Following the Disaster: The Mediating Role of Intolerance of Uncertainty in the Relationship Between Fear of Earthquake and Fear of Death

Abstract

The recent earthquakes in Türkiye have been recorded as the most severe natural disaster of the century. This research focused on the role of intolerance of uncertainty as a mediator in the association between fear of earthquakes and mortality fearfulness in individuals. The study consisted of 364 participants aged 18 years and older who resided in 11 provinces affected by the February 6, 2023 earthquake. The findings revealed a significant positive correlation between the fear of earthquakes and both intolerance of uncertainty and mortality fearfulness. In addition, a significant positive correlation was observed between intolerance of uncertainty and mortality fearfulness. Intolerance of uncertainty was found to significantly mediate the relationship between fear of earthquakes and mortality fearfulness. The results highlight the significance of reducing and managing risk factors to enhance the psychological well-being of earthquake survivors as well as to assist in developing appropriate intervention and treatment programs.

Keywords

• Disaster
• fear of earthquakes
• intolerance of uncertainty
• Mortality Fearfulness

References

1. Adamis, A. M., Cole, D. A., & Olatunji, B. O. (2024). Intolerance of uncertainty and worry prospectively predict Covıd-19 anxiety and distress: A 4-year longitudinal study. Behavior Therapy, 55(2), 320-330. https://doi.org/10.1016/j.beth.2023.07.009
2. Ahn, A. Y., Takikawa, H., Maly, E., Bostrom, A., Kuriyama, S., Matsubara, H., Izumi, T., Tarayashiki, T., & Imamura, F. (2021). Perception of earthquake risks and disaster prevention awareness: A comparison of resident surveys in Sendai, Japan and Seattle, WA, USA. International Journal of Disaster Risk Reduction, 66, 102624. https://doi.org/10.1016/j.ijdrr.2021.102624
3. Armash, I. (2006). Earthquake risk perception in Bucharest, Romania. Risk Analysis, 26(5), 1223-1234. https://doi.org/10.1111/j.1539-6924.2006.00810.x
4. Aydın, G. Ç., & Aytaç, S. (2023). The psycho-socıal effect of the earthquake on women ın the eartquake, one of the dısadvantaged groups: A qualıtatıve research. Journal of Mehmet Akif Ersoy University Economics and Administrative Sciences Faculty, 10(3), 2195-2218. https://doi.org/10.30798/makuiibf.1281904
5. Bertinelli, L., Mahé, C., & Strobl, E. (2023). Earthquakes and mental health. World Development, 169, 106283. https://doi.org/10.1016/j.worlddev.2023.106283
6. Bırni, G., Deniz, M. E., Karaağaç, Z. G., Erişen, Y., Kaya, Y., & Satıcı, S. A. (2024). Rebuilding wellbeing: understanding the role of self-criticism, anger rumination, and death distress after the February 6, 2023, Türkiye Earthquake. Death Studies, 48(5), 511-521. https://doi.org/10.1080/07481187.2023.2241401
7. Buhr, K., & Dugas, M. J. (2009). The role of fear of anxiety and intolerance of uncertainty in worry: An experimental manipulation. Behaviour Research and Therapy, 47(3), 215-223. https://doi.org/10.1016/j.brat.2008.12.004
8. Bulut, M. B. (2023). Relationship between COVID-19 anxiety and fear of death: The mediating role of intolerance of uncertainty among a Turkish sample. Current Psychology, 42(10), 8441-8450. https://doi.org/10.1007/s12144-022-03281-x

