Neural vulnerability and hurricane-related media predict posttraumatic stress in youth

As natural disasters increase in frequency and severity1, 2, mounting evidence reveals that their human toll extends beyond death, injury, and loss. Posttraumatic stress (PTS) can be common among directly exposed individuals, and children are particularly vulnerable3, 4. Curiously, PTS can even be found among youth far removed from harms way, and media-based exposure may partially account for this phenomenon5-8. Unfortunately, susceptibility to media effects has been difficult to characterize because most research is initiated post-event, precluding examination of pre-disaster factors. In this study, we mitigate this issue with data from nearly 400 9-to 11-year-old children collected prior to and after Hurricane Irma. We evaluate whether preexisting neural patterns moderate associations between hurricane experiences and later Irma-related PTS. We show that "dose" of both objective exposure and Irma-related media exposure predicted Irma-related PTS, the latter even among children dwelling thousands of kilometers away from the hurricane. Furthermore, we show, using pre-hurricane functional magnetic resonance imaging data, that neural responses in brain regions associated with anxiety and stress confer particular vulnerability to the psychological effects of hurricane exposure among certain children. Surprisingly, this was even the case for media exposure- we found that that right amygdala reactivity to fearful stimuli moderated the association between Irma-related media exposure and PTS symptoms, with the media-PTS association strongest for children showing pre-hurricane heightened amygdala reactivity to Fear vs Neutral Faces. In contrast, in bilateral orbitofrontal cortex and left parahippocampal gyrus, children showing a weak response to the Fear condition relative to the Neutral condition were especially susceptible to PTS as a result of Irma-related media exposure. Collectively, these findings run counter to outdated "bullseye" models of disaster exposure that assume negative effects are narrowly circumscribed around a disasters geographic epicenter9. In contrast, for some youth with measurable preexisting vulnerability, consumption of extensive disaster-related media appears to offer an alternative pathway to disaster exposure that transcends geography and objective risk. This preventable exposure should be considered in disaster-related mental health efforts.