Experience of sibling death in childhood and risk of psychiatric care in adulthood: a national cohort study from Sweden

Beyond troubled and untroubled positions - an intersectional analysis of siblings who are bereaved by drug-related deaths' meaning-making stories about their deceased brothers and sisters

PURPOSE

This study investigates how social categories work and intersect in siblings bereaved by drug-related deaths' (DRDs) stories about their relationships to their deceased brother or sister. The sociocultural embedded process of making meaning of the relationship with the deceased individual is essential in adapting to the loss. However, insight into such experiences of siblings bereaved by a DRD is scarce. Previous research has suggested that DRDs may be stigmatized life experiences for bereaved family members, and this paper furthers understanding of the experiences and issues involved in losing a sibling in a stigmatized death.

METHODS

An intersectional analysis is applied to interviews with 14 bereaved siblings. By investigating and displaying how different categories intertwine, various positionings are identified.

FINDINGS

Categorization of the deceased siblings as "addicts" constructs a troubled position. However, when "addict" intersects with the categories "unique," "sibling," and "uncle," the troubled subject's position as an "addict" can be concealed.

CONCLUSIONS

Normative conceptions of addiction and DRDs produce troubled subject positions. By intermingling the category of "addict" with other categories, less problematic positions are created. Still, intersections of categories can also construct further complexities of remorse and self-blame for the bereaved siblings.

Does losing family members in midlife matter for late-life mental and cognitive health? A longitudinal study of older Swedes spanning 30 years

OBJECTIVES

Mental and cognitive health is crucial to ensure well-being in older age. However, prolonged periods of stress, grief, and bereavement might compromise mental health balance, leading to profound changes. This study investigated the sex-stratified associations between midlife bereavement experiences (e.g. sibling loss, spousal loss, and multiple losses) and late-life depression (LLD) and cognitive impairment.

METHOD

Linked data from the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) were used. Multiple logistic regressions were performed to examine the associations between midlife bereavement and LLD (n = 1078) and cognitive impairment (n = 995), separately.

RESULTS

Sibling loss and multiple losses in midlife were associated with lower odds of LLD, especially among women. Among men, sibling loss in midlife was associated with lower odds of cognitive impairment, while the experience of two losses among women suggested an increased (but non-significant) risk of cognitive impairment. Interaction analyses did not show significant effects between bereavement and gender on LLD and cognitive impairment.

CONCLUSION

Midlife bereavement might have gendered implications on LLD and cognitive impairment, but associations need to be confirmed by well-powered studies. Further research is warranted to elucidate the association between multiple midlife losses and reduced LLD risk.

Attitudes and Experiences of Community Palliative Care Nurses Regarding Pediatric Home-Based End-of-Life Care: A Statewide Survey

Objectives: Pediatric end-of-life (EOL) care at home is often provided by community palliative care (CPC) nurses who do not specialize in pediatrics. This study aimed to better understand the challenges CPC nurses face when providing EOL care to children at home. Methods: A total of 52 CPC nurses across New South Wales (NSW), Australia, participated in an online survey about their training, attitudes, and experiences regarding the provision of home-based pediatric EOL care. Participants were asked to reflect back over a "negative" experience of caring for a child at EOL, where things did not go as well as hoped, and a "positive" EOL care experience, where nurses perceived that care of the child and family went well, and respond to questions about these experiences. Results: Confidence of CPC nurses when providing EOL care to pediatric patients was significantly lower than when caring for adults (p's < .05). Most respondents expressed the desire for more training in pediatric EOL care. Cases identified as negative by CPC nurses did not significantly differ from positive cases in terms of the timing of the referral to CPC, clinical symptoms at EOL, or how well informed the nurses felt. Siblings were present at EOL in 74% of the negative experiences and 86% of the positive experiences, reportedly receiving significantly poorer support in the negative experiences (p = .002). Conclusion: This research contributes to an improved understanding of the challenges associated with home-based pediatric EOL care and highlights potential areas for improvement in CPC service delivery and training.

'People don't realise how much their past experiences affect them in adulthood': A qualitative study of adult siblings' experiences of growing-up with a sister/brother with a childhood life-limiting condition and their perceived support needs

BACKGROUND

There is a lack of research about the experiences and impact of having a sibling with a life-limiting condition. Studies focus on the sibling experience during childhood but the experience and impact during adulthood is unknown despite the increased life-expectancy of children with life-limiting conditions.

AIM

To explore adult siblings' perspectives on the experience of having a sister/brother with a childhood life-limiting condition and to identify their perceived needs and preferences for support.

DESIGN

A qualitative exploratory study design with data generated by semi-structured interviews and analysed using reflexive thematic analysis, underpinned by interpretivism.

