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J Inj Violence Res. 2019 Jul;11(2):225-232. doi: 10.5249/jivr.v11i2.1203. Epub 2019 Jul 2.

The relationship of severity of symptoms of depression, anxiety, and stress with sleep quality in earthquake survivors in Kermanshah.

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Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.



Earthquake is one of the most common natural disasters. A 7.3" Richter earthquake happened at 5km from the town of Ezgeleh in Kermanshah province in 2017, which caused several physical and mental injuries. The present study was conducted to investigate the sleep quality and mental health difficulties of those affected by earthquake and predict sleep quality according to severity of symptoms of depression, anxiety, and stress in the township of Sarpol-e Zahab, which suffered the most damage.


A total of 999 earthquake survivors living in temporary tents and camps were assessed in terms of sleep quality and pattern using Pittsburgh Sleep Quality Index, and severity of psychological symptoms using Depression, Anxiety, and Stress scale 10 days after the disaster.


According to the results, poor sleep quality was experienced by 20.61% of survivors, severe stress by 60.5%, and severe depression by 41.5%, and moderate anxiety by 74%. The subjective quality, efficiency, daily dysfunction, use of hypnotics, and total sleep quality had a positive and significant relation with severity of experienced depression, anxiety, and stress. Sleep latency had a positive and significant relation only with stress, and sleep disturbance with depression and stress.


Severity of depression, anxiety, and stress can predict changes in total sleep quality of those affected by earthquake. Stress can be considered as the sole predictor of total sleep quality and the only factor that can explain components of sleep quality. The implications of the present study are debatable.

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