The Mediating Role of Dissociation in the Relationship Between Emotion Regulation Difficulties and Post-Traumatic Stress Symptoms After the 2023 Kahramanmaraş Earthquakes

Abstract

Purpose: On February 6, 2023, devastating earthquakes occurred in Turkey. In the literature, emotion regulation difficulties have consistently been associated with post-traumatic stress symptoms after traumatic events. In addition, dissociative symptoms have been linked to both emotion regulation difficulties and post-traumatic stress symptoms. Given these associations, dissociation may represent a potential mechanism linking these variables. However, this possibility has been insufficiently investigated among disaster survivors. Therefore, this study examined whether dissociation mediates the association between emotion regulation difficulties and post-traumatic stress symptoms among adults directly exposed to the 2023 Kahramanmaraş earthquakes. 
Method: Using a cross-sectional design, 667 adults (79.9% women, 20.1% men; M = 22.81, SD = 6.61) who were directly exposed to the February 6 Kahramanmaraş Earthquakes were recruited via snowball sampling. Participants completed a sociodemographic information form, the Impact of Event Scale-R, the Peri-Traumatic Dissociative Experience Scale, and the Difficulties in Emotion Regulation Scale. Data were analyzed using Hayes' PROCESS Macro (Version 4.2, Model 4) with 5,000 bootstrap resamples. 
Results: Emotion regulation difficulties were positively associated with dissociative symptoms (B = .17, SE = .040, t(665) = 4.285, p < .001, 95% CI [.092, .248]). Dissociative symptoms were also positively associated with post-traumatic stress symptoms (B = .306, SE = .029, t(665) = 10.442, p < .001, 95% CI [.249, .364]). Emotion regulation difficulties had a significant total effect on post-traumatic stress symptoms (B = .223, SE = .032, t(665) = 6.895, p < .001, 95% CI [.159, .286]). After dissociation was included as a mediator, the direct effect of emotion regulation difficulties remained significant (B = .171, SE = .030, t(665) = 5.622, p < .001, 95% CI [.111, .231]). The indirect effect through dissociation was also significant (B = .052, BootSE = .014, 95% CI [.026, .082]), indicating partial mediation. These findings reveal that greater difficulties in emotion regulation are associated with higher levels of dissociative symptoms, which, in turn, are associated with greater severity of traumatic stress 
symptoms. Furthermore, dissociation partially mediates the relationship between emotion regulation difficulties and traumatic stress symptom severity. Emotion regulation difficulties alone explained 7% (R² = .067, p < .001) of the variance in traumatic stress symptoms. When dissociation was added to the model, the two variables together explained 19.8% of the variance in post-traumatic stress symptoms (R² = .198, p < .001). 
Conclusion: The findings suggest that both emotion regulation difficulties and dissociative symptoms are associated with higher post-traumatic stress symptoms among earthquake survivors. These findings underscore the importance of assessing dissociative symptoms in post-disaster mental health evaluations. Longitudinal studies are warranted to clarify the relationships among emotion regulation difficulties, dissociation, and post-traumatic stress symptoms and to better understand their long-term impact after earthquake exposure.