Problems: This study was conducted to examine the association between posttraumatic stress disorder and mental health status of adolescents exposed to the worst disaster of the century. Methods: This study was descriptive, cross‐sectional, and correlational. This research was conducted between March 31 and July 1, 2023. The study was conducted with earthquake survivors who migrated from Kahramanmaraş, the epicenter of the earthquake, and Adıyaman and Hatay, the other two cities where it was most effective, to Şanlıurfa. The study was conducted with a total of 947 adolescents. "Personal Information Form," "Child Posttraumatic Stress Reaction Index," and "Symptom Distress Check List‐ (SCL‐90)" were used to collect data. Linear regression method was used in the analysis of the research. Path analysis was performed using PATH analysis. Findings: The mean age of the adolescents participating in the study was 16.69 ± 1.41 years. It was found that the Global Severity Index (GSI) of the adolescents was at the pathological level with a mean of 2.36 ± 0.68. Posttraumatic stress reactions of the adolescents who experienced the earthquake was found to explain 97.2% of their mental symptoms (anxiety, depression, somatization, anger‐hostility, obsession‐compulsion, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychotic symptoms, other problems, and GSI) (p < 0.001). It was found that the age of the adolescents, total number of losses in the earthquake, the time they stayed under the rubble, the time they waited for siblings to be pulled from under the rubble and the state of having loss due to the earthquake explained 74.4% of the posttraumatic stress reactions (p < 0.001). Conclusions: As a conclusion, it was found that the adolescents who experienced the earthquake experienced severe posttraumatic stress symptoms. It was also found that adolescents who experienced high levels of trauma symptoms showed pathological mental symptoms. After the earthquake, adolescents should be evaluated periodically in terms of posttraumatic stress symptoms. In the evaluations to be made, it is important to determine how adolescents are affected especially mentally. In this context, interventions should be implemented for the identified mental symptoms (anxiety, depression, somatization, etc.). Highlights: The first strength of the study was that the adolescents who experienced the earthquake had severe trauma symptoms.The second strength of the study was that the general mental symptom level mean scores of the adolescents who experienced the earthquake were at the pathological level.The third strength of the study is that the posttraumatic stress reactions of the adolescents who experienced the earthquake were related to the psychological symptoms (anxiety, depression, somatization, anger‐hostility, obsessive–compulsive symptoms, interpersonal sensitivity, phobic anxiety, paranoid thoughts, psychotic symptoms, other problems, and general mental symptom levels) revealed that it explained 97.2%.It was seen that the most important predictor of the psychological symptoms of the adolescents who experienced the earthquake was the trauma symptoms.The fourth strongest aspect of the study is the age of the adolescents who experienced the earthquake, the total number of losses they experienced in the earthquake, the number of losses they experienced in the nuclear family, the hours they were buried under the rubble, the time they waited for their father to come out under the rubble, the time they waited for their mother to come out under the rubble, It was determined that the duration of waiting time, injury status and loss due to earthquake explained 74.4% of posttraumatic stress response states. [ABSTRACT FROM AUTHOR]