The mental health and wellbeing of siblings of children with mental health problems: two decades of research.

Abstract

Childhood mental health problems (MHPs) can have a significant long-term impact on the lives of children and on the systems to which the child belongs, including family and school. For example, it is widely accepted that there is a bi-directional, interactional relationship between family functioning and childhood mental health, and extensive research has explored this relationship (Parritz & Troy, 2011). However, the role of siblings has largely been ignored. Sibling relationships have been identified as making significant contributions to our psychological wellbeing (Dunn, 1983; Fagan & Najman, 2003). For example, sibling relationship problems (e.g. conflict) have been linked to negative attributes such as depressive symptoms and decreased social competence (Milevsky, 2005). Furthermore, existing theoretical frameworks, such as developmental psychopathology (Parritz & Troy, 2011) and impact of illness frameworks (Wallander & Varni, 1992), suggest that siblings of children with MHPs would have an increased risk of MHPs and poorer wellbeing. Yet, little research has been conducted with this population. This dissertation describes an attempt to address this gap and advance our understanding of the mental health and wellbeing of siblings of children with MHPs. Papers 1 to 4 report on a 20-year systematic review of the existing literature with each study reporting on a different aspect of the mental health and wellbeing of siblings: The prevalence of psychopathology from a categorical and dimensional perspective, the quality of family relationships, and the experiences and coping strategies of siblings. The reviews of the quantitative literature suggest that siblings of children with MHPs are at greater risk of MHPs than control children. Developmental psychopathology risk factors, such as parental psychopathology, were implicated as predictors of the mental health of siblings. However, the data were not conclusive due to significant methodological limitations in the literature. The reviews of family relationships and qualitative literature described a significant negative impact on all areas of the sibling’s life, including relationships and daily routine. These reviews supported impact of illness frameworks as having a role in the mental health of siblings of children with MHPs. Papers 5 and 6 report on primary research aimed at exploring the mental health and treatment utilisation of siblings of children with MHPs within a clinical population. The key findings were that these siblings were almost four times more likely to have MHPs compared to the general population and had high rates of treatment utilisation. Furthermore, birth order and age difference were related to MHPs in siblings. These findings have important implications for clinical practice and assessment. The present dissertation argues that although limited by methodological issues, the literature strongly suggests that siblings of children with MHPs are a high-risk group for poorer mental health and wellbeing. This dissertation highlights the role of multiple theories, including developmental psychopathology and impact of illness frameworks, in the mental health of siblings. Methodological guidelines and potential treatment and prevention strategies are outlined. This dissertation has contributed significantly to our understanding of siblings of children with MHPs with important implications for both clinical practice and research.