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The Mental Health Implications of Obstetric Brachial Plexus Injuries (OBPI) on Parents
Karan Dua, MD; Catherine Miller, LCSW-C; Nathan O'Hara, MHA; Joshua M. Abzug, MD
University of Maryland School of Medicine, Baltimore, MD
Introduction: Obstetric brachial plexus injuries (OBPI) can have mental health implications on parents coping with this injury to their newborn. Previous studies have reported increased rates of depression in mothers of children with an OBPI and parents having unresolved feelings of sadness and anger. However, the rates of post-traumatic stress disorder (PTSD) have never been reported. The purpose of this study was to assess the mental health of parents with newborns with an OBPI and create an interdisciplinary model that can identify and provide the proper resources to help these parents.
Materials and Methods: Three groups of parents were prospectively given a 10-minute self-reported survey: 1) Newborns with OBPI; 2) Newborns in nursery without OBPI; 3) Newborns in neonatal ICU (NICU). The survey consisted of demographic questions, the PHQ-9 and PCL-S screening tools, and parents’ exposure to community violence, family support, and use of drugs or alcohol. The PHQ-9 is a 10-item depression survey that asks respondents to rate their mood symptoms on a likert scale and the PCL-S is a 17-item PTSD survey that rates symptoms on a likert scale.
Results: 51 parents were enrolled including 41 mothers and 10 fathers. 33 mothers took the PHQ-9 portion of the survey and 4 screened in for depression (15.4% for NICU, 0% for newborn nursery, 9% for OBPI). 41 mothers took the PCL-S portion of the survey and 18 screened in for PTSD (46% for NICU, 0% for newborn nursery, 45.5% for OBPI). Mothers were more likely to experience PTSD than depression symptoms with newborns with an OBPI or admitted to the NICU (p < .05). Exposure to community or family violence did not affect the rate of PTSD.
Of the 10 fathers, two in the OBPI group screened in for depression. Two fathers (1 in OBPI and 1 in NICU) reported exposure to community or family violence.
Conclusion: OBPI can be very difficult to cope with for parents and family members. 46% of mothers with newborns with OBPI or children in the NICU screened in for PTSD, which is well above the national average of 3.5% for PTSD during pregnancy. PTSD is treatable and possibly preventable with appropriate psychosocial care following newborn delivery. Untreated PTSD in parents with a child with an OBPI affects the entire family. OBPI clinics should be staffed similarly to the NICU with clinical social workers to appropriately screen and treat parents with PTSD symptoms.
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