The Sequential Roles of Psychological Flexibility and Positivity in the Association Between Post-Traumatic Stress Symptoms and Depressive Symptoms Among Earthquake Survivors in Türkiye

Earthquakes can have substantial consequences for psychological well-being, including post-traumatic stress and depressive symptoms. Drawing on Acceptance and Commitment Therapy (ACT), which conceptualizes psychological flexibility as a central process in adaptive psychological functioning, this study examined the sequential mediating roles of psychological flexibility and positivity in the association between post-traumatic stress symptoms and depressive symptoms among survivors of the two major earthquakes that struck Türkiye on 6 February 2023. This cross-sectional study included 834 earthquake survivors (Mage = 26.7; 71.1% female) who were assessed approximately three months after the earthquakes. Participants completed validated self-report measures of post-traumatic stress symptoms, psychological flexibility, positivity, and depressive symptoms. Depressive symptoms were assessed using the 12-item depression subscale of the Brief Symptom Inventory and were analyzed as a continuous variable. Correlation and sequential mediation analyses were conducted, with indirect effects evaluated using bootstrapping. Post-traumatic stress symptoms were positively associated with depressive symptoms and negatively associated with psychological flexibility and positivity. Psychological flexibility was positively associated with positivity and negatively associated with depressive symptoms, while positivity was negatively associated with depressive symptoms. Sequential mediation analysis indicated that psychological flexibility and positivity mediated the association between post-traumatic stress symptoms and depressive symptoms. These findings suggest that psychological flexibility and positivity may represent relevant psychological processes in the association between post-traumatic stress and depressive symptoms among earthquake survivors and may inform post-disaster psychological support.