Are orthopedists mentally ready for the next disaster? Surgeons who performed amputations after the 2023 Kahramanmaraş earthquakes report high traumatic stress symptoms.

BACKGROUND

This study aims to evaluate the mental health outcomes of orthopedists after the 2023 Kahramanmaraş earthquakes through a comprehensive analysis based on orthopedic care and amputations.

METHODS

This cross-sectional, questionnaire-based study, conducted six months after the 2023 Kahramanmaraş earthquakes, included a total of 95 orthopedists. The online questionnaire assessed demographic characteristics, professional experience, and mental health outcomes using the Impact of Event Scale-Revised (IES-R) and the Depression Anxiety Stress Scale-21 (DASS-21). Scale scores were analyzed according to earthquake zone challenges, orthopedic care provision, and amputation-related stress factors.

RESULTS

Care for earthquake victims was provided by 61.5% of orthopedists in the earthquake area, including local (16.8%) and supporting orthopedists (42.1%), while 36.8% treated victims at referral hospitals outside the area. Overall, 76.8% of participants reported performing amputation surgery on earthquake victims. Performing amputations in the pediatric age group (82.2%), witnessing patients' losses or other earthquake-related difficulties (64.4%), and amputations involving multiple extremities (56.2%) were reported as the three most common stress factors related to amputations. Orthopedists at referral hospitals and local orthopedists reported higher total IES-R scores (11.0 [0-58] and 11.5 [0-46] vs. 1.0 [0-39]), as well as higher avoidance (3.0 [0-20] and 3.0 [0-17] vs. 0.0 [0-13]) and intrusion (4.0 [0-20] and 5.0 [0-20] vs. 0.0 [0-14]) subscale scores. Referral hospital orthopedists showed higher anxiety (2.0 [0-13] vs. 0.0 [0-7]), stress (5.0 [0-16] vs. 2.0 [0-12]), and total DASS-21 scores (11.0 [0-44] vs. 6.0 [0-29]) than supporting ortho-pedists in the disaster zone. Those performing amputations in patients with earthquake-related difficulties reported higher DASS-21 depression scores (4 [0-18] vs. 1 [0-15], p=0.013). IES-R scores were negatively correlated with age (r=-0.203, p=0.049), while other factors showed no correlation with IES-R or DASS-21 scores.

CONCLUSION

Our study shows that treating earthquake victims has a significant impact on orthopedists' emotional states and traumatic stress, especially for local and referral hospital orthopedists. The key stress factors included pediatric amputations, multiple extremity amputations, and patient-related difficulties. While tragic events involving relatives did not show a significant association with the scores, performing amputations on patients with earthquake-related difficulties increased depression scores, and younger orthopedists reported higher IES-R scores than older orthopedists. Our findings highlight the need for regular mental health screening, risk group identification, structured psychological support, and resilience training among orthopedic surgeons following large-scale disasters, as well as enhanced preparedness for future emergencies.