Sibling perspectives on severe mental illness: reflections on self and family

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.

Filling the Void: The Role of Adult Siblings Caring for a Brother or Sister With Severe Mental Illness

Little is known about the role of adult siblings’ caregiver role within the context of mental illness. Therefore, our purpose was to explore how siblings narrate their experiences of being the main caregivers of a brother or sister with severe mental illness and how they cooperate with their ill sibling and their family of origin. We used a narrative hermeneutic approach and performed a secondary analysis of two interviews of siblings derived from a study of peoples’ experiences of hearing voices. The findings illuminate the participants’ multifaceted roles and how differently siblings might deal with the multiple challenges of caring for an ill sibling. The mediating role between their ill sibling and their family of origin to reestablish the broken family bonds was a significant aspect. Nurses’ awareness of the important and multidimensional role of caregiving siblings can improve the provision of family support and promote involvement of siblings in the treatment of an ill family member.

Experiences of Siblings of Children With Neurodevelopmental Disorders: Comparing Qualitative Analysis and Machine Learning to Study Narratives

INTRODUCTION

Relatively few studies have focused on the wellbeing, experiences and needs of the siblings of children with a psychiatric diagnosis. However, the studies that have been conducted suggest that the impact of such circumstances on these siblings is significant. Studying narratives of diagnosed children or relatives has proven to be a successful approach to gain insights that could help improve care. Only a few attempts have been made to study narratives in psychiatry utilizing a machine learning approach.

METHOD

In this current study, 13 narratives of the experiences of siblings of children with a neurodevelopmental disorders were collected through largely unstructured interviews. The interviews were analyzed using the traditional qualitative, hermeneutic phenomenology method as well as latent Dirichlet allocation (LDA), an unsupervised machine learning method clustering words from documents into topics. One aim of this study was to evaluate the experiences of the siblings in order to find leads to improve care and support for these siblings. Furthermore, the outcomes of both analyses were compared to evaluate the role of machine learning in analyzing narratives.

RESULTS

Qualitative analysis of the interviews led to the formulation of nine main themes: confrontation with conflicts, coping strategies siblings, need for rest and time for myself, need for support and attention from personal circle, wish for normality, influence on personal choices and possibilities for development, doing things together, recommendations and advices, ambivalence and loyalty. Using unsupervised machine learning (LDA) 24 topics were formed that mostly overlapped with the qualitative themes found. Both the qualitative analysis and the LDA analysis detected themes that were unique to the respective analysis.

CONCLUSION

The present study found that studying narratives of siblings of children with a neurodevelopmental disorder contributes to a better understanding of the subjects' experiences. Siblings cope with ambivalent feelings toward their brother or sister and this emotional conflict often leads to adapted behavior. Several coping strategies are developed to deal with the behavior of their brother or sister like seeking support or ignoring. Devoted support, time and attention from close relatives, especially parents, is needed. The LDA analysis didn't appear useful to distract meaning and context from the narratives, but it was proposed that machine learning could be a valuable and quick addition to the traditional qualitative methods by finding overlooked topics and giving a rudimental overview of topics in narratives.

Comparison of relationships among French adult siblings with or without schizophrenia using the ASRQ-S: mediating effect on emotional distress

BACKGROUND

Good sibling relationships in adulthood are known to be a protective factor for mental health. The present study examined and compared the relationships of siblings with either a healthy brother or sister or one experiencing schizophrenia.

METHODS

In the first phase, we ran a statistical comparison of the two sibling groups on the quality of their sibling relationships (warmth, conflict, and rivalry), emotional distress, and self-esteem. In the second phase, we looked at whether the quality of the sibling relationship modifies the impact of having a brother or sister with schizophrenia on emotional distress and self-esteem.

RESULTS

Results showed that sibling relationships in schizophrenia are less warm and are characterized by heightened rivalry and conflict. In addition, analysis revealed a mediating effect of sibling relationship on the emotional distress of siblings with a brother/sister diagnosed with schizophrenia.

CONCLUSION

More needs to be done to enhance the mental health of adults who have a brother or sister with schizophrenia, notably via their sibling relationships.

Siblings of Individuals With Eating Disorders: A Review of the Literature

Eating disorders (EDs) are serious psychopathologies characterized by a persistent disturbance in eating or eating-related behavior. Studies have shown EDs' detrimental consequences not only for patients, but also for their families. Nevertheless, a specific group that has so far been neglected, in both the research and clinical fields, are siblings of individuals with EDs. In an effort to identify this population's needs, and to facilitate effective prevention and treatment, this paper aims to review the existing literature on the subject, and examine siblings' personal experience, ways of coping, and levels of psychopathology. PubMed and PsycNet databases were searched with no publication date restrictions, yielding 26 relevant papers. Studies were categorized according to common themes they addressed, and subsequently summarized by highlighting common features, as well as information unique to each study. Several themes emerged, including emotional well-being, psychopathology, social consequences, family dynamics, and coping strategies. Results show that EDs experienced by one individual have significant effects on one's siblings, such as a decrease in quality of life, social isolation, and elevated familial strain. In several studies siblings were found to have elevated levels of psychopathology and EDs related symptoms. Nevertheless, findings' nature and magnitude were highly varied. The review indicates the need for further studies that will examine possible intra- and interpersonal moderating factors for EDs' impact on well-being among siblings, and take into consideration the substantial heterogeneity in studies conducted thus far. Additionally, this review highlights the need for novel and effective interventions, specifically targeting this at-risk group.

What is related to the well-being of the siblings of patients with schizophrenia: An evaluation within the Lazarus and Folkman's Transactional Stress and Coping Model

BACKGROUND

Schizophrenia is a chronic mental illness that strongly affects not only the patients with schizophrenia, but also their families and close relatives. So far, family research on patients with schizophrenia has mainly focused on parents, but has neglected siblings.

AIM

This study aims to evaluate the well-being of 103 siblings of patients with schizophrenia within the Lazarus and Folkman's Transactional Coping and Stress Model.

MATERIALS

A Sociodemographic Information Form, Subjective Well-being Scale, Zarit Caregiver Burden Scale, Multidimensional Perceived Social Support Scale, Ways of Coping Scale and Shortened Perceived Parental Rearing Styles Form were administered to the siblings of patients with schizophrenia.

RESULTS

The results of this study revealed that well-being was associated with perceived mother overprotection, perceived social support, problem-focused coping and indirect coping. Social support moderated the relationship between burden and well-being as a buffering factor.

CONCLUSION

Therefore, siblings of patients with schizophrenia should be given access to social support and their problem-focused coping strategies should be strengthened. Besides, parents should be supported to provide suitable care for the siblings of patients with schizophrenia.

Aggressive Children With Mental Illness: A Conceptual Model of Family-Level Outcomes

The purpose of this research was to examine how families adapt and respond to an aggressive child with mental illness. This article presents findings from a qualitative study of four families, which were selected as typifying the experiences of a larger sample of 14 families; each family included a child with mental illness and a history of violent behavior. The analysis revealed a five-stage pattern in how families perceived and responded to victimization and their child or sibling's mental illness. The study suggests that families with a violent child with mental illness and other healthy children cannot live through episodes of violence without removing the child with mental illness from the home or suffering considerable damage to the family. The article concludes with recommendations for mental health practitioners and family intervention specialists.

Short term effects of brief need based psychoeducation on knowledge, self-stigma, and burden among siblings of persons with schizophrenia: A prospective controlled trial

Siblings of persons with schizophrenia are important in providing long-term social support to the patients. Interventions addressing their needs are very sparse. Hence, this study aimed at testing the short-term effects of brief need based psychoeducation on knowledge, self-stigma, and burden among siblings of persons with schizophrenia. In this prospective controlled open label trial, 80 siblings of persons with schizophrenia were allocated in equal numbers to the brief need based psychoeducation group and the treatment-as-usual group. The outcomes were measured at baseline, and after the first and third month post-intervention. RM-ANCOVA was conducted to test the effect of the brief psychoeducation on outcome scores. The groups were similar with respect to socio-demographic, clinical, and outcome scores at the baseline. There was a significant group×time interaction effect on knowledge (F=8.71; p<0.01; η_p²=0.14) and self-stigma scores (F=14.47; p<0.001; η_p²=0.21), wherein the brief psychoeducation group showed a significant increase in knowledge and reduction in self-stigma with medium effect size through baseline to the third month follow-up as compared to the treatment as usual group. We also observed a significant main effect of time; irrespective of the group allocation, there was a significant increase in the knowledge through baseline to third month follow-up (F=5.69; p=0.02; η_p²=0.09). No main or interaction effects of group and time were observed on burden. The findings suggest that brief need based psychoeducation may increase knowledge about the illness and reduce self-stigma. Further systematic studies are warranted to test this intervention for long-term effects.

The Positive and Negative Experiences of Caregiving for Siblings of Young People with First Episode Psychosis

Background: The impact of first episode psychosis (FEP) upon parents’ experience of caregiving has been well-documented. However, the determinants and nature of this remain poorly understood in siblings. It is hypothesized that siblings of young people with FEP are also impacted by caregiving and burden. This study aimed to characterize the experience of caregiving for siblings of young people with FEP.

Method: Survey methodology was used to explore the experience of 157 siblings in the first 18 months of their brother or sister’s treatment for FEP. Participants reported on their appraisal of the negative and positive aspects of caregiving as measured by the Experience of Caregiving Inventory (ECI). Descriptive statistics were used to establish the results for the total sample as well as for gender and birth order differences. A series of multivariate regression analyses were conducted to determine the relationships between illness characteristics and siblings’ experience of caregiving.

Results: Older brothers reported the lowest scores for negative experiences in caregiving and younger sisters reported the highest. Negative experiences in caregiving resulted in less warmth within the sibling relationship and impacted negatively upon quality of life. When the young person with FEP had attempted suicide and/or been physically violent, siblings experienced more caregiver burden. Multivariate analysis showed that female gender was a significant factor in explaining the impact of illness related variables on the experience of caregiving.

Conclusion: Suicide attempts and a history of violence resulted in higher caregiving burden for siblings regardless of whether they lived with the young person experiencing FEP or not. Female siblings are at higher risk of negative experiences from caregiving resulting in a reduced quality of life and a changed sibling relationship. Suicide attempts and violence are indicators for intensive case management to improve outcomes for the individual with FEP which may in turn reduce the burden experienced by the sibling. Clinicians can use these findings to identify siblings, assertively intervene and provide increased psychological support, psychoeducation and practical problem solving to reduce the burden. The caregiving role that they already play for their ill brother or sister should be recognized.

Sociocultural Determinants of HIV/AIDS Risk and Service Use Among Immigrant Latinos in North Carolina

Latinos in the United States have been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases. Using a community-based participatory research approach to problem identification, the objective of this study is to explore sociocultural determinants of HIV/AIDS risk and service use among immigrant Latino men living with HIV/AIDS in North Carolina. In-depth key-informant interviews with stake-holders ( n = 8) and Latino men living with HIV/AIDS ( n = 10) were conducted. Major themes identified among Latino men living with HIV/AIDS are misconceptions about HIV/AIDS prevention and treatment, intracommunity discrimination against individuals living with HIV, and feared discovery of their undocumented status. Further research is needed to reduce HIV risk and improve access to medical services among Latino men living with HIV/AIDS.

Identifying and intervening on barriers to healthcare access among members of a small Korean community in the southern USA

OBJECTIVE

We used community-based participatory research (CBPR) to explore barriers to healthcare access and utilization and identify potentially effective intervention strategies to increase access among members of the Korean community in North Carolina (NC).

METHODS

Our CBPR partnership conducted 8 focus groups with 63 adult Korean immigrants in northwest NC and 15 individual in-depth interviews and conducted an empowerment-based community forum.

RESULTS

We identified 20 themes that we organized into four domains, including practical barriers to health care, negative perceptions about care, contingencies for care, and provider misconceptions about local needs. Forum attendees identified four strategies to improve Korean community health.

CONCLUSION

Despite the implementation of the Patient Protection and Affordable Care Act (ACA), many Korean community members will continue to remain uninsured, and among those who obtain insurance, many barriers will remain. It is imperative to ensure the health of this highly neglected and vulnerable community.

PRACTICE IMPLICATIONS

Potential strategies include the development of (1) low-literacy materials to educate members of the Korean community about how to access healthcare services, (2) lay health advisor programs to support navigation of service access and utilization, (3) church-based programming, and (4) provider education to reduce misconceptions about Korean community needs.

The impact of first episode psychosis on sibling quality of life

PURPOSE

The adverse impact of first episode psychosis (FEP) upon parents' quality of life (QoL) has been well documented. However, the determinants and levels of QoL remain poorly understood in siblings of young people experiencing FEP. This study aimed to characterise and establish the predictors of QoL for siblings of young people with FEP.

METHOD

Survey methodology was used to examine the experience of 157 siblings in the first 18 months of their brother or sister's treatment for FEP. The World Health Organisation Quality of Life Scale-Bref (WHOQOL-Bref) was used to assess siblings' QoL. A series of multivariate regression analyses were conducted to determine the relationships between illness characteristics and siblings' QoL.

RESULTS

Younger sisters reported the lowest satisfaction of QoL. Older brothers were the most satisfied. When the young person with FEP had attempted suicide and/or had been physically violent, siblings reported less satisfaction in all domains of QoL. Living with the ill brother or sister resulted in less satisfaction in the social domain. Multivariate analysis showed that female gender was a significant factor in explaining the impact of illness-related variables on QoL, particularly suicide attempts.

CONCLUSION

Suicide attempts and a history of violence impacted negatively on all four domains of QoL. Female siblings are at higher risk of reduced QoL and may be particularly vulnerable to the effects of suicide attempts and violence. These findings have significant implications for early, targeted interventions for this vulnerable group.

The family roles of siblings of people diagnosed with a mental disorder: heroes and lost children

In order to cope with the diagnosis of mental illness in a family member, siblings may be forced to adjust their roles in the family. Taking into account the crucial role that some siblings play in caregiving for the mentally ill especially when the parents are no longer available, it is imperative to develop awareness of their unique needs and address them. Thirty-three adult siblings of people diagnosed with a mental disorder completed the Role Behaviour Inventory (RBI) and a general questionnaire including open-ended questions regarding the roles they played in their families of origin. Findings from the inventory and general questionnaire suggest that the well siblings score higher on two roles, the Hero and Lost Child, and lower on the Mascot and Scapegoat roles relative to a comparison group (N = 33). Being a sibling caregiver emerged as a risk factor to assume certain dysfunctional roles in the family. Implications for future research and therapy are discussed.

Spotlight on sibling involvement in schizophrenia treatment

OBJECTIVE

The purpose of this paper is to explore a literature gap--sibling involvement in the care and support of people with schizophrenia, and to make recommendations for filling the gap.

METHOD

The method used was observation and documentation of clinical notes over a ten-year period in an outpatient clinic for women with schizophrenia. Illustrative examples were selected from approximately 200 entries dealing with sibling relationships.

FINDINGS

Siblings constitute an important segment of the social network of persons with schizophrenia, although they do not usually take an active part in their brother or sister's care until parents are no longer able to cope alone. The role of primary caregiver appears to be a stressful one for siblings. The closest sibling bonds were those between sisters, and in most cases, the eldest girl in the family assumed the caregiver role. This depended, however, on the family's means, values, and cultural traditions, as well as on the personal attributes and life circumstances of the siblings. Financial, human, and social capital were critical determinants of sibling involvement. Sharing responsibilities and negotiating the distribution of required caretaking tasks was often the most effective way of dealing with the burden of care giving.

CONCLUSION

Although some clinical recommendations can be made, specificities that distinguish this population and the effectiveness of sibling caregiving need to be further researched.

The role of personal loss in the caregiving experiences of well siblings of adults with serious mental illness

OBJECTIVE

The present study examined the role of personal loss due to mental illness and meaning-related coping strategies on reports of caregiving among well siblings of adults with serious mental illness.

METHOD

A sample of 103 well siblings of adults with serious mental illness completed an online survey. Participants were recruited through websites related to mental illness and through contact with leaders of family support groups.

RESULTS

Personal loss, not meaning-related coping, was the strongest predictor of current caregiving among well siblings. Well siblings' age, support group affiliation, and perceived level of sibling dependence also contributed to variation in reports of current caregiving.

CONCLUSION

Personal loss has powerful implications for research and interventions focused on sibling involvement in caregiving for adults with mental illness.

Burdens and difficulties experienced by caregivers of children and adolescents with schizophrenia-spectrum disorders: a qualitative study

AIM

The purpose of this qualitative study was to investigate the burdens and difficulties associated with the experience of caring for youth with schizophrenia-spectrum disorders.

METHODS

Ten caregivers participated in a modified version of the Knowledge about Schizophrenia Illness interview.

RESULTS

The most common areas of general difficulties reported by caregivers were emotional burdens and the everyday practical demands and sacrifices required in caring for their dependents. RESULTS also suggested high levels of burden for caregivers concerning difficulties with mental health services.

CONCLUSION

Additional work is needed to learn more about the challenges that caregivers of youth with schizophrenia-spectrum disorders are facing, as well as to develop empirically based strategies for helping these caregivers and their dependents.

Caring for a sibling with anorexia nervosa: a qualitative study

OBJECTIVE

Few studies have explored eating disorders from the perspective of non-affected siblings. The aim of this investigation was to explore the unique experiences and challenges of siblings of women with anorexia nervosa (AN).

METHOD

Twelve semi-structured qualitative interviews were conducted with sibling participants to ascertain their perspective of caring for a sister with chronic AN.

RESULTS

Qualitative analyses gleaned six themes: (1) the sibling role as protector and mediator; (2) familial factors that influence and reinforce these sibling roles; (3) consequences and benefits of AN to non-affected sibling; (4) coping strategies; (5) current and future intentions of caregiving and (6) professional and informal support.

DISCUSSION

The findings from this qualitative study provide a window into the perceptions, feelings, and roles of siblings of women afflicted with AN. An intervention guided by the elicited themes may facilitate family functioning that is more adaptive for both siblings.

Siblings of individuals with first-episode psychosis: understanding their experiences and needs

The growth of early intervention in psychosis services (EIPS) has prompted needed research to provide a robust evidence base to underpin practice. The typical service model embraces key psychosocial interventions, including family interventions. A literature review revealed a number of relevant studies that recognized the role of siblings in families affected by severe mental illness or mental impairment, but little was found about the impact of first-episode psychosis on siblings. To address this apparent oversight, we conducted a study to gain an understanding of sibling experiences. Ten siblings (ages 16 to 30) with a brother or sister diagnosed with first-episode psychosis took part in individual semi-structured interviews. The key findings were grouped in regard to emotional impact, relationships in the family, and siblings' roles and coping patterns. The study also revealed that families are able to identify positive gains out of a fundamentally negative experience.

Whose life am i living? Relatives living in the shadow of depression

BACKGROUND

Families living with mental illness experience added burden and need information and support.

AIM

This aim of this study was to explore the experiences of families living close to a depressed individual.

METHODS

Eighteen persons were interviewed individually or in focus groups. Data was analysed using a grounded theory-inspired methodology.

RESULTS

Most participants expressed a feeling of not living their own life, struggling to balance relationships, adapting to and re-evaluating their life circumstances, and struggling to voice their ill relatives' and their own needs.

CONCLUSIONS

More can be done to help and sustain hope in the relatives of persons with depression.

The power and the promise: working with communities to analyze data, interpret findings, and get to outcomes

Although the intent of community-based participatory research (CBPR) is to include community voices in all phases of a research initiative, community partners appear less frequently engaged in data analysis and interpretation than in other research phases. Using 4 brief case studies, each with a different data collection methodology, we provide examples of how community members participated in data analysis, interpretation, or both, thereby strengthening community capacity and providing unique insight. The roles and skills of the community and academic partners were different from but complementary to each other. We suggest that including community partners in data analysis and interpretation, while lengthening project time, enriches insights and findings and consequently should be a focus of the next generation of CBPR initiatives.

Factors contributing to the quality of sibling relationships for adults with schizophrenia

OBJECTIVES

Research suggests that the quality of sibling relationships has a significant impact on the lives of adults with schizophrenia. A life course perspective was used to guide an investigation of the predictors of the quality of the relationship between adults with schizophrenia and their siblings.

METHODS

The data come from a longitudinal study of families of adults with schizophrenia. This study is based on a survey of 136 siblings of adults with schizophrenia. Multiple regression was used to estimate the predictors of sibling relationship quality.

RESULTS

Siblings reported a better relationship when they grew up in a more cohesive family environment (beta=.16, p<.05) and when they experienced more personal gains from coping with the challenges of a brother's or sister's mental illness (beta=.37, p<.001). Siblings reported a worse relationship when they perceived their brother or sister with schizophrenia as having control over his or her symptoms (beta=-.18, p<.05), expressed greater fear of their brother's or sister's behavior (beta=-.17, p<.05), and indicated that their brother or sister had struck or threatened them at some point in their lives (beta=-.18, p<.05).

CONCLUSIONS

The quality of the sibling relationship is a major contributor to sibling involvement in the future and to the quality of life of adults with schizophrenia. By identifying the factors associated with positive sibling relationships, mental health providers will be better prepared to engage siblings in the treatment process and help promote stronger bonds of affection between adults with schizophrenia and their siblings.

The effect of the quality of sibling relationships on the life satisfaction of adults with schizophrenia

OBJECTIVE

This study examined the importance of the quality of the sibling relationship to the life satisfaction of adults with schizophrenia.

METHODS

Data were drawn from a longitudinal survey of aging families of adults with schizophrenia. Ninety-three dyads of adults with schizophrenia and their siblings participated. Participants independently completed a self-administered mail questionnaire. Data on the quality of the sibling relationship were taken from the siblings' scores on the Positive Affect Index, and data on life satisfaction of the adult with schizophrenia were measured by the self and present life subscale of the Satisfaction With Life Scale.

RESULTS

Adults with schizophrenia had higher levels of life satisfaction when their siblings reported having a closer and more supportive relationship with their sibling with schizophrenia.

CONCLUSIONS

Our findings provide evidence of the saliency of the sibling relationship to quality of life of adults with schizophrenia in midlife.

Siblings of adults with schizophrenia: expectations about future caregiving roles

Sibling expectations to provide future instrumental or emotional support for a brother or sister with schizophrenia when parents became disabled or died were examined. Data came from a sample of 137 siblings participating in a longitudinal study of aging families of adults with schizophrenia. Early socialization experiences, the quality of the sibling relationship, and personal caregiver gains propel siblings toward a future caregiving role, whereas geographic distance and beliefs about the controