After the Quake: Sleep Suffers Most in Older Turkish Earthquake Survivors

When a magnitude 7.8 earthquake tore through southern Türkiye in the early hours of February 6, 2023, followed hours later by a second massive shock, it did more than level buildings across Kahramanmaraş and neighboring provinces. It shattered the nightly rhythms of survivors, and new research suggests that for older adults, the damage to sleep and mental health may have been both profound and persistent. A comparative study published in BMC Psychology by Mustafa Cemali of Trakya University and colleagues examined older people living in the earthquake-stricken city of Hatay and compared them with peers in Ankara, a major city far from the epicenters. The findings paint a sobering picture: two-thirds of the earthquake-exposed older adults reported poor sleep quality, and their anxiety and depression scores were dramatically higher than those of their unexposed counterparts.

The study recruited 100 adults aged 65 and older, with observed ages ranging from 65 to 75. Fifty participants came from Hatay, one of the hardest-hit provinces, while fifty came from Ankara, which was not directly exposed to the earthquakes. This cross-sectional and comparative design allowed the researchers to measure three interlocking dimensions of psychological and physical wellbeing: sleep quality, assessed with the well-validated Pittsburgh Sleep Quality Index, or PSQI; anxiety, measured with the Beck Anxiety Inventory; and depressive symptoms, captured by the Beck Depression Inventory. These instruments are among the most widely used tools in sleep and mood research, which makes the results directly comparable with a large international literature.

The headline numbers are striking. Poor sleep quality, defined by the PSQI’s standard cutoff, was found in 64.0 percent of the earthquake-exposed older adults, compared with just 32.0 percent of the non-exposed group, a difference the authors report as statistically significant with a p-value of 0.001. In other words, older survivors in Hatay were twice as likely to be sleeping badly as their peers in the capital. The total PSQI scores, which aggregate seven components including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction, were also significantly higher in the exposed group, with p equal to 0.014.

The mood findings were even more pronounced. Earthquake-exposed older adults scored significantly higher on both the Beck Anxiety Inventory and the Beck Depression Inventory, with p-values below 0.001 for both comparisons. For a population already at elevated risk of late-life depression and anxiety, this doubling down of psychological burden matters enormously. Older adults who experience disasters face a well-documented vulnerability: they may lose familiar environments, social networks, and routines that anchor their mental health, and their capacity to recover physically and psychologically can be reduced compared with younger survivors. The Turkish study provides quantitative confirmation that, months after the disaster, this vulnerability was visible in standardized clinical measurements.

But the study went beyond simple group comparisons. Using hierarchical multiple linear regression, the researchers asked which factors best predicted sleep quality across the whole sample. They entered age, gender, earthquake exposure, anxiety, and depression as candidate predictors and examined which remained associated with PSQI scores in the final model. Two variables emerged as significant: anxiety, with a standardized beta coefficient of 0.293 and a p-value of 0.003, and depression, with a beta of 0.706 and a p-value below 0.001. Notably, earthquake exposure itself did not remain a significant independent predictor in the final model, a result with important implications for how the findings should be interpreted.

That beta of 0.706 for depression is unusually large, and it suggests that depressive symptoms were by far the strongest correlate of poor sleep in this sample. The relationship between sleep and depression is famously bidirectional. Depression disrupts sleep architecture, shortening slow-wave sleep and fragmenting sleep continuity, while chronic insomnia is one of the strongest known risk factors for developing depression. In older adults, this feedback loop can be particularly damaging, because sleep loss also worsens cognitive function, physical health, and medication tolerance. The Turkish findings are consistent with a large body of literature showing that where depression goes, disturbed sleep tends to follow, and vice versa.

The authors are refreshingly candid about the limits of their design, and readers should take those limits seriously. Because the study is cross-sectional, it captures a single moment in time and cannot establish causation: we cannot tell from these data whether poor sleep preceded and contributed to anxiety and depression, whether psychological distress disrupted sleep, or whether both arose from a shared cause. More importantly, the comparison groups came from two geographically distinct cities. Hatay and Ankara differ not only in earthquake exposure but in countless other ways, including the scale of physical destruction, displacement, economic disruption, and access to health services after February 2023. As the authors themselves note, the specific contribution of earthquake exposure cannot be cleanly distinguished from these geographic and contextual differences. The absence of earthquake exposure as an independent predictor in the regression model reinforces this caution: the psychological distress that accompanies disaster, rather than the disaster label itself, appears to travel with the sleep problems.

Why should the general public care about sleep quality in older disaster survivors? The answer lies in what sleep does. Sleep is when the brain consolidates memories, clears metabolic waste, and recalibrates the emotional circuits of the amygdala and prefrontal cortex. Chronic poor sleep in later life is associated with impaired immune function, elevated cardiovascular risk, worsening diabetes control, and accelerated cognitive decline. For older adults already navigating chronic disease and social isolation, disaster-induced insomnia is not a trivial inconvenience; it is a medical risk factor that can compound every other vulnerability. The fact that nearly two-thirds of exposed older adults in this study slept poorly suggests a substantial hidden burden of post-disaster morbidity, one that may persist long after rubble has been cleared and headlines have moved on.

The study also carries practical implications for disaster response. If anxiety and depression are the variables most tightly linked to sleep quality, then mental health support after disasters is not a luxury reserved for those with overt psychiatric illness; it is a core component of protecting physical health in aging populations. Screening older survivors for sleep disturbance could serve as a low-cost sentinel indicator, flagging individuals who may also be struggling with depression or anxiety and who would benefit from psychological intervention. Conversely, treating post-disaster insomnia with evidence-based approaches, such as cognitive behavioral therapy for insomnia, might interrupt the spiral linking sleep loss to mood deterioration. The Turkish researchers, supported by the Scientific and Technological Research Council of Türkiye under its university students research projects program, worked with the Turkish Retirees Association to reach their participants, a reminder that community organizations are often the most effective conduits for research and support among older people.

The 2023 earthquakes were among the deadliest disasters in modern Turkish history, and the psychological aftershocks will reverberate for years. This study, published open access in BMC Psychology with ethical approval from Lokman Hekim University and conducted under the Declaration of Helsinki, offers a measured but urgent data point: older adults in the disaster zone were sleeping worse, worrying more, and feeling darker than their peers elsewhere in the country. The authors rightly resist overclaiming causation, and their honesty strengthens rather than weakens the message. Whether the driver is the earthquake itself, the devastation that followed, or the grinding displacement and uncertainty of its aftermath, the mental health and sleep of older survivors deserve sustained clinical attention. As climate change, urbanization, and seismic risk continue to put aging populations in harm’s way around the world, studies like this one remind us that the true cost of a disaster is measured not only in buildings destroyed but in nights of sleep lost, and that restoring those nights may be one of the most powerful interventions we can offer.

Subject of Research: Sleep quality, anxiety, and depression in older adults exposed to the 2023 Türkiye earthquakes

Article Title: Sleep and psychological health in older adults after the 2023 Türkiye earthquakes: a comparative study

Article References: Cemali, M., Yılmaz, İ., Kanlıca, A., Yılmaz, S., Elmas, Ö., & Karaduman, A. A. (2026). Sleep and psychological health in older adults after the 2023 Türkiye earthquakes: a comparative study. BMC Psychology. https://doi.org/10.1186/s40359-026-05711-y

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05711-y

Keywords: earthquake, older adults, sleep quality, anxiety, depression, Pittsburgh Sleep Quality Index, Türkiye, disaster mental health, insomnia, cross-sectional study, aging population, BMC Psychology