"Everything changed, this was the constant thing that stayed the same." A mixed-method investigation of the role of online group-based supervision for Syrian mental health workers in the aftermath of the Türkiye-Syria earthquakes.

The 2023 Turkiye-Syria earthquakes caused widespread destruction and resulted in millions of people lacking access to basic needs and services. The Caring for Carers (C4C), online group-based supervision program, provided to Syrian mental health workers commenced three months before the earthquakes. In the present study, we aimed to test the stress-buffering role of supervision for the psychological distress and compassion satisfaction of participants following the earthquakes. A mixed-method study was conducted with Syrian mental health workers in Turkiye and Northwest Syria (N = 55, 41.8% female). Quantitative data included 16 months of survey data on psychological distress (Kessler-6) and compassion satisfaction (a subscale of ProQOL). Qualitative data included online semi-structured interviews with the supervisors (N=10) on the impacts of the earthquakes and video recordings of supervision sessions (N=9). A piecewise mixed-effects model within a Bayesian Hierarchical framework was conducted to examine changes in psychological distress and compassion satisfaction among participants between the active control period (7 months), pre-earthquake supervision period (3 months), and post-earthquake supervision period (6 months). The thematic analysis combined with the elements from the grounded theory was applied to analyze the qualitative data from the interviews and supervision sessions. For both psychological distress and compassion satisfaction, there were no changes across time during pre-earthquake supervision or active control periods. However, there were improvements during the post-earthquake supervision period. The post-earthquake supervision showed significant improvements when compared to the active control and pre-earthquake supervision periods. Qualitative results identified five key features of supervision that enabled participants to perceive it as a safe space where they received both emotional and practical support after the earthquakes. The current findings provide initial evidence of the effectiveness of the supervision program for improving the psychological distress and compassion satisfaction of Syrian mental health workers and supports the stress-buffering role of the supervision program in the aftermath of the earthquakes.