9. Bulut, M. B., McDermott, M., & McEwan, O. (2017). Adapting the multidimensional mortality awareness measure: A study of validity and reliability. The Journal of International Social Research, 10(49), 268–275. https://doi.org/10.17719/jisr.2017.1578
10. Butler, G., & Mathews, A. (1983). Cognitive processes in anxiety. Advances in Behavior Research and Therapy, 5(1), 51-62. https://doi.org/10.1016/0146-6402(83)90015-2
11. Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30-43. https://doi.org/10.1016/j.janxdis.2016.02.007
12. Carleton, R. N., Norton, M. A., & Asmundson, G. J. G. (2007). Fearing the unknown: A short version of the intolerance of uncertainty scale. Journal of Anxiety Disorders, 21(1), 105-117. https://doi.org/10.1016/j.janxdis.2006.03.014
13. Clark, D. A., & Beck, A. T. (2011). Cognitive therapy of anxiety disorders: Science and practice. Guilford Press. Disaster and Emergency Management Presidency. (2023). 06 Şubat 2023 Pazarcık-Elbistan (Kahramanmaraş) Mw: 7.7 – Mw: 7.6 Depremleri Raporu. https://deprem.afad.gov.tr/assets/pdf/Kahramanmaraş%20Depremi%20%20Raporu_02.06.2023.pdf
14. Doyle, E. E., McClure, J., Potter, S. H., Lindell, M. K., Becker, J. S., Fraser, S. A., & Johnston, D. M. (2020). Interpretations of aftershock advice and probabilities after the 2013 Cook Strait earthquakes, Aotearoa New Zealand. International Journal of Disaster Risk Reduction, 49, 101653. https://doi.org/10.1016/j.ijdrr.2020.101653
15. Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behavior Research and Therapy, 36(2), 215-226. https://doi.org/10.1016/S0005- 7967(97)00070-3
16. Dugas, M. J., Laugesen, N., & Bukowski, W. M. (2012). Intolerance of uncertainty, fear of anxiety, and adolescent worry. Journal of Abnormal Child Psychology, 40, 863-870. https://doi.org/10.1007/s10802-012-9611-1
17. Düken, M. E. (2023). Investigation of the relationship between mental health status and sleep patterns of children who experienced the Kahramanmaraş Earthquake: Data from the earthquake region. Journal of the American Psychiatric Nurses Association, 10783903231211506. https://doi.org/10.1177/10783903231211506
18. Efendi, G. Y., Temeltürk, R. D., Çakmak, I. B., & Dinçer, M. (2023). Surviving the immediate aftermath of a disaster: a preliminary investigation of adolescents’ acute stress reactions and mental health needs after the 2023 turkey earthquakes. Children, 10(9), 1485. https://doi.org/10.3390/children10091485
19. Ellis, A., David, D., & Lynn, S. J. (2010). Rational and irrational beliefs: A historical and conceptual perspective. In D. David, S. J. Lynn, & A. Ellis (Eds.), Rational and irrational beliefs: Research, theory, and clinical practice (pp. 3–22). Oxford University Press.
20. Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4. https://doi.org/10.11648/j.ajtas.20160501.11
21. Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18(3), 233-239. https://doi.org/10.1111/j.1467-9280.2007.01882.x
22. George, D., & Mallery, P. (2016). IBM SPSS Statistics 23 Step by Step. In IBM SPSS Statistics 23 Step by Step (14th ed.). Routledge. https://doi.org/10.4324/9781315545899
23. Goltz, J. D. (2016). Status and power differentials in the generation of fear in three California earthquakes. International Journal of Disaster Risk Reduction, 16, 200-207. https://doi.org/10.1016/j.ijdrr.2016.02.011
24. Greco, V., & Roger, D. (2003). Uncertainty, stress, and health. Personality and Individual Differences, 34(6), 1057-1068. https://doi.org/10.1016/S0191-8869(02)00091-0
25. Grupe, D. W., & Nitschke, J. B. (2013). Uncertainty and anticipation in anxiety: An integrated neurobiological and psychological perspective. Nature Reviews Neuroscience, 14(7), 488-501. https://doi.org/10.1038/nrn3524
26. Güler, A., Gül, S., & Yıldırım, M. (2024). Social comparison, resilience, life satisfaction, depression, and anxiety among earthquake survivors in Turkey. International Journal of Disaster Risk Reduction, 104426. https://doi.org/10.1016/j.ijdrr.2024.104426
