Psychological distress in siblings of people with mental illness: A systematic review and meta-analysis

Jayasinghe, Anuradhi; Wrobel, Anna L; Filia, Kate; Byrne, Linda K.; Melvin, Glenn; Berk, Lesley; Berk, Michael; Cotton, Sue

doi:10.1177/00048674221123481

Cited by 6 publications

(11 citation statements)

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“…Finally, our moderator analyses indicate that siblings’ anxiety symptoms decrease with their age. This stands in contrast with the findings of our prior review, which suggests sibling age is unrelated to the severity of their anxiety symptoms (Jayasinghe et al, 2022 ). One possibility for this inconsistency is that siblings’ anxiety is moderated by factors that we were unable to assess such as category of MI, stage of illness, illness severity, level of parental involvement, time spent with a sibling with an MI, and/or extent of caregiving.…”

Section: Discussioncontrasting

confidence: 99%

“…However, there are no prior reviews comparing sibling subgroups to shed further light on this difference. Our finding that male siblings experience greater depressive symptoms, while potentially interesting due to its discrepancy with previous reviews (Baronet, 1999;Fekadu et al, 2019;Jayasinghe et al, 2022;Shivers & Textoris, 2021), should be interpreted with caution. Gender was no longer a significant covariate after removal of two outlying studies, which both included siblings of people with a schizophrenia spectrum disorder.…”

Section: Distresscontrasting

confidence: 93%

“…The synthesis of such broad-ranging constructs is likely to have contributed to the mixed findings in previous reviews and hinders our ability to elucidate the nature of specific psychological characteristics in siblings. A recent meta-analytic review conducted by our study team suggests that individuals with a sibling with MI experience significantly greater symptoms of depression and anxiety than those without (Jayasinghe et al, 2022 ). However, no review to date has synthesised quantitative findings on burden and wellbeing in siblings, and the extent of distress in siblings remains unclear.…”

Section: Introductionmentioning

confidence: 97%

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Distress, burden, and wellbeing in siblings of people with mental illness: a mixed studies systematic review and meta-analysis

Jayasinghe,

Wrobel,

Filia

et al. 2023

Psychol. Med.

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Background Family members of people with mental illness (MI) may experience a host of psychological adversities such as increased stress, burden, and reduced wellbeing. However, relatively little is known about siblings. This study aimed to characterise the experience of distress (viz. depressive and anxiety symptoms), burden, and wellbeing in siblings of people with MI. Methods Studies reporting on quantitative measures of depression, anxiety, burden, or wellbeing in siblings; and/or qualitative findings on siblings’ experience were eligible. The literature search was conducted up until 20th October 2022. Results Sixty-two studies comprising data from 3744 siblings were included. The pooled mean percentage of depressive symptoms fell in the mild range at 15.71 (k = 28, N = 2187, 95% CI 12.99–18.43) and anxiety symptoms fell in the minimal range at 22.45 (k = 16, N = 1122, 95% CI 17.09–27.80). Moderator analyses indicate that siblings of people with a schizophrenia spectrum disorder experience greater depressive symptoms than siblings of people with other types of MI (β = −16.38, p < 0.001). Qualitative findings suggest that individuals may be particularly vulnerable during their siblings’ illness onset and times of relapse. Limited communication, confusion about MI, and the need to compensate may contribute to siblings’ distress and/or burden. Siblings’ experience of wellbeing and caregiving were closely related. Conclusion This review highlights the complex psychological experience of siblings and the need for greater research and clinical support for this important yet often overlooked cohort.

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Section: Discussioncontrasting

confidence: 99%

Section: Distresscontrasting

confidence: 93%

Section: Introductionmentioning

confidence: 97%

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Distress, burden, and wellbeing in siblings of people with mental illness: a mixed studies systematic review and meta-analysis

Jayasinghe,

Wrobel,

Filia

et al. 2023

Psychol. Med.

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“…On the other hand, parents exposed to a child's mental disorder may experience distress arising from witnessing their own child's disorder, which is often accompanied by a need to invest additional economic resources and social support to provide care for their child. Each of these can adversely affect the well-being of the caregiver and other family members [7][8][9][10][11][12][13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

The Associations of Mental Disorders in Children With Parents’ Subsequent Mental Disorders: A Nationwide Cohort Study From Finland and Denmark

