Bereavement after sibling death: a population‐based longitudinal case‐control study

Abstract

The objective of this study was to examine mental disorders and treatment use among bereaved siblings in the general population. Siblings (N57243) of all deceased children in the population of Manitoba, Canada who died between 1984 and 2009 were matched 1:3 to control siblings (N521,729) who did not have a sibling die in the study period. Generalized estimating equations were used to compare the two sibling groups in the two years before and after the index child's death on physician-diagnosed mental disorders and treatment utilization, with adjustment for confounding factors including pre-existing mental illness. Analyses were stratified by age of the bereaved (<13 vs. 131). Results revealed that, in the two years after the death of the child, bereaved siblings had significantly higher rates of mental disorders than control siblings, even after adjusting for pre-existing mental illness. When comparing the effect of a child's death on younger versus older siblings, the rise in depression rates from pre-death to post-death was significantly higher for siblings aged under 13 (p<0.0001), increasing more than 7-fold (adjusted relative rate, ARR57.25, 95% CI: 3.65-14.43). Bereaved siblings aged 131 had substantial morbidity in the two years after the death: 25% were diagnosed with a mental disorder (vs. 17% of controls), and they had higher rates of almost all mental disorder outcomes compared to controls, including twice the rate of suicide attempts (ARR52.01, 95% CI: 1.29-3.12). Siblings in the bereaved cohort had higher rates of alcohol and drug use disorders already before the death of their sibling. In conclusion, the death of a child is associated with considerable mental disorder burden among surviving siblings. Pre-existing health problems and social disadvantage do not fully account for the increase in mental disorder rates.Key words: Sibling, bereavement, epidemiology, depression, suicide, mental disorder (World Psychiatry 2016;15:59-66) Most children have a sibling 1 . While fertility rates are lower in Western nations and family sizes have diminished in recent decades, the majority of households with children in the U.S. in 2010 had two or more children 2 . Each year more than 40,000 children and adolescents die in the U.S., leaving a substantial number of bereaved siblings 3 .Sibling bereavement is an experience with a very sparse literature and thus the consequences of losing a sibling are unclear. A series of Swedish national cohort studies revealed increased mortality of bereaved siblings when compared to non-bereaved controls 4-8 . These analyses, however, were restricted to adult sibling populations and did not examine outcomes other than death.Other smaller studies have examined bereavement experiences related to specific causes of sibling death, namely cancer and suicide, with mixed findings 9-12 . One study of cancerrelated bereavement showed no differences in anxiety and depression between bereaved and non-bereaved siblings 13 , while other descriptive case series found anxiety, substance mis...

Risk of suicide, deliberate self‐harm and psychiatric illness after the loss of a close relative: A nationwide cohort study

“…Although bereavement is a natural life event, it is often followed by emotional suffering and adjustment challenges. Studies have shown an association between the loss of a loved one and a range of mental health complications, particularly depression and post‐traumatic stress disorder.…”

Perder um irmão até à adolescência - a experiência e o significado na vida adulta

“…[3][4][5] The relation between siblings is perhaps the most significant and lasting relation that if you live The child, who loses a brother during his or her childhood or adolescence, is naturally the family member who lives the most time with this loss. 2,[6][7]30 It is explained that in the situation where there is a child / adolescent with a complex chronic life-limiting illness, which may even be prolonged for some time and which is understandably the center of care for the whole family, the brother resents for lack of equal attention, 9,24 loses visibility within his own family, 10,28 sometimes receiving messages from close friends to restrain his hurt, to be strong by his parents. These behaviors lead the child to feel that the pain of their loss is discredited, devalued, misunderstood, ignored.…”

“…Some studies 8,14,21,28 show that, in the long run, surviving siblings may still feel guilty, high vulnerability, anxiety, fear of dying prematurely, excessive concern with others, especially with regard to their own children. 18 It is evidenced, through the results of investigations, 6,30 fraternal grieving as a period of vulnerability and an important focus of attention for the accompaniment of the people who live this experience. They also underline the relevance to public awareness of the importance of developing support structures for bereaved people.…”

Psychosocial outcomes in cancer‐bereaved children and adolescents: A systematic review

“…Siblings of children with cancer might experience this lack of attention already during the sibling's cancer illness, leading to feelings of loneliness, jealousy, anger, and guilt . Bereaved siblings showed prolonged grief; higher rates of mental disorders, ie, depression, anxiety, and substance use disorder; and higher rates of suicide attempts compared with nonbereaved siblings . After a major life crisis, like the death of a family member, individuals might also experience a positive change, as indicated by reports of personal or posttraumatic growth (PTG) after parental or sibling loss …”