sanlıurfa, Adıyaman, Kilis.

^bAll first grade students reported that they did not receive disaster education (n = 21).

SD, standard deviation; Min, minimum; Max, maximum.

Measurements and Data Collection

Data were collected by the researchers face-to-face in the classroom environment based on self-report. Students were reluctant to participate in the study because they did not want to remember the Kahramanmaraş earthquake. The students were persuaded by giving more information about the purpose of the study, confidentiality, the gains to be obtained from the study and the expectations of the researcher. Before the questionnaires were delivered to the individuals, the usability and technical functionality of the forms were tested. The students were asked to complete the questionnaire after permission was obtained. Data collection took 20–25 minutes.

This Were the Instruments and Their Characteristics

Data were collected using the “Personal Information Form”, “Thorson-Powell Death Anxiety Scale”, “Beck Depression Scale”, “Beck Hopelessness Scale”.

Personal Information Form

It is a 19-question form developed by the researchers based on the literature, including socio-demographic characteristics of the students and characteristics related to the disaster situation (Birni et al., 2024; Canli & Yilmaz, 2024; Guler et al., 2024; Ilhan et al., 2023).

Thorson-Powell Death Anxiety Scale

The Turkish validity and reliability study of the scale developed by Nehrke (1973) and revised by Thorson and Powell (2015) was conducted by Karaca and Yildiz (2001). The internal consistency coefficient was found to be 0.85 in the original scale (Thorson & Powell, 1990) and 0.84 in the Turkish form (Karaca & Yildiz, 2001). In this study, Cronbach’s alpha value was found to be 0.89. The scale is a 5-point Likert-type scale consisting of 25 questions and four sub-dimensions (0 = Strongly Disagree, 4 = Strongly Agree) (Thorson & Powell, 1990). A score of 0–100 can be obtained from the scale. Accordingly; 0–25 points indicate very low death anxiety, 26–50 points indicate mild death anxiety, 51–75 points indicate moderate death anxiety, 76–100 points indicate very high death anxiety. A high score on the scale indicates high death anxiety (Karaca & Yildiz, 2001).

Beck Depression Scale

It is a self-report scale developed by Beck et al. (1974) to measure depression. Its Turkish validity and reliability was conducted by Hisli (1989). The internal consistency coefficient of the Turkish scale was found to be 0.80 (Hisli, 1989). In the present study, the Cronbach’s alpha coefficient of the scale was found to be 0.91. The scale consists of 21 items and is 4-point Likert type. Each question in the scale is scored between 0–3. A score between 0–63 can be obtained from the scale. Accordingly, 0–9 points indicate minimal depression, 10–16 points indicate mild depression, 17–29 points indicate moderate depression, 30–63 points indicate severe depression. A high score on the scale indicates a high level of depression.

Beck Hopelessness Scale

It was developed by Beck et al. (1974) to determine the degree of pessimism towards the future. Its Turkish validity and reliability was performed by Durak and Palabiyikoglu (1994). The Cronbach’s alpha coefficient of the original scale was reported as 0.93 (Beck et al., 1974). In the present study, Cronbach’s alpha value was 0.72. The scale consists of 20 items and three sub-dimensions. A score between 0–20 can be obtained from the scale. Accordingly, 0–3 points indicate minimal hopelessness, 4–8 points indicate mild hopelessness, 9–14 points indicate moderate hopelessness, and 15–20 points indicate severe hopelessness. A high score on the scale indicates a high level of hopelessness.

Statistical Analysis

IBM SPSS 22 statistical program was used to analyze the research data (IBM, 2017). Descriptive (number, percentage, mean and standard deviation) and multiple linear regression statistics were used to evaluate the data. The kurtosis and skewness coefficients were calculated to see whether the data were normally distributed, and data with values between −1.5 and +1.5 were considered normal (Tabachnick & Fidell, 2013). Independent Sample t test and One Way ANOVA test were used to know if there is differences in fear of death based on the descriptive characteristics. Pearson Correlation Analysis was performed to determine the relationship between the scales. In addition, multiple linear regression analysis was performed to explain the total change in depression and hopelessness variables and death anxiety. The results were evaluated at w 95% confidence interval and p < .05 significance level.