27. Gümüş, R. (2023). The disaster of the century: Earthquakes in Türkiye. International Journal of Health Services Research and Policy, 8(1), 1-2.
28. Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression‐based approach. Guilford Publications.
29. Iqbal, A., & Sheikh, A. (2023). The devastating earthquake that struck Turkey and Syria: Post‐traumatic stress disorder and mental health issues among the victims. The International Journal of Health Planning and Management, 38(4), 1080-1083. https://doi.org/10.1002/hpm.3644
30. Jooste, J., Wolfson, S., & Kruger, A. (2023). Irrational performance beliefs and mental well-being upon returning to sport during the COVID-19 pandemic: A test of mediation by intolerance of uncertainty. Research Quarterly for Exercise and Sport, 94(3), 802-811. https://doi.org/10.1080/02701367.2022.2056117
31. Kannis-Dymand, L., Dorahy, M. J., Crake, R., Gibbon, P., & Luckey, R. (2015). An exploration of reported cognitions during an earthquake and its aftershocks: Differences across affected communities and associations with psychological distress. The Journal of Nervous and Mental Disease, 203(4), 279-286. https://doi.org/10.1097/NMD.0000000000000282
32. Kanwal, M. (2023). Natural disaster (earthquake) in Türkiye and Syria 2023: Humanitarian response. SSRN, 4382051.
33. Kardaş, F. (2021). The fear of COVID-19 raises the level of depression, anxiety and stress through the mediating role of intolerance of uncertainty. Studia Psychologica, 63(3), 291-306. https://doi.org/10.31577/sp.2021.03.828
34. Kartol, A., Üztemur, S., & Yaşar, P. (2024). Development and validation of the Earthquake Obsession Scale. Death Studies, 49(3), 219-227. https://doi.org/10.1080/07481187.2024.2317177
35. Khachadourian, V., Armenian, H., Demirchyan, A., Melkonian, A., & Hovanesian, A. (2016). A post‐earthquake psychopathological investigation in Armenia: Methodology, summary of findings, and follow‐up. Disasters, 40(3), 518-533. https://doi.org/10.1111/disa.12166
36. Kısa, C., & Karakoç, H. (2023). Investigation of the effects of Covid-19 on anxiety, fear of death, and obsessive-compulsive disorder. Turkish Journal of Holistic Psychotherapy, 6(11), 31–43. https://doi.org/10.56955/bpd.1063876
37. Kowalski, K. M., & Kalayjian, A. (2001). Responding to mass emotional trauma: A mental health outreach program for Turkey earthquake victims. Safety Science, 39(1-2), 71-81. https://doi.org/10.1016/S0925-7535(01)00027-3
38. Kurt, G., Uygun, E., Aker, A. T., & Acarturk, C. (2023). Addressing the mental health needs of those affected by the earthquakes in Türkiye. The Lancet Psychiatry, 10(4), 247-248. https://doi.org/10.1016/S2215-0366(23)00059-7
39. Kwon, H. J., Leem, J., Kim, D. W., Kwon, C. Y., & Kim, S. H. (2023). Effect of acupuncture on patients with major psychiatric disorder and related symptoms caused by earthquake exposure: Protocol for a scoping review of clinical studies. Plos One, 18(1), e0281207. https://doi.org/10.1371/journal.pone.0281207
40. Lee, S. A., Jobe, M. C., Mathis, A. A., & Gibbons, J. A. (2020). Incremental validity of coronaphobia: Coronavirus anxiety explains depression, generalized anxiety, and death anxiety. Journal of Anxiety Disorders, 74, 102268. https://doi.org/10.1016/j.janxdis.2020.102268
41. Levasseur, O., McDermott, M. R., & Lafreniere, K. D. (2015). The multidimensional mortality awareness measure and model: Development and validation of a new self-report questionnaire and psychological framework. OMEGA-Journal of Death and Dying, 70(3), 317-341. https://doi.org/10.1177/0030222815569440
42. Mazloomzadeh, M., Mashhadi, A., & Hosseini, S. R. (2022). Prediction of death anxiety through fear of COVID-19, neuroticism, behavioral inhibition system and uncertainty intolerance. Journal of Fundamentals of Mental Health, 24(6). https://doi.org/10.22067/tpccp.2024.79613.1402
