Problem management plus for improving mental health among earthquake-affected individuals in turkiye: pilot randomised controlled trial

Abstract

Earthquakes present significant threats to community mental health, yet post-disaster resource limitations and high demand restrict access to care. The 2023 Türkiye–Syria earthquakes affected millions, increasing psychological problems and highlighting the urgent need for scalable interventions. Aims This study assessed (a) the feasibility of procedures prior to a fully powered randomised controlled trial (RCT) and (b) the potential effectiveness of Problem Management Plus (PM+), a scalable psychological intervention, in reducing common mental health problems among Turkish earthquake survivors. Method A two-arm, single-blind pilot RCT was conducted with survivors residing in temporary housing in Türkiye. Participants were randomly allocated (1:1) to PM+ ( n = 38) or enhanced care-as-usual (E-CAU; n = 38) and assessed at baseline, 1 week post intervention and at the 1-month follow-up. The primary outcome was depression (Patient Health Questionnaire, PHQ-9); secondary outcomes were self-identified problems (Psychological Outcome Profiles, PSYCHLOPS), functional impairment (World Health Organization Disability Assessment Schedule, WHODAS 2.0), psychological distress (Kessler-10 Psychological Distress Scale, K-10), anxiety (Generalised Anxiety Disorder Scale, GAD-7) and post-traumatic stress (Post-traumatic Stress Disorder Checklist, PCL-5). The trial was prospectively registered (NCT06026306). Results Recruitment, retention (74%) and treatment adherence (79%) supported feasibility. At post-assessment, PM+ showed greater reductions than E-CAU across all outcomes: PHQ-9 (adjusted mean difference −5.91, 95% CI –8.23 to –3.58), PSYCHLOPS (−6.94, –8.88 to –5.01), WHODAS 2.0 (−8.77, –12.50 to –5.03), K-10 (−9.66, –13.35 to –5.97), GAD-7 (−4.31, –6.39 to –2.24) and PCL-5 (−18.72, –25.97 to –11.47). At follow-up, improvements remained significant for psychological distress and self-identified problems. Conclusions Findings provide preliminary evidence that PM+ is a feasible and potentially effective intervention for alleviating common mental health problems among Turkish earthquake survivors.