Psychosocial Adjustment of Adolescent Siblings of Hematopoietic Stem Cell Transplant Patients

Abstract

Hematopoietic stem cell transplantation (HSCT) is a widely practiced therapy for many life-threatening childhood disorders. The authors investigated the psychosocial effects of HSCT on siblings of pediatric HSCT patients (n = 44; 21 donors, 23 nondonors, ages 6 to 18 years). Donor siblings reported significantly more anxiety and lower self-esteem than did nondonors. Nondonors showed significantly more school problems. Approximately one third of all siblings reported moderate to severe posttraumatic stress. The study drew on the developmental theory of Erik Erikson and the psychosocial model of posttraumatic stress. As part of the study, the authors used the Measures of Psychosocial Development (MPD), a self-report measure based on Eriksonian constructs. The MPD was used to assess the psychosocial adjustment of 12 siblings who were adolescents (> or =13 years) at the time the study was conducted. In this article, findings are presented from the MPD as well as salient findings from the larger study.

Psychological effects of hematopoietic SCT on pediatric patients, siblings and parents: a review

“…The literature has shown that siblings of HSCT patients are at risk of developing emotional reactions such as post-traumatic stress disorder, anxiety, and overall low self-esteem. [31][32][33][34] Pot-Mees and Zeitlin 8 found new behavior problems occurred far more frequently among siblings who were BM donors than among nondonors. See Table 4 for a list of psychosocial reactions specific to siblings.…”

Family Strategies to Support Siblings of Pediatric Hematopoietic Stem Cell Transplant Patients

“…30–32 Interestingly, rates of moderate-to-severe posttraumatic stress symptoms were equal among donor and nondonor siblings in 1 study. 31 In addition, siblings have indicated that their needs are not being met and have made suggestions about how the health care team could better support them. 13 …”

Unmet Needs of Siblings of Pediatric Stem Cell Transplant Recipients

“…10,11 But our data also document that the lack of choice was not a concern for either parents or children. Lack of choice, whether a concern or not, may imply the need for an advocate to help the family understand the medical options, but this information may be most effective coming from the treating physician.…”

“…5,6 One barrier to determining appropriate stringency for a donor protection policy is the relative lack of empirical data regarding the experience of families and specifically siblings who are typed and/or serve as donors. 7,8 Most studies have relied on cross-sectional, retrospective interviews years after donation, [9][10][11][12] with few exceptions. [13][14][15] Across these studies, both positive and negative psychosocial consequences of typing and donation are reported, including sibling donors' lack of choice, lack of appropriate information, and need for greater support.…”

“…[13][14][15] Across these studies, both positive and negative psychosocial consequences of typing and donation are reported, including sibling donors' lack of choice, lack of appropriate information, and need for greater support. [7][8][9][10][11][12][13] The purpose of this study was to prospectively document (pretransplant through 9 to 11 months posttransplant) all family members' views regarding choice, concerns/regrets, and benefit of sibling HLA typing and HSC donation.…”