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To study the relationship of post-traumatic stress disorder (PTSD) to severity of the disaster experience.A sample of 1785 adult participants of an epidemiological study initiated in the immediate aftermath of the 1988 earthquake in Armenia were interviewed about 2 years following the disaster based on the NIMH DIS-Disaster Supplement. All 154 cases of pure PTSD were compared with 583 controls without symptoms satisfying psychiatric diagnoses of interest.PTSD cases included more persons from areas with the worst destruction. Having the highest level of education compared to lowest (OR 0.6 [95% CI 0.4-0.9]), being accompanied at the moment of the earthquake (OR 0.6 [95% CI 0.4-0.9]) and making new friends after the earthquake (OR 0.6 [95% CI 0.5-0.8]) were protective for PTSD. PTSD risk increased with the total amount of loss to the family (OR for highest level of loss 4.1 [95% CI 2.3-7.5]).Based on this large population sample, we believe that early support to survivors with high levels of loss may reduce PTSD following earthquakes.