Traumatic stress and eating-related behaviours after the 6 February 2023 Kahramanmaraş earthquakes: a cross-sectional comparative study

Large earthquakes may be associated with traumatic stress and eating-related outcomes, but evidence from Turkey remains limited. This study examined the associations between direct earthquake exposure, post-earthquake traumatic stress, and eating-related outcomes approximately two years after the 6 February 2023 Kahramanmaraş-centred earthquakes. This cross-sectional comparative online survey was conducted in Turkey between March and June 2025. Adults were classified as directly exposed (n = 602) or comparison (n = 615) based on residence in the 11 affected provinces and self-reported earthquake experience. Participants completed the Post-Earthquake Trauma Level Determination Scale (PETLDS), Salzburg Emotional Eating Scale (SEES), Mindful Eating Questionnaire (MEQ), and SCOFF eating disorder screening tool, together with sociodemographic and self-reported anthropometric measures. Adjusted group differences were estimated using multivariable regression models controlling for age, BMI, gender, marital status, education, employment, income status, and earthquake-related loss. Additional adjusted models examined whether PETLDS total score was independently associated with eating-related outcomes. Direct exposure was strongly associated with higher traumatic stress (PETLDS total: B = 12.30, 95%CI 10.66 to 13.94; p < 0.001) and with higher scores on most PETLDS subscales, whereas the PETLDS emotional subscale was higher in the comparison group (B=-1.09, 95%CI -1.37 to -0.81; p < 0.001). Direct exposure was not independently associated with SEES total score (p = 0.153), MEQ total score (p = 0.584), or a positive SCOFF screen (OR = 1.286, 95%CI 0.969 to 1.706; p = 0.081), although small exploratory subscale differences were observed. In additional adjusted models, higher PETLDS total score was associated with lower MEQ total score and greater odds of a positive SCOFF screen (both p < 0.001), but not with SEES total score. Direct exposure was strongly associated with traumatic stress, whereas eating-related associations were limited. Traumatic stress severity was more clearly associated with lower mindful eating and higher eating disorder risk screening positivity, supporting trauma-informed post-disaster care and nutritional screening in highly stressed individuals. The 6 February 2023 Kahramanmaraş earthquakes affected many people in Turkey and may have had long-term effects on their mental health and eating behaviours. In this study, we compared adults who experienced the earthquakes directly with those who were not directly exposed to them. Over 1,200 people completed an online survey regarding traumatic stress, emotional eating, mindful eating and the potential risk of eating disorders. Those who directly experienced the earthquakes reported higher levels of traumatic stress. However, when other factors were taken into account, direct exposure to the earthquakes alone was not found to have a clear association with general emotional eating, mindful eating, or the risk of eating disorders. Instead, individuals with higher levels of traumatic stress were more likely to report lower levels of mindful eating and a higher risk of eating disorders. These findings suggest that post-disaster support should include mental health assessments, and that screening for eating-related issues could be particularly beneficial for those experiencing high levels of traumatic stress.