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

The role of schemas in the experience of distress, burden, and wellbeing in parents and siblings of people with serious mental health difficulties

BACKGROUND

Caregivers of people with serious mental health difficulties (SMHD), such as schizophrenia or bipolar disorder, face various psychological challenges. It is unclear if the mechanisms underlying these challenges differ between different groups of caregivers. This study examined whether the relationship between maladaptive schemas and distress, burden, and reduced wellbeing differed between parents and siblings of people with SMHD.

METHODS

70 parents and 40 siblings completed an online survey that included measures of schemas (Young Schema Questionnaire-Short Form), depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (Generalised Anxiety Disorder Assessment-7), burden (Experience of Caregiving Inventory), and wellbeing (Ryff Scales of Psychological Wellbeing). Multivariate linear regression models with interaction effects were tested for each outcome of interest.

RESULTS

Compared to parents, siblings reported significantly higher scores in each schema domain, greater distress and burden, and reduced wellbeing. Univariate analyses revealed that Disconnection (β=0.52 [0.17, 0.91], t(100)=2.90, p=.005) and the interaction between Caregiver Group and Disconnection (β=-1.17 [-2.27, -0.13], t(100) =-2.49, p=.014) significantly predicted depressive symptoms. Schema domains predicted anxiety symptoms, burden, and wellbeing; there were no significant interaction effects in these models.

CONCLUSION

Siblings seem to experience greater psychological challenges than parents. Maladaptive schemas were linked to greater psychological challenges in both groups and the relationship between schemas and distress, burden, and wellbeing was similar in parents and siblings. Further research is needed to determine if there are group differences at the individual schema level.

Associations of mental disorders in children with parents' subsequent mental disorders: nationwide cohort study from Finland and Denmark

BACKGROUND

Intergenerational 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.

AIMS

We examined the association of mental disorders in children with their parents' subsequent mental disorders.

METHOD

In this population-based cohort study, we included all individuals with children born in Finland or Denmark in 1990-2010. Information about mental disorders was acquired from national registers. The follow-up period began when the parent's eldest child was 5 years old (for ICD-10 codes F10-F60) or 1 year old (for codes F70-F98) and ended on 31 December 2019 or when the parent received a mental disorder diagnosis, died, or emigrated from Finland or Denmark. The associations of mental disorders in children with their parents' subsequent mental disorders were examined using Cox proportional hazards models.

RESULTS

The study cohort included 1 651 723 parents. In total, 248 328 women and 250 763 men had at least one child who had been 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 with those who did not. For both parents, the hazard ratios were greatest in the first 6 months after the child's diagnosis (hazard ratio 2.04-2.54), followed by a subtle decline in the risk (after 2 years, the hazard ratio was 1.33-1.77).

CONCLUSION

Mental disorders in children are associated with a greater risk of subsequent mental disorders among their parents. Additional support is needed for parents whose children have been recently diagnosed with a mental disorder.

The temporal alignment of mental health consultations across family members: a study of Norwegian adolescents, their parents, and siblings

PURPOSE

Mental health problems among adolescents have become more prevalent in recent years. Parents' and siblings' mental health might be affected by living with a depressed adolescent. This study examines how the mental health of family members develops in the years before and after an adolescent seeks help for depression.

METHODS

Unique Norwegian register data that cover the full population are used to estimate models with individual fixed effects. The development in the probability of mental health consultations for parents and older siblings in families with a second-born adolescent seeking help for depression from a GP for the first time is compared to the respective development in families where the second-born adolescent has not had such health care consultation.

RESULTS

Results indicate that adolescents' depression consultations are associated with a simultaneous increase in mental health consultations in parents and siblings. Mothers and fathers are affected similarly, although the effect seems to be short-lived. Siblings experience a short-term increase in mental health consultations, in addition to a steeper long-term increase across the observation period, compared to peers in families where the second-born adolescent does not seek help for depression. Events that might affect the mental health of multiple family members simultaneously, specifically parental breakup and unemployment, did not explain the observed patterns.

CONCLUSION

Help-seeking for mental health problems is temporally aligned across family members. Intra- and intergenerational spillovers might contribute to this.

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

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.