Brachial Plexus Birth Injuries May Increase the Risk of Mental Health Issues

The brachial plexus is a network of nerves located near the neck, which are connected to the arm. Sometimes, these nerves are damaged during the delivery process, when physicians apply excess force to get the baby out of the birth canal. The risk of shoulder dystocia is increased by use of forceps or vacuum extractors, and this can lead to brachial plexus injury.  While some babies with brachial plexus birth injuries may make a full recovery, others  have permanent arm weakness or paralysis (this is a condition known as Erb’s palsy). Moreover, recent research indicates that brachial plexus nerve damage may increase the risk of psychological issues later in life.

Researching the Connection Between Brachial Plexus Injury and Mental Health

Elia Psouni and colleagues from Lund University in Sweden recently published a paper on mental health in adolescents who had brachial plexus injuries at birth. They used data collected by Statistics Sweden and the National Board of Health and Welfare, which included information on birth injuries as well as prescriptions for psychotropic drugs this was used as an indication of mental health conditions. Psouni et al. (2018) included all children born in Sweden between 1987 and 1993, who had not died or emigrated. The authors excluded subjects whose parents were not born in Sweden, due to “evidence of relative underuse of psychotropic drugs in relation to needs in adolescent descendants of migrant women” (this information was derived from a study by Van Leeuwen et al. 2012). They were left with a sample of 641,151 adolescents between the ages of 12 and 21, who had sustained brachial plexus injuries of varying severities.

Rather than simply looking for an association between brachial plexus injuries and psychotropic drug prescriptions, Psouni et al. also examined the potential roles of socioeconomic status and sex.

Conclusions

Psouni et al. found that adolescents who had sustained a brachial plexus injury at birth were more likely to have psychological conditions. This was true of all socioeconomic levels, and equally important in males and females. Being female or having a lower family income further increased the likelihood of psychotropic drug use. Among girls from low income families, brachial plexus injury added no additional risk, but in the other subgroups it did.

The authors note that children’s own concerns about their injury even if damage is not severe may lead to mental health issues. Parents of children with brachial plexus injuries may also experience psychological problems due to the stress of caring for their children.

Previous research on mental health in young children with brachial plexus injuries showed mixed results. However, Psouni et al. note that this is the first study to look at adolescence, which is “an emotionally turbulent period when peer acceptance and independent achievement become increasingly important.”

Limitations

Although psychotropic drug use is a useful proxy for mental health issues, the authors did not have data on other indicators, such as psychotherapy. This means that the incidence of psychological conditions may have been underestimated in all study populations.

Moreover, children with brachial plexus injuries may have more regular contact with medical professionals, due to physical complications, and may also turn to these people when experiencing mental health problems. Therefore, these children might be more likely to get prescriptions for psychotropic drugs.

Overall, the study by Psouni et al. indicates that children with brachial plexus injuries may require additional psychological support as they grow up. However, further research should be done to elucidate whether there is indeed a causal relationship between brachial plexus injury and mental health issues.

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