Ethical Procedures

Before the research data were collected, the necessary permission was obtained from the Social and Human Sciences Scientific Research and Publication Ethics Committee of a university (Date: 07.03.2024/03/09). In addition, permission was obtained from the institution where the study would be conducted. Approvals were obtained from the authors of the scales used in the study via e-mail. All participants signed the electronic informed consent form before the data collection process began. No incentive payments were made to the individuals participating in the study. Their participation was completely voluntary. Confidentiality of the research data was ensured by providing access to an author. The study was conducted in accordance with the Declaration of Helsinki.

Results

The mean age of the participants was 21.49 ± 1.71 years. 63.9% of the participants were female; 33.5% were studying in the second grade; 81.9% of the participants’ families resided in the earthquake zone; 30.3% had lost a relative in the earthquake; 51.6% had suffered financial loss in the earthquake; 86.5% received training on disasters before the earthquake; 38.7% prepared a disaster kit after the earthquake; 56.8% had death anxiety; 41.3% had moderate depression; 60.7% had severe hopelessness (Table 1).

The mean total death anxiety score of the students was 48.45 ± 17.82, and the earthquake survivors had mild death anxiety. The mean total depression score of the students was 19.10 ± 12.20, and the earthquake victims had moderate depression. The mean total hopelessness score of the students was 15.56 ± 2.98 and the earthquake victims had severe level of hopelessness. The mean score of loss of motivation (7.19 ± 1.06) was higher than the sub-dimension scores of the hopelessness scale (Table 2).

Table 2.

Mean Death Anxiety, Depression and Hopelessness Scale Scores of the Participants.

Variables	Mean ± SD	Min-Max
Total death anxiety score	48.45 ± 17.82	4–100
Total depression score	19.10 ± 12.20	1–63
Total hopelessness score	15.56 ± 2.98	1–20
Expectations about the future	4.54 ± 0.80	1–8
Loss of motivation	7.19 ± 1.06	0–5
Hopes about the future	3.83 ± 1.83	0–7

SD, standard deviation; Min, minimum; Max, maximum.

When the mean total scores of death anxiety according to the descriptive characteristics of the participants were examined, it was determined that there was a statistically significant difference between gender and the mean total score of death anxiety (p < .001) and that males had higher death anxiety than females. It was determined that there was a statistically significant difference between the loss of relatives/friends in the earthquake and the mean total score of death anxiety (p < .05) and those who lost a relative in the earthquake had higher death anxiety. There was no statistically significant difference between the city where the family lives, experiencing financial loss in the earthquake, receiving training on disasters before the earthquake, preparing a disaster kit after the earthquake and the mean total score of death anxiety (p > .05, Table 3).

Table 3.

Distribution of Death Anxiety Total Scores According to Participants’ Descriptive Characteristics.

Variables	Death Anxiety
Variables	Mean ± SD	Test, p Value
Gender
Female	44.07 ± 12.20	t = 3.672^a
Male	56.21 ± 22.98	p = .000
Class
1st grade	47.63 ± 15.46	F = .636^b p = .593
2nd grade	48.42 ± 10.85
3rd grade	51.72 ± 21.52
4th grade	46.28 ± 21.88
City where the family lives
Earthquake zone	49.20 ± 18.38	t = 1.112^a
Outside the earthquake zone	45.07 ± 14.81	p = .268
Loss of relatives/friends in earthquake
Yes	53.46 ± 21.47	t = 2.070^a
No	46.27 ± 15.59	p = .042
Experiencing material/monetary loss in an earthquake
Yes	47.70 ± 17.40	t = −.546^a
No	49.26 ± 18.34	p = .586
Receiving training on pre-earthquake disasters
Yes	49.14 ± 18.75	t = 1.959^a
No	44.09 ± 9.18	p = .056
Preparing a disaster bag after an earthquake
Yes	46.83 ± 15.40	t = −.901^a
No	49.48 ± 19.20	p = .369

SD, standard deviation.

