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Psychological Burden Following Traumatic Brachial Plexus Injury and the Protective Mental Benefits of Timely Surgical Reconstruction
Jackson Cathey, BS
1, Joey M Liang, BS
2, Neill Y. Li, MD
3; Eliana Saltzman, MD
2(1)Duke University, Durham, NC, (2)Duke University School of Medicine, Durham, NC, (3)Duke University Medical Center, Durham, NC
Introduction: The psychological burden of traumatic brachial plexus injury (BPI) is poorly characterized, and the impact of reconstruction on mental health remains unknown. This study evaluated psychological outcomes following BPI in comparison to distal peripheral nerve injuries (PNI) and explored whether timely reconstruction led to a reduction in psychiatric diagnoses. We hypothesize that BPI leads to greater incidence of anxiety and depression, but timely reconstruction confers protection against these sequelae.
Materials/Methods: We queried a large, multicenter database (TriNetX) identifying adults with traumatic BPI (ICD-10=S14.3) between 2010-2025. Three-year incidence of
new psychiatric diagnoses (composite groupings following DSM5 categorizations) was compared to the general population (active enrollment, no BPI) and a matched cohort with distal PNI (S44, S54, S64). Propensity-score matching was 1:1 based on age, sex, BMI, and pre-injury antidepressant use. The BPI cohort was stratified by receipt of nerve reconstruction/transfer within 1 year of injury. Outcomes were compared between matched BPI and PNI cohorts, BPI patients with and without reconstruction (matched), and the reconstruction cohort and general population.
Results: Among 25,019 BPI patients, the 3-year cumulative incidence of psychologic diagnoses was significantly higher than in the general population (Table 1). Compared to matched controls, BPI patients had a 31% higher risk of mood disorders (RR=1.31[1.22-1.40], p<0.001), 23% higher risk of anxiety/stress disorders (RR=1.23[1.15-1.31], p<0.001), and 25% higher risk of composite diagnoses (RR=1.25[1.19-1.34], p<0.001) (Figure 1). BPI patients with reconstruction (n=1,600) had significantly lower risk of mood (RR=0.76[0.58-0.99], p=0.048) and anxiety disorders (RR=0.77[0.60-0.99], p=0.040) (Figure 2), with rates comparable to the general population (Table 2).
Conclusions: Traumatic BPI carries a significant psychological burden, warranting routine mental health screening and interdisciplinary care through utilization of psychologists, psychiatrists, pain management physicians, and physical/occupational therapy providers. Timely evaluation and surgical reconstruction may confer protective benefit and should factor into treatment planning for high-risk patients.
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