SETTING/PARTICIPANTS

Twenty-two siblings (17-42 years old) were recruited via a children's hospice in England.

RESULTS

The experience of having a sibling with a life-limiting condition changes over time in response to how understandings of the meaning of a life-limiting condition develop and changing roles/relationships with parents and siblings. These experiences have an enduring impact on adult sibling's mental health which is compounded by their unmet (and sometimes unrecognised) support needs in adolescence and adulthood. Siblings described the importance of support continuing into adulthood with a focus on the provision of psychotherapy and peer support.

CONCLUSIONS

Having a sister/brother with a childhood life-limiting condition appeared to have a significant and ongoing impact on adult siblings but their support needs, particularly for psychotherapy and peer support, are overlooked. The findings highlight the importance of ensuring siblings are included in family assessments and that family-based interventions are developed to promote sibling-parent relationships.

Mortality among twin individuals exposed to loss of a co-twin

BACKGROUND

Although the death of a child, sibling or spouse has been associated with elevated risk of mortality, less is known about the survival of twin siblings exposed to a co-twin loss.

METHODS

In a Swedish population-based sibling-matched cohort, we compared the mortality of 5548 twin individuals who lost their co-twin between 1932 and 2011 with that of 27 740 age-matched and sex-matched twin individuals without such a loss and 6772 full siblings of these exposed twin individuals. Cox regression models were used to estimate the hazard ratios (HRs) of all-cause and cause-specific mortality.

RESULTS

We found increased risk of all-cause mortality among twin individuals exposed to a co-twin loss compared with matched unexposed twin individuals (HR = 1.30, 95% CI: 1.18-1.43) and their full siblings (HR = 1.10, 95% CI: 0.96-1.27) after adjusting for multiple covariates. The all-cause mortality risk was greater for loss of a co-twin due to unnatural deaths (HR = 1.54, 95% CI: 1.17-2.03) than natural deaths (HR = 1.26, 95% CI: 1.14-1.40). For cause-specific mortality, co-twin loss was associated with a higher risk of unnatural deaths both among twin individuals who lost their co-twin due to unnatural deaths (HR = 1.98, 95% CI: 1.27-3.10) and those whose loss was due to natural deaths (HR = 1.48, 95% CI: 1.07-2.06). The risk elevations were generally stronger for loss of a monozygotic co-twin than loss of a dizygotic co-twin.

CONCLUSION

Loss of a co-twin, especially a monozygotic co-twin, was associated with increased mortality, particularly of unnatural causes, among the surviving twin individuals. The excess mortality is likely attributable to both shared disease susceptibility within the twin pair and the adverse health sequelae of bereavement.

Why Informal Support Fails for Siblings Bereaved by a Drug-Related Death: A Qualitative and Interactional Perspective

Drug-related deaths constitute a significant challenge that strongly impacts the lives of the bereaved and the risks of mental and social problems are well-documented. This paper is the first one to explore how bereaved siblings experience informal support after drug-related deaths. Reflexive thematic analysis is used to analyze ten semi-structured interviews with bereaved siblings. Three main themes were identified: (1) valued support elaborates on the range of desired support and content of the support received; (2) barriers to support were connected to complex family relations, different grief reactions, and stigma, shame, and devaluation; (3) ways to promote support focus on openness and mutual closeness. The discussion revolves around the 'strong' sibling role, complex family relations, stigma, protective silence, and disenfranchised grief. Interactional aspects involved in social support and the importance of addressing this in clinical practice, to utilize the vital support potential for the bereaved experiencing drug-related death, are discussed.

Facing the loss of siblings in childhood: Interactions and dynamics between bereaved siblings and their parents

INTRODUCTION

The loss of a child in a family is a painful experience. Despite this, most studies focus on the grieving experience of parents. Our understanding of sibling bereavement therefore remains underexplored. This study aims to address this gap by exploring the bereavement experience of younger bereaved siblings from the perspective of the bereaved child and the parents.

METHOD

This study is a qualitative study conducted in Hong Kong. We recruited eleven bereaved families from 2019 to 2020. Semi-structured interviews were conducted separately with bereaved children and parents. Thematic analyses were performed.

FINDINGS

Eleven bereaved siblings, aged 5 to 11, and their parents were interviewed. Four themes were generated: Parents' unawareness of bereaved siblings' grief, protecting parents from grief, comparison with the deceased siblings, and learning how to grieve.

CONCLUSION

Our findings suggest that the family dynamics and interactions in the grieving experience are complex. The impact of grief on the bereaved child could emanate from the loss of the sibling or from the grief of the parents or from family interactions.