^at: Independent Sample t test.

^bF: One Way Anova.

Table 4 shows the relationship between death anxiety and depression and hopelessness levels of the participants. In this study, a significant moderate positive relationship was found between death anxiety and depression (r = .396, p < .01) and hopelessness (r = .308, p < .01).

Table 4.

The Relationship Between Death Anxiety and Depression and Hopelessness Levels of the Participants.

	1	2	3	4	5	6
Death anxiety	1
Depression	.396**	1
Hopelessness	.308**	.333**	1
Expectations about the future	.171*	.234**	.661**	1
Loss of motivation	.205*	.276**	.778**	.474**	1
Hopes about the future	.306**	.278**	.883**	.359**	.475**	1

r: Pearson correlation, **p < .01, *p < .05.

Retrospective multiple regression analysis method was used to evaluate the effect of participants’ depression and hopelessness levels on death anxiety. It was found that depression and hopelessness levels of the participants had a significant effect on death anxiety (p < .001). According to the regression analysis, depression and hopelessness levels were found to have a positive effect on death anxiety. The mean scores of depression (β = .330) and hopelessness (β = .198) explained 18.1% (Adjusted R² = .181) of the change in death anxiety (Table 5).

Table 5.

The Effects of Participants’ Depression and Hopelessness Levels on Death Anxiety.

Factors	Death Anxiety
						95% CI		Collinearity
	B	SE	β	t	p	Low Value	High Value	Tolerance	VIF
(Constant)	20.821	6.911		3.013	.003	7.166	34.475
Depression	.482	.113	.330	4.266	.000	.259	.705	.889	1.125
Hopelessness	1.184	.462	.198	2.561	.011	.270	2.097	.889	1.125

R = .438, R² = .192, Adjusted R² = .181, F = 18.016, p < .001.

Discussion

In this study, death anxiety was found to increase as depression and hopelessness increased. Death anxiety is a feeling that is present throughout a person’s life and becomes more pronounced in a traumatic event (Menzies & Menzies, 2020). Experiencing a disaster such as an earthquake increases death stress in individuals (Birni et al., 2024). In the present study, it was observed that one year after the earthquake, earthquake survivor students experienced mild death anxiety. In a descriptive and correlational study conducted by Cevik Aktura et al. (2024) immediately after the earthquake, it was reported that individuals experienced moderate death anxiety. In a study by Qi and FPRT (2023) investigating the cognitive structure of death among Chinese university students after the Wenchuan earthquake and long-term changes in death cognition after disasters, it was reported that students experienced high levels of death anxiety. Akturk and Yenigun (2024) reported that participants experienced high death anxiety in their study conducted immediately after the earthquake. Many factors such as being alone, being exposed to the shocking effects of the earthquake, wanting to get out of the collapsed building after the earthquake (Akturk & Yenigun, 2024), and experiencing loss of life and property during the two major earthquakes centered in Kahramanmaras in Türkiye are very difficult for people. This experience is expected to increase death anxiety. Although studies have shown that death anxiety is positively associated with traumatic events and life-threatening experiences, some studies have also reported that survivors of near-death accidents or illnesses reported that their fear of death decreased after the accident or illness (Ozmen & Ocakdan, 2022). The mild level of death anxiety in this study compared to previous results may be related to the fact that one year passed after the earthquake and the effect of the earthquake partially disappeared.

