The Psychological Impact of Adult Traumatic Brachial Plexus Injury.

PURPOSE: There is a high incidence of posttraumatic stress disorder (PTSD), depression, suicide risk, and psychological distress after orthopedic trauma and hand and upper-extremity injury. Although patients with traumatic adult brachial plexus injury are particularly vulnerable to psychologic distress, minimal clinical data exist about this cohort of patients. In this study, we sought to discover the prevalence of depression, PTSD, suicidal ideation, and substance abuse.

METHODS: Between February, 2013 and July, 2014, during scheduled preoperative and/or postoperative appointments, the social worker at a metropolitan brachial plexus center conducted psychosocial assessments and questionnaire assessments of 21 patients evaluating for PTSD, depression, and substance use using 3 validated scales: PTSD Checklist-Specific, Patient Health Questionnaire-8, and National Institute on Drug Abuse Quick Screen.

RESULTS: Brachial plexus injury strongly affected self-reported psychological well-being; 7 of 21 (33.3%) divulged suicidal ideation. Diagnosticand Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) diagnosis was supported by PTSD Checklist-Specific and Patient Health Questionnaire-8 results: 4 of 21 (19.0%) met criteria for PTSD and 4 of 21 (19.0%) exhibited clinical depression. Patients reported no changes in social alcohol and tobacco use or substance abuse.

CONCLUSIONS: Brachial plexus injury significantly influences psychological well-being and daily functioning. As a result, patients experience a high prevalence of PTSD, depression, and suicidal ideation. Patients with brachial plexus injury have a high prevalence of psychological concerns and challenges that require continued attention throughout treatment.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.