Youth may develop posttraumatic stress disorder (PTSD) following a hurricane. Triaging of mental health services is crucial to effectively deliver trauma-focused interventions following natural disasters. Given the increased likelihood of hurricanes due to the current climate crisis, this study sought to examine the dose-response effect between hurricane-related stressors and PTSD, identify a cumulative stressor cutoff score based on the number of hurricane-related stressors experienced, and identify important individual hurricane-related stressors in explaining PTSD symptoms among youth. Participants included 92,293 youth (Grades 3-12) who completed a needs-based assessment in schools across Puerto Rico 5-9 months following Hurricane Maria. Machine learning analyses were used to examine the relationship between hurricane-related stressors and the severity and elevated levels of PTSD. Youth who endorsed more disaster-related exposures exhibited greater severity and elevated levels of PTSD symptoms. A cutoff of seven or more cumulative stressors best discriminated between youth with elevated and nonelevated PTSD symptoms. Three high-value stressors were identified that best explained the variance in PTSD severity scores and provided acceptable accuracy in classifying youth by elevated versus nonelevated PTSD status: fear of dying, fights, or violence in the home or neighborhood and difficulties accessing food or water. Hurricane-related stressors explained 20.1% of variance in PTSD severity scores and accurately classified 77.6% of youth with elevated PTSD, with the relative importance of stressors varying between outcomes. Implications for triaging care for comprehensive trauma treatment, policies affecting disaster response efforts, and directions for future natural disaster research are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
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