In the current study, it was observed that one year after the earthquake, earthquake survivors experienced moderate depression. After the Kermanshah earthquake, a dramatic increase in mental disorders was reported among all age groups who survived the earthquake (Mahmoud et al., 2019). Tasci and Ozsoy (2021) reported that the depression scores of participants who experienced an earthquake 2.5 months after the earthquake, the epicenter of which was the city of Elazığ in Turkey in 2020, were higher than normal scores. Bavafa et al. (2019), in a study conducted 10 days after the earthquake in Iran in 2017, reported that almost half of the participants had depressive symptoms. Gerstner et al. (2020) reported high levels of depression in adolescents in a study conducted 9 months after the April 16, 2016 earthquake in Ecuador. Similarly, Sharma et al. (2021) reported high levels of depression among 125 medical students attending a university in Kathmandu, Nepal, four years after the earthquake. The findings suggest that individuals with post-earthquake symptoms of depression should receive intervention as soon as possible. In the systematic review and meta-analysis study conducted by Cénat et al. (2020), it was reported that the time elapsed after the earthquake decreased the level of depression. Thus, while the high levels of depression in earthquake victims emphasize the negative effects of traumatic events on the mental health of individuals, it should not be ignored that time also has a healing effect.

This study found that students exposed to the earthquake experienced high levels of hopelessness one year after the earthquake. In a study conducted by Sharma et al. (2021) on university students exposed to the 2015 Nepal earthquake, it was reported that hopelessness levels were high four years after the earthquake. Similarly, post-earthquake surveys report high levels of hopelessness (Nalbantoglu et al., 2024). The results are similar to the literature. The high levels of hopelessness in earthquake victims may be due to the trauma they have experienced, which creates negative expectations about the future. This suggests that trauma negatively affects individuals’ future expectations.

Death anxiety has been theoretically and empirically linked to mental health (Menzies et al., 2019). In the current study, a positive moderately significant relationship was found between depression and hopelessness and death anxiety, and depression and hopelessness explained 18.1% of the change in death anxiety levels. In the study conducted by Gurbuz and Yorulmaz (2024), high levels of death anxiety were associated with many psychological conditions. In the study conducted by Xu and Wei (2013), it was reported that those with high anxiety levels were more likely to be depressed. In the study conducted by Yildiz (2011), it was shown that there was a positive significant relationship between levels of unhappiness and levels of depression and death anxiety related to death. Studies support the results of our study. Similarly, in the study conducted by Koc and Basgol (2022), a significant positive relationship was found between stress, depression and anxiety levels of individuals and death anxiety. It is believed that many situations, such as students losing someone close to them, experiencing property losses, moving away from educational institutions, losing a job, not being able to find enough social support due to the earthquake, increase the level of depression and affect death anxiety. It is also thought that the situation may be due to the perception of danger, uncertainty, and lack of control created by the earthquake.

In the current study, it was found that in addition to psychological factors, there are sociodemographic characteristics such as gender and loss of a loved one that influence death anxiety in adolescents. It was observed that male students have higher death anxiety than female students. It has been reported in the literature that women’s death anxiety is higher than men’s after an earthquake (Akturk & Yenigun, 2024; Canli & Yilmaz, 2024). It has been interpreted that women’s higher death anxiety may be due to biological structure, social norms, upbringing and cultural values, as well as women’s more vocal and expressive anxiety. Similar to the findings of this study, the study conducted by Sahan and Yildiz (2022) found that death anxiety is higher in men. The fact that men have higher levels of death anxiety can be explained by the fact that they have more responsibilities within the family and social structure and are more likely to struggle with difficult life events. In addition, the fact that the group in which the study was conducted consisted of adolescents may suggest that gender may be a common risk factor.

In the current study, 30.3% of the students who experienced the earthquake reported that at least one relative or friend had died, and students who lost a relative in the earthquake had higher death anxiety. Similarly, 35% of the individuals who participated in the study of the Kahramanmaras-centered earthquake reported that at least one person in their family had died (WHO, 2023). In the study conducted by Akturk and Yenigun (2024), it was found that those who lost their relatives in the earthquake had higher death anxiety. Ozmen et al. (2024) reported that the loss of a parent was the most important stress predictor of psychological distress after the earthquake. In a study conducted by Bondjers et al. (2018) after the Swedish tsunami, the loss of a relative or friend was found to increase participants’ symptom burden and cause posttraumatic stress disorder. After a severe earthquake, the sudden loss of a parent, relative, or friend may make an individual more vulnerable to psychological and mental disorders.

