Based on preliminary findings, one of the severely affected areas was Islahiye in Gaziantep province during the recent and highly severe earthquake on February 6, 2023. This earthquake was centered in the Sofalaca-?ehitkamil-Gaziantep region (coordinates: 37.1123 Longitude, 37.1195 Latitude) with a focal depth of approximately 5 km. The seismic activity was felt across a wide geographic area, spanning Southeastern Anatolia, Eastern Anatolia, Central Anatolia, and the Mediterranean Regions. Official data, as of March 23, 2023, reported an official death toll of 50,096 and 107,204 individuals injured.

This report assesses mothers with postpartum depression and PTSD in rural Islahiye/Gaziantep after the earthquake. The report also discusses the impact of acute stress on the lack of breast milk. In this case series, we reported 17 mothers, who were diagnosed with PTSD by 2 psychiatrists following the earthquake. Of those 17 mothers, 10 of them were on sertraline and 7 of them were on escitalopram.  They stopped lactation due to stress and their babies were devoid of breast milk.

According to Ericson’s theory, infants develop trust-mistrust in the early 6 months and lack of breastfeeding may lead to increased levels of distress and chronic mental conditions [1, 2]. One study after the Van earthquake in Turkey, reported PTSD symptoms can be seen in infants. These authors evaluated the earthquake survivor children between 7 and 12 years of age with the Childhood Post-Traumatic Stress Reaction Index (CPTS-RI) questionnaire and found that many psychological problems occurred after earthquakes and might last for years [3]. Adolescent earthquake survivors faced to persistent sleep disturbances following the 2008 earthquake in China and depression, anxiety, poor social support, and adverse life events were seen in these victims [4].

The devoid of breast milk can cause many problems. Epidemic viral infections could develop because of being devoid of immunity miracles and the lack of vaccination. The infants were fed with rice and cow milk formula in the first 6 months because of a lack of breast milk and age-appropriate formula. Viral upper respiratory tract infections and bronchopneumonia frequently occur in these infants because of protein-energy malnutrition. These infants would tend to have an increased risk of autoimmune diseases like type 1 diabetes and celiac disease because of cow milk formula feeding [2, 5]. A nationwide cohort study has found that PTSD is related to a 2.26-fold increase in risk for any autoimmune after adjusting confounding factors [6].

Our observations for the prevalence of PTSD after an earthquake have been consistent with the literature. Planning and coordination in an earthquake zone should follow international and national guidelines. Comprehensive psychiatric support should be provided to the mother’s resident in the earthquake region. Monitoring the mental symptoms is very crucial for the mental health of the community.

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2. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al; Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475-90.
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6. Hsu TW, Bai YM, Tsai SJ, Chen TJ, Chen MH, Liang CS. Risk of autoimmune diseases after post-traumatic stress disorder: a nationwide cohort study. Eur Arch Psychiatry Clin Neurosci 2023.