43. Paudel, D. (2020). ABC framework of fear of COVID-19 for psychotherapeutic intervention in Nepal: A review. PsyArXiv. https://doi.org/10.31234/osf.io/9sj4a
44. Prizmić-Larsen, Z., Vujčić, M. T., & Lipovčan, L. K. (2025). Fear of COVID-19 and fear of earthquake: Multiple distressing events and well-being in Croatia. Psychological Reports, 128(2), 435–456. https://doi.org/10.1177/00332941231156813
45. Salzman, M. B., & Halloran, M. J. (2004). Cultural Trauma and Recovery: Cultural Meaning, Self-Esteem, and the Reconstruction of the Cultural Anxiety Buffer. In J. Greenberg, S. L. Koole, & T. Pyszczynski (Eds.), Handbook of Experimental Existential Psychology (pp. 231–246). The Guilford Press.
46. Sánchez, Y., Coma, T., Aguelo, A., & Cerezo, E. (2019). ABC-EBDI: An affective framework for BDI agents. Cognitive Systems Research, 58, 195-216. https://doi.org/10.1016/j.cogsys.2019.07.002
47. Santos-Reyes, J. (2020). Multi-hazard awareness, risk perception and fear to earthquakes: the case of high-school students in Mexico City. Journal of Risk Analysis and Crisis Response, 10(3). https://doi.org/10.2991/jracr.k.200923.001
48. Sarıçam, H., Erguvan, F. M., Akın, A. & Akça, M. Ş. (2014). Belirsizliğe Tahammülsüzlük Ölçeği (BTÖ-12) Türkçe Formu: Geçerlik ve güvenirlik çalışması. Route Educational and Social Science Journal, 1(3), 148-157. https://doi.org/10.17121/ressjournal.109
49. Satıcı, S. A., Okur, S., Deniz, M. E., Karaağaç, Z. G., Yılmaz, F. B., Kütük, H., Satıcı, B., & Kaya, Y. (2024). The development and initial validation of the Earthquake Fear Scale: Its links to personality traits, psychological distress, harmony in life, and mental wellbeing. Stress and Health, 40(2), e3306. https://doi.org/10.1002/smi.3306
50. Teke, E., & Karaman, H. B. (2025). Perceived stress and satisfaction with life following the 2023 earthquake in Türkiye: investigating the effects of irrational beliefs and hope. Frontiers in Psychology, 16, 1506669. https://doi.org/10.3389/fpsyg.2025.1506669
51. Terpstra, T. (2011). Emotions, trust, and perceived risk: Affective and cognitive routes to flood preparedness behavior. Risk Analysis: An International Journal, 31(10), 1658-1675. https://doi.org/10.1111/j.1539-6924.2011.01616.x
52. Torpus, K., Usta, G., Özbay, S. Ç., & Kanbay, Y. (2024). The moderating role of gender in the impact of intolerance of uncertainty on earthquake fear. Psychology, Health & Medicine, 26, 1-18. https://doi.org/10.21203/rs.3.rs-3656610/v1
53. Usta, G., Torpus, K., Kanbay, Y., & Özbay, S. Ç. (2024). The Turkish adaptation of the fear of earthquake scale. Natural Hazards, 120(1), 463-476. https://doi.org/10.1007/s11069-023-06228-y
54. Van den Bos, K., & Lind, E. A. (2002). Uncertainty management by means of fairness judgments. Advances in Experimental Social Psychology, 34, 1–60. https://doi.org/10.1016/S0065-2601(02) 80003-X
55. World Health Organization. (2023). WHO flash Appeal Earthquake Response in Türkiye and Whole of Syria. https://cdn.who.int/media/docs/default-source/documents/emergencies/2023/who_flashappeal_earthquakeresponse.pdf?sfvrsn=210f845d_3&download=true
56. Xu, J., Dai, J., Rao, R., & Xie, H. (2016). The association between exposure and psychological health in earthquake survivors from the Longmen Shan Fault area: the mediating effect of risk perception. BMC Public Health, 16, 1-14. https://doi.org/10.1186/s12889-016-2999-8
57. Yari, A., Zarezadeh, Y., & Taghizadeh, A. O. (2019). Prevalence of fatalistic attitudes toward earthquake disaster risk management in citizens of Tehran, Iran. International Journal of Disaster Risk Reduction, 38, 101181. https://doi.org/10.1016/j.ijdrr.2019.101181
58. Yıldırım, M., Çağış, Z. G., & Williams, G. (2023). Fear of COVID-19, intolerance of uncertainty, psychological capital, and positive future expectations: Tests of mediating relationships with healthcare workers. Archives of Psychiatric Nursing, 45, 158-163. https://doi.org/10.1016/j.apnu.2023.06.016