PRACTICE IMPLICATIONS

This study highlights the importance of viewing the sibling bereavement experience in a family context and of enhancing sibling bereavement services. Helping professionals should not only provide more bereavement support to the bereaved siblings individually, but they should also enhance parents' capacity to support their bereaved children.

The bereavement experiences of children following sibling death: An integrative review

PROBLEM

Sibling bereavement is one of the most distressing adverse life events during childhood but has received less attention in research than other forms of childhood bereavement. This integrative review identifies potential risk and protective factors for maladaptive coping following sibling bereavement and the influence of these factors on adjustment to loss.

ELIGIBILITY CRITERIA

Articles were limited to peer-reviewed studies, published in English in 2000 and beyond. Target population was bereaved siblings 0-18 years, and outcomes examined grief experiences by child self-report or parent-proxy report.

SAMPLE

The Whittemore and Knafl integrative framework was applied. Multidimensional Grief Theory guided the review with twenty-five studies synthesized across its domains: Separation Distress, Existential/Identity Crisis, and Circumstance-Related Distress.

RESULTS

Adjustment following sibling death is a complex process associated with a host of risk and protective factors that contribute to the bereavement process for this population. Age, sex, circumstance-related factors, continuing bonds, parental distress, and limited social support were critical influencing factors.

CONCLUSION

Definitive predictor variables were not identified but a combination of variables that influence the adjustment of bereaved siblings are discussed.

IMPLICATIONS

Future research is needed to explore the risk and protective factors of maladaptive coping to inform intervention development to promote individual and family adjustment following sibling death.

Association between parental absence during childhood and depressive symptoms in adulthood in rural Vietnam

BACKGROUND

While parental absence during childhood has been linked to depression/depressive symptoms in adulthood, no research has been conducted on this association in Vietnam, where many children were separated from their parents during and after the Vietnam War (1955-1975). We examined the association between parental absence in childhood and depressive symptoms among rural community dwellers in Khanh Hoa Province, Vietnam.

METHODS

Data came from 3000 individuals aged 40-60 years old who participated in the baseline survey of the Khanh Hoa Cardiovascular Study. Depressive symptoms were assessed with the 11-item Center for Epidemiologic Studies Depression Scale. Self-reported information on parental absence due to death, divorce, or outmigration to other locations before the age of 15 was also obtained. A Poisson regression analysis with a robust variance estimator was used to examine associations.

RESULTS

Experiencing parental absence at 3 - < 15 years old and before 3 years old was associated with a 1.21 times (95% confidence interval [CI] = 1.02-1.43) and 1.41 times (95% CI = 1.15-1.73) higher prevalence of depressive symptoms, respectively (p trend <0.001). When examining the associations by the different reasons for the parental absence, the strongest association was found for parental absence due to outmigration to other locations.

LIMITATIONS

We had no information on who respondents lived with after they experienced parental absence. In addition, self-reported information on childhood experiences was subject to recall bias.

CONCLUSIONS

In rural Vietnam, parental absence during childhood was associated with a significantly increased prevalence of depressive symptoms in middle adulthood.

Children or adolescents who lost someone close during the Southeast Asia tsunami 2004 - The life as young

INTRODUCTION

To lose a person close suddenly, during childhood or adolescence, can be devastating. Many children or adolescents experienced the 2004 Indonesian tsunami when they were between 10- and 15-years-old. This study, from Stockholm, Sweden, describes the long-term effects of loss, eight- or nine-years post disaster, in young adulthood.

METHOD

A mixed-method approach was used including statistical analyses (n = 210) and interpretative phenomenological analysis (IPA).

RESULTS

It was shown that there was a significant difference between bereaved (n = 34) and nonbereaved (n = 176) respondents concerning, psychological distress, posttraumatic stress symptoms, and self-rated health. Three themes were found by using the IPA approach (n = 9): Living in traumas, carrying heavy baggage, and living with change.

CONCLUSION

The respondents described personal feelings of grief that are not expressed in their outward appearance or behavior in their daily living. When meeting young adults that have lost someone close in childhood or adolescence, this is important to have in mind.

Psychotherapists' rated working alliance in an internet-based intervention for bereaved siblings

Bereaved siblings often receive insufficient social support and are at higher risk for mental disorders. This study aimed to examine the role of the therapist-rated working alliance in an online intervention for bereaved siblings. Clients (n = 74, 95% female), aged 17-59 received writing assignments and individual feedback by CBT trained therapists over 6 weeks. Working alliance (Working Alliance Inventory) and treatment outcomes (Inventory of Complicated Grief, Beck Depression Inventory-II) were assessed. Results revealed that the working alliance significantly increased during the course of the treatment and a significant association between working alliance and the change in depression was found.