Study Limitations

In this study, disaster-related socio-demographic and some descriptive characteristics were based on self-report. Students who survived the earthquake may have been reluctant to report negative experiences or emotions due to social desirability bias. Besides, the relationships found in this study are correlational and not causal. This study provides a snapshot of the earthquake-induced psychological state of earthquake survivor students at a specific point in time. Although this is sufficient to understand the current situation, it may make it difficult to establish a cause and effect relationship. Longitudinal studies may allow for the examination of changes and trends over time by collecting data at different intervals. Another limitation is that the findings may not be generalizable to all earthquake survivors. The participants were only students who experienced the Kahramanmaraş earthquake and the results of this study can only be generalized to the sample. In addition, death anxiety is a multidimensional concept and how it is perceived differs from one culture to another, and the cultural characteristics of Turkish society that affect death anxiety were not evaluated in this study. However, in future studies, a conclusion can be reached by making direct cross-cultural comparisons.

Conclusion

In this study, depression and hopelessness were found to have a positive effect on death anxiety in earthquake-affected students one year after the earthquake. Men and those who lost a relative in the earthquake are in the risk group for death anxiety. Based on this, psychosocial support systems should be activated for people with death anxiety. Therefore, it is recommended to teach stress coping skills through individual and social empowerment programs and to plan intervention programs to reduce death anxiety. It can be recommended to establish psychological support units in schools to help students who have such experiences and to encourage those in need to benefit from these resources. In addition, this study provides an important resource for assessing post-earthquake depression and hope levels and emphasizes the importance of including the healing power of hope in health education. It may be recommended that hope-building programs be included in the curriculum, especially for health education students, to develop their coping mechanisms against negative events and to undergo psychological screening before going into the field. Implementing these interventions can help to mitigate the long-term effects of traumatic experiences for students affected by the earthquake. Supporting students’ psychological well-being after the earthquake can reduce the effects of depression, hopelessness, and death anxiety. The totality of these proposed solutions can create a structure that will help students overcome the difficulties they face in the post-disaster process, improve their psychological well-being, and increase their quality of life. In addition, although certain potential limitations of this study are recognized, it is recommended that future research be conducted with different age groups and in geographical regions with different cultural characteristics.

Footnotes

Author contributions

Yasemin Gümüş Şekerci: Writing – original draft, Visualization, Methodology, Conceptualization, Data curation. Gülşah Ayvazoğlu: Writing – review & editing, Supervision, Data collection, Mustafa Çekiç: Data collection, Review & editing.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Statement

ORCID iD

Yasemin Gümüş Şekerci

Author Biographies

Yasemin Gümüş Şekerci is an associate professor at Selcuk University Faculty of Nursing, Department of Public Health Nursing. Her research interests are child, adolescent, adult, elderly and community mental health, nursing care, Type 2 diabetes, health behavior, physical activity, cognitive functions, depression, death anxiety, quality of life, migration, disaster nursing, transtheoretical model, motivational interview, solution-focused approach and other evidence-based practices.

Gülşah Ayvazoğlu is an doctoral faculty member at Hatay Mustafa Kemal University, Faculty of Health Sciences, Department of Emergency Aid and Disaster Management. Her research interests include disaster management, volunteering in disasters, CBRN, humanitarian aid logistics, disaster awareness, NGOs in disasters, human resources in disasters and disaster planning. It includes DELPHI and other multi-criteria decision-making techniques where mixed methods other than qualitative and quantitative research are used.

Mustafa Çekiç an lecturer faculty member at Hatay Mustafa Kemal University, Faculty of Health Sciences, Department of Emergency Aid and Disaster Management. His research interests include disaster awareness, disaster management, underwater research, lifesaving and scuba, as well as fire training.

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