Hakulinen,

Gutvilig,

Niemi

et al. 2024

Preprint

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BackgroundIntergenerational transmission of mental disorders has been well established, but it is unclear whether exposure to a child’s mental disorder increases parents’ subsequent risk of mental disorders. We examined the association of mental disorders in children with their parents’ subsequent mental disorders.MethodsIn this population based-cohort study, we included all persons with children born in Finland or Denmark in 1990–2010. Information of mental disorder was acquired from national registers. The follow-up period began when the parent’s eldest child was 5 years old ( for codes F10–F60 ICD-10) or 1 year old (for codes F70–F98 of the ICD-10). Follow-up ended on December 31st, 2019, or when the parent received a mental disorder diagnosis, died, or emigrated from Finland or Denmark. We used the time to a parental mental disorder as the main outcome.FindingsThe study cohort included 1 651 723 parents. In total, 248 328 women and 250 763 men had at least one child who was diagnosed with a mental disorder. The risk of a parent receiving a mental disorder diagnosis was higher among those who had a child with a mental disorder compared to those who did not. For both parents, the hazard ratios were greatest in the first six months after the child’s diagnosis, followed by a subtle decline in the risk.InterpretationMental disorders in children were associated with a greater risk of subsequent mental disorders among their parents. Although shared genetic and environmental mechanisms plausibly explain a share of these associations, the time-dependent associations suggest that offspring mental disorders may temporarily increase parental risk of mental disorders. Additional support is needed for parents whose children have been recently diagnosed with a mental disorder.FundingEuropean Research Council (ERC), Research Council of Finland, Lundbeck FoundationResearch in contextEvidence before this studyWe searched for titles and abstracts of articles published in Web of Science and PubMed from 1stJanuary 1 1990 to 1stApril 2024, using the following terms: ((parent* or maternal or paternal or mother* or father* or family or familial or care giver) and (generation* or intergeneration* or transmission) and (mental or psychiatric or alcohol or drug or substance or schizo* or depress* or mood disorder* or bipolar or personality or neurotic or somatoform or obsessive compulsive or eating disorder or anorexia or psychos* or psychotic). We additionally screened reference lists of identified articles. Our literature review indicated that, although the intergenerational transmission of mental disorders has been well established, it remains unclear whether child’s mental disorder increases the risk of parents’ mental disorders. Many earlier studies focused on those persons taking care of a family member with a mental disorder and where small in scale and used non-representative samples. Previous studies that explicitly examined the consequences of children’s mental disorders for their parents focused on specific disorders, such as schizophrenia and autism.Added value of this studyIn this cohort study of over 1.6 million parents from Finland and Denmark, we conducted a comprehensive investigation of whether mental disorders in children are associated with their parents’ subsequent risk of mental disorders. We examined the population-level associations across the full spectrum of mental disorders diagnosed in childhood, adolescence, and early adulthood. Our results demonstrate that, there was a time-dependent association of offspring mental disorder with subsequent risk of parental mental disorder. For both women and men, the risk of a parent receiving a mental disorder diagnosis was at its highest in the first six months following the child’s diagnosis. In contrast to the analyses including any diagnosis of a child, our results from the analyses limited to specific disorders showed that was observed among women, but not in men, across most of the children’s diagnostic categories. Our reslults across Finland and Denmark were generally consistent.Implication of all the available evidenceOur results indicate that children’s mental disorders may temporarily increase their parents’ risk of mental disorders. Although shared genetic and environmental mechanisms are likely to explain a share of these associations, further research for specific mechanisms is needed.Parents whose children have been recently diagnosed with a mental disorder could potentially benefit from additional support.

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“…The negative outcomes reported for siblings were increased behavioural and internalizing symptoms, and social problems. A later metaanalytic review focused more specifically on depression and anxiety outcomes in siblings of persons with mental illness (Jayasinghe et al, 2023). This review included 15 studies with siblings aged >10 years of persons with various mental disorders ranging from anxiety/depression to schizophrenia.…”

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confidence: 99%

Mental Health and Well-being in Adolescent and Adult Siblings of Persons with Severe Mental Illness: A Scoping review

Lønning,

Fjermestad,

Haugland

2024

J Child Fam Stud

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Systematic knowledge about siblings of persons with mental illness is needed. The aim of this literature review was to gain knowledge about the mental health and well-being of siblings of individuals with severe mental illness (i.e., bipolar disorder, schizophrenia, eating disorders, psychosis) and factors associated with sibling outcomes. We reviewed quantitative studies published between 1990 and 2022 where siblings aged >12 years were compared to healthy control individuals. Eleven studies were included (combined sibling n = 1736). Seven of the 11 studies reported solely more negative outcomes for siblings than for healthy control individuals. Two studies reported both more negative and more positive sibling outcomes, with one study reported solely more positive outcomes and one no difference between siblings and healthy control individuals. The studies reporting negative outcomes had the highest methodological quality. The following factors were associated with sibling outcomes; demographic factors, i.e., age, sex, and number of siblings in the family, contextual factors, i.e., having contact with health care professionals due to own mental health problems, and characteristics of the sibling with severe mental illness, i.e., premorbid adjustment. The findings show that a family system approach with interventions addressing the entire family is indicated when a person is treated for severe mental illness. Further research on sibling outcomes should address methodological challenges such as poor representativeness and a wide age range in samples and use well-validated outcome measures. Factors associated with sibling outcomes should be examined further to increase the understanding of risk and protective factors in siblings.

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Psychological distress in siblings of people with mental illness: A systematic review and meta-analysis

Cited by 6 publications

References 91 publications

Distress, burden, and wellbeing in siblings of people with mental illness: a mixed studies systematic review and meta-analysis

Distress, burden, and wellbeing in siblings of people with mental illness: a mixed studies systematic review and meta-analysis

The Associations of Mental Disorders in Children With Parents’ Subsequent Mental Disorders: A Nationwide Cohort Study From Finland and Denmark

Mental Health and Well-being in Adolescent and Adult Siblings of Persons with Severe Mental Illness: A Scoping review

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