"It Changes Your Orbit": The Impact of Suicide and Traumatic Death on Adolescents as Experienced by Adolescents and Parents

BACKGROUND

Having someone close die through suicide or another form of traumatic death is a distressing event in the lives of adolescents, putting them at risk of grief and mental health ramifications. As most research in this field has been focused on intrapersonal grief reactions, this study aimed to broaden the perspective by exploring the impact of the death through an interpersonal lens.

METHODS

The study involved individual and group interviews with bereaved adolescents (n = 20) and parents of bereaved adolescents (n = 18), and thematic analysis of the data.

RESULTS

The analysis yielded three themes: (i) the death is a life-changing experience, (ii) the death differentiates you from your peers, and (iii) the death impacts on the family system.

CONCLUSIONS

The study revealed the devastating impact of the deaths on adolescents, their relationships with peers and the family system. Adolescents' grief must be understood within the context of their agency and their immediate social environment. The findings clearly indicate that support for bereaved adolescents should incorporate the familial context.

Sibling mortality burden in low-income countries: A descriptive analysis of sibling death in Africa, Asia, and Latin America and the Caribbean

In high-income countries, emerging research suggests sibling bereavement can have significant health and life course consequences for young people. Yet, we know far less about its burden in lower-income countries. Due to higher fertility and mortality in lower-income countries, the level, timing, intensity, and circumstances surrounding sibling mortality are likely to follow patterns distinct from those in higher-income settings. Thus, in this study, we offer a descriptive overview of sibling death in 43 countries across sub-Saharan Africa, South and Southeast Asia, and Latin America and the Caribbean. Specifically, we analyze Demographic and Health Survey data from nationally representative samples of 352,930 15- to 34-year-old women, born between 1985 and 2003, to document experiences of sibling death before age 25. On average, roughly one-third of individuals report a deceased sibling in these countries; estimates reach 40-50% of respondents in multiple African countries, particularly those that have experienced conflict and war. Although some sibling deaths occurred before the focal respondent was born, most bereaved individuals recalled a death during their lifetime-often in late childhood/early adolescence. High proportions of bereaved respondents report multiple sibling deaths, highlighting the clustering of deaths within families. Even so, bereaved individuals tend to come from large families and thus frequently have a comparable number of surviving siblings as people who never experienced a sibling die. Together, the results offer a window into global inequality in childhood experiences, and they attest to the need for research that explores the implications of sibling mortality for young people in world regions where the experience is concentrated.

Law and mental health: A bridge between individual neurobiology and the collective organization of behaviors

Mental disorders (MD) or mental symptoms (MS) have multifactorial causes. Today we know much more about the variables that cause individual MD\MS, but in our opinion these characterizations, although essential, are not sufficient to account for the complexity in which we live. For example, they do not explain in a coherent and empirically verifiable way how the biological individual relates to the social architecture in which he lives. This article presents a hypothesis that connects social and organizational structures to the emergence of symptoms and mental disorders in the population. It is our belief that some of these structures fundamentally impact the distribution of MD/MS in a population and the medical and psychological communities must consider this impact seriously. Laws aim at directing the behavior of groups of people, whose behavior is strictly interdependent with their neurobiology. Given the ability of laws to direct the behaviors that regulate social interactions, traumatic factors may be considered capable of linking a non-material object (e.g., a law) to a real effect (e.g., MS/MD). We discuss, as a paradigmatic example, the laws that regulate the use of psychotropic substances.

Risk of psychiatric disorders among the surviving twins after a co-twin loss

Losing a co-twin by death is a severely stressful event yet with unknown impact on the surviving twin's risk of psychiatric disorders. We identified all Swedish-born twins who lost a co-twin by death between 1973 and 2013 (n = 4,528), their 4939 non-twin full siblings, together with 22,640 age- and sex-matched non-bereaved twins. Compared to the non-bereaved twins, exposed twins were at increased risk of receiving a first diagnosis of psychiatric disorders (hazard ratio = 1.65, 95% confidence interval1.48-1.83), particularly during the first month after loss. Similarly, compared to non-twin full siblings, the relative risks were significantly increased after loss of monozygotic co-twin (2.45-fold), and loss of a dizygotic co-twin (1.29-fold), with higher HR observed with greater age gaps between twins and non-twin siblings. As dizygotic twins share equal genetic relatedness to the deceased twin as their full siblings, this pattern suggests that beyond the contribution of genetic factors, shared early life experiences and attachment contribute to the risk of psychiatric disorders among surviving twins after co-twin loss.