Siblings of children with chronic health conditions could be at an increased risk for depression, according to a new report.
In a systematic review of 34 studies, siblings of children with chronic health conditions had significantly higher scores on depressive rating scales than individuals without a sibling with a chronic health condition (standardized mean difference [SMD] = 0.53; P < .001). Findings related to other clinical health outcomes, such as physical health conditions or mortality, were inconsistent.
“We’ve known for a long time that siblings of kids with chronic conditions undergo stress, and there have been conflicting data on how that stress is manifested in terms of their own health,” senior study author Eyal Cohen, MD, program head for child health evaluative sciences at the Hospital for Sick Children in Toronto, Canada, told Medscape Medical News.
“For some siblings, having the experience of being raised with a child with a chronic condition may be an asset and build resiliency, while other siblings may feel strong negative emotions, such as sadness, anger, and fear,” he said. “Although we know that this experience is stressful for many siblings, it is important to know whether it changes their health outcomes, so that appropriate support can be put in place for those who need it.”
The study was published online July 7 in The Journal of Pediatrics.
Risk for Psychological Challenges
About a quarter of children in the United States have a mental, emotional, developmental, or behavioral condition, and more than a third have at least one current or lifelong health condition, the study authors write. A childhood chronic health condition can affect family members through worse mental health outcomes, increased stress, and poorer health-related quality of life.
Cohen and colleagues conducted a systematic review and meta-analysis to assess the clinical mental and physical health outcomes of siblings of children with chronic health conditions in comparison with siblings of healthy children or normative data.
The research team included English-language studies that reported on clinically diagnosable mental or physical health outcomes among siblings of persons younger than 18 years who had a chronic health condition. They included a comparison group and used an experimental or observational design for their study. The researchers analyzed 34 studies, including 28 that reported on mental health, three that reported on physical health, and three that reported on mortality.
Overall, siblings of children with chronic health conditions had significantly higher scores on depression rating scales than their comparison groups. Siblings’ anxiety scores weren’t substantially higher, however (SMD = 0.21; P = .07).
The effects for confirmed psychiatric diagnoses, physical health outcomes, and mortality could not be included in the meta-analysis, owing to the limited number of studies and the high level of heterogeneity between the studies.
Cohen noted that although the researchers weren’t surprised that siblings may be at increased risk of mental health challenges, they were surprised by the limited data regarding physical health.
“At a minimum, our findings support the importance of asking open-ended questions about how a family is doing during clinical encounters,” he said. “These siblings may also benefit from programs such as support groups or summer camps, which have been shown to improve mental health and behavioral outcomes in siblings of children with chronic health conditions, such as cancer and neurodevelopmental disabilities.”
Future studies should assess the specific risk factors for mental health problems in siblings of children with chronic health conditions, Cohen said. Additional research could also investigate the design and effectiveness of interventions that address these concerns.
Message of Inclusiveness
“The message that resonates with me is about the interventions and resources needed to support siblings,” Linda Nguyen, a doctoral student in rehabilitation science and researcher with the CanChild Center for Childhood Disability Research at McMaster University in Hamilton, Ontario, told Medscape.
Nguyen, who wasn’t involved with this study, has researched the resources available to siblings in Canada and has found a lack of support options, particularly when it comes to specific healthcare management roles.
“Consistently throughout my research, I’ve seen the need for resources that go beyond a focus on siblings’ well-being and instead support them in their different roles,” she said. “Some want to be friends, mentors, supporters, and caregivers for their siblings in the future.”
Siblings often adopt different roles as they form their own identity, Nguyen noted, which becomes a larger part of the healthcare conversation as children with chronic conditions make the transition from pediatric to adult healthcare. Siblings want to be asked how they’d like to be involved, she said. Some would like to be involved with healthcare appointments, the chronic condition community, research, and policymaking.
“At the societal level and public level, there’s also a message of inclusiveness and making sure that we’re welcoming youth with disabilities and chronic conditions,” Jan Willem Gorter, MD, PhD, a professor of pediatrics and scientist for CanChild at McMaster University, told Medscape.
Gorter, who also was not involved with this study, noted that children with chronic conditions often feel left behind, which can influence the involvement of their siblings as well.
“There are a lot of places in the world where children with disabilities go to special schools, and they spend a lot of time in a different world, with different experiences than their siblings,” he said. “At the public health level, we want to advocate for an inclusive society and support the whole family, which benefits everybody.”
The study was funded by the Canadian Institutes of Health Research and the CHILD-BRIGHT Network summer studentship, which is supported by the Canadian Institute for Health Research Strategy for Patient-Oriented Research. Cohen, Nguyen, and Gorter have disclosed no relevant financial relationships.
J Pediatr. Published July 7, 2022. Abstract
Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.
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