This blog offers a summary of the findings and implications of a recent systematic review of studies looking at the effectiveness of interventions for young people with sibling mental health conditions. Only four papers were included in this review, highlighting the lack of evaluations for interventions supporting these young people.
Two studies used family-based treatment for eating disorders and the other two assessed sibling support groups. The evidence included is largely of weak quality. This review found that sibling support groups may offer relief to siblings, whilst family-based treatments might undermine sibling well-being. We then consider the implications these findings have for mental health services and families.
Why is sibling mental health important?
Mental health conditions can affect the whole family. A young person’s mental health condition can have a knock-on effect, as their siblings are more likely to develop mental health difficulties as well. Half of young people with a sibling experiencing mental health difficulties also face mental health challenges (Ma et al., 2015) and a third of siblings show behaviours in the clinical range (Barnett & Hunter, 2012). These young people are at greater risk for mental health conditions such as depression and anxiety (Jayasinghe et al., 2023).
Since these siblings are at greater risk of mental health difficulties, it is important to understand what support is available to them. We searched for evidence-based interventions aimed at supporting young people with sibling mental health conditions and assessed the quality of this evidence.
What we did
We conducted a systematic review of interventions aimed at supporting siblings. We included sibling internalising conditions such as depression. We excluded sibling neurodevelopmental conditions such as autism because there is research in this area already (Wolff et al., 2023).
Interventions were included for individuals aged four to 24 years, who have a sibling with a mental health condition that has lasted for at least three months. We searched seven electronic databases using terms reflecting a broad range of sibling mental health conditions and interventions from 1980 until 2024.
By performing forward and backward citations, we enhanced the robustness of our methodology. We used the Critical Appraisal Skills Programme qualitative checklist for the quality evaluation of qualitative studies and the Effective Public Health Project Practice quality assessment Tool for quantitative studies.
“Half of young people with a sibling experiencing mental health difficulties also face mental health challenges.”
What we found
In our review, only four studies met our criteria, resulting in a total of 708 siblings included in this review. Of the four studies included, two research groups each conducted two studies on a single type of intervention.
The papers were from Australia and the US. Two studies used surveys, one used a cohort design, and another used semi-structured interviews. Where reported, mean participant age ranged from 14.6 to 16.3 years.
Interventions were conducted in outpatient services, in-patient paediatric psychiatry services, in-patient adolescent psychiatry units, and community centres. Outcomes included mental health/well‐being/quality of life measures of siblings using a range of validated measures and qualitative measures of siblings’ experience and acceptability of interventions. Methodological quality was largely weak for quantitative studies, whilst qualitative studies were rated moderated and high.
Although 27 texts screened in at first, most of these papers did not meet our inclusion criteria for the systematic review. There were two main reasons for this:
- The sibling did not present with a mental health condition but experienced a neurodevelopmental condition, i.e. ADHD.
- The studies did not present outcomes that related to just the siblings.
In these cases, interventions typically included young people with sibling and parent mental health conditions. The outcomes measured were then reported without differentiating between young people growing up with sibling or parental mental health conditions. Therefore, we could not use these studies to understand just the sibling outcomes.
Our systematic review therefore compared outcomes for family-based treatment for eating disorders (Van Langenberg et al., 2016; Van Langenberg et al., 2018) and a sibling support group (Rubin et al., 2018; Feriante et al., 2022). The studies were mostly quantitative. The sibling support group demonstrated high acceptability amongst siblings. In comparison, the family-based treatment raised concerns over the wellbeing of the young person with the sibling mental health condition. After the intervention, a third of well siblings, unwell siblings, and parents reported being concerned the intervention might have had a negative impact on the well sibling.
“Since these siblings are at greater risk of mental health difficulties, it is important to understand what support is available to them.”
Key findings:
- Limited evidence evaluating interventions for sibling mental health conditions
- Intervention evaluations are largely of low quality
- There was evidence to support the acceptability of sibling support groups, suggesting a single drop-in group might offer relief to siblings
- Family based treatment was not specifically aimed at improving sibling mental health and might undermine it
Limitations
We acknowledged the limitations of our study – for example, the small number of papers, mostly poor quality of papers, and the inclusion of only peer-reviewed studies. Due to these limitations, it is impossible to firmly reach conclusions on the effectiveness of interventions for sibling mental health conditions.
Implications
Young people with sibling mental health conditions frequently present to clinical services, and their poor mental health suggests the need for support. There is currently a gap in the data because we do not know who is most at risk of adverse outcomes. We need more information on how best to provide effective support and which sibling characteristics may influence outcomes both generally and post-intervention.
Clinicians should ensure that the benefit of including siblings in treatment outweighs the risk. Therefore, interventions should track siblings’ well-being continuously using validated measures. Services should provide information and resources to siblings and support parents in tracking their children’s well-being. Parents are advised to speak to siblings about family dynamics and potential challenges their children may face.
“Young people with sibling mental health conditions frequently present to clinical services, and their poor mental health suggests the need for support.”
Conclusions
The lack of literature to evaluate sibling mental health interventions signals a missed opportunity. We know that children and young people with sibling mental health conditions are at risk of poor mental health. However, further research is needed to better understand the most effective ways to support them.
Offering more evidence-based support to siblings could influence the entire family system, thereby providing additional support to the sibling with the mental health condition. We recommend that clinicians encourage parents to speak openly with their children about their experiences. This would give them the space to share any challenges they might face.
NB this blog has been peer-reviewed
References
- Barnett, R. A., & Hunter, M. (2012). Adjustment of siblings of children with mental health problems: Behaviour, self-concept, quality of life and family functioning. Journal of Child and Family Studies, 21, 262-272.
- Feriante, J., Shayani, A., Lauer, E., Pressman, A., & Rubin, E. (2022). Sibling Support Program: A Novel Peer Support Intervention for Parents, Caregivers and Siblings of Youth Experiencing Mental Illness. 10(5), 908.
- Ma, N., Roberts, R., Winefield, H., & Furber, G. (2015). The prevalence of psychopathology insiblings of children with mental health problems: A 20-year systematic review. Child Psychiatry & Human Development, 46, 130-149.
- Jayasinghe, A., Wrobel, A., Filia, K., Byrne, L. K., Melvin, G., Berk, L., … & Cotton, S. (2023).Psychological distress in siblings of people with mental illness: A systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 57(5), 642-660.
- Rubin, E., Ostrowsky, L., Janopaul-Naylor, E., Sehgal, P., Cama, S., Tanski, E., & Curtin, C. (2018). The sibling support demonstration project: A pilot study assessing feasibility, preliminary effectiveness, and participant satisfaction. Adolescent Psychiatry, 8(1), 48–60.
- Van Langenberg, T., Duncan, R. E., Allen, J. S., Sawyer, S. M., Le Grange, D., & Hughes, E. K. (2018). “They don’t really get heard”: A qualitative study of sibling involvement across two forms of family-based treatment for adolescent anorexia nervosa. Eating Disorders, 26(4), 373–387.
- Van Langenberg, T., Sawyer, S. M., Le Grange, D., & Hughes, E. K. (2016). Psychosocial well‐being of siblings of adolescents with anorexia nervosa. European Eating Disorders Review, 24(6), 438–445.
- Wolff, B., Magiati, I., Roberts, R., Skoss, R., & Glasson, E. J. (2023a). Psychosocial interventions and support groups for siblings of individuals with neurodevelopmental conditions: A mixed methods systematic review of sibling self-reported mental health and wellbeing outcomes. Clinical Child and Family Psychology Review, 26(1), 143–189.
About the author
Irena Tetkovic is a PhD student at the University of Cambridge, specialising in sibling mental health. Her project, Sibwell, aims to understand why some young people cope more effectively than others after growing up with a sibling who has a mental health condition.