Beyond direct trauma: Vicarious exposure, media-induced stress, and external stress overload as emerging public mental health challenges

Abstract

People are increasingly exposed to distressing events through news feeds, social media, images, videos, and continuous digital updates. In clinical practice, some patients describe anxiety, sleep disturbance, irritability, exhaustion, and difficulty disengaging from threat-related information, even when they have not been directly exposed to a traumatic event. Existing concepts, including vicarious trauma, media-induced stress, doomscrolling, and infodemic-related distress, address aspects of this phenomenon but do not provide an integrated conceptual framework. This structured narrative review examines how indirect exposure to threat-related information may contribute to psychological distress and proposes external stress overload as a clinical and public mental health framework. A structured literature search was conducted in PubMed, PsycINFO, and Google Scholar for studies published between 1990 and 2025. Evidence from longitudinal, cross-sectional, experimental, review, and conceptual studies was narratively synthesised. Most available evidence is observational and heterogeneous. Therefore, external stress overload should be regarded as a hypothesis-generating conceptual framework rather than a new diagnosis or an empirically established construct. The available literature suggests that repeated exposure to emotionally salient and uncertainty-amplifying information is associated with anxiety, depressive symptoms, sleep disturbance, acute stress reactions, and functional impairment. The association appears stronger when exposure is repetitive, graphic, prolonged, or difficult to disengage from. Cognitive processes such as intolerance of uncertainty and rumination, together with behavioral patterns such as repeated checking or doomscrolling, may help sustain distress. Neurobiological findings on stress-system activation, amygdala reactivity, prefrontal regulation, and allostatic load provide biologically plausible, albeit indirect, support for the proposed framework. External stress overload should not be understood as a new diagnosis. Rather, it should be viewed as a working conceptual framework for understanding how persistent indirect threat exposure, insufficient recovery, and maladaptive information engagement may contribute to psychological distress in contemporary digital environments.

Keywords: External stress overload; Vicarious trauma; Media-induced stress; Digital mental health; Doomscrolling; Psychological distress; Intolerance of uncertainty; Public mental health

Core Tip: This review proposes external stress overload as a clinical framework for understanding how repeated indirect exposure to threatening information may contribute to distress in contemporary digital environments. The model integrates evidence on vicarious trauma, media-induced stress, doomscrolling, uncertainty, rumination, impaired recovery, and stress biology. It is not presented as a new diagnosis, but as a working concept that may help clinicians assess when media exposure, poor recovery, and repeated checking become maintaining factors for anxiety, sleep disturbance, emotional dysregulation, and functional impairment.