Psychological impact and resilience among healthcare workers following the 2023 Kahramanmaraş earthquakes: systematic review and meta-analysis.

BACKGROUND

Healthcare workers are uniquely vulnerable to psychological distress following large-scale disasters, through simultaneous exposure as survivors and responders. The 2023 Kahramanmaraş earthquakes placed extraordinary demands on frontline health professionals in Türkiye. This mixed-methods systematic review and meta-analysis aimed to synthesise quantitative and qualitative evidence on post-traumatic psychological outcomes and resilience strategies among healthcare workers following the earthquakes.

METHODS

Following PRISMA 2020 and Joanna Briggs Institute guidance, we conducted a mixed-methods systematic review with convergent segregated synthesis. Nine sources (PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cochrane Library, DergiPark, TR Dizin and Google Scholar) were searched for studies published between February 2023 and September 2025, supplemented by forward and backward citation chasing. Twenty studies met inclusion criteria (fifteen quantitative, five qualitative). Random-effects meta-analysis estimated pooled probable-PTSD prevalence and pooled resilience-distress correlations, with leave-one-out, risk-of-bias, instrument and population sensitivity analyses. Qualitative findings were synthesised thematically and integrated with quantitative results.

RESULTS

Pooled prevalence of probable PTSD was 36.3% (95% CI 28.2-45.4), with high heterogeneity (I2 = 86.2%). Prevalence was 43.8% (95% CI 36.1-51.9) among direct survivors and 19.5% (95% CI 3.5-61.8) among deployed responders, but the latter was imprecise and is not interpreted as an exposure effect. Measurement was one apparent contributor: two studies applying PCL-5 ≥ 47 agreed closely (39.0%, I2 = 0.0%), but two applying IES-R ≥ 33 diverged widely (8.1 and 47.7%); measurement could not be separated from exposure, timing or sampling. Higher resilience, hardiness and adaptive coping were consistently associated with lower traumatic stress (pooled r = -0.42, 95% CI - 0.52 to -0.31, k = 4). Structural models indicated direct and coping-mediated associations, while fatigue and unmet basic needs predicted worse outcomes. Qualitative synthesis identified acute distress, secondary traumatisation, spirituality-based meaning-making, peer support and psychological distancing.

CONCLUSION

Healthcare workers following the Kahramanmaraş earthquakes experienced high levels of trauma-related distress, particularly those with direct exposure. Resilience and adaptive coping were consistently inversely associated with distress, although cross-sectional designs cannot establish direction of effect, and organizational conditions were strongly implicated. Disaster preparedness and recovery efforts must integrate individual, social, and structural interventions to safeguard healthcare workers' mental health.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251247026, identifier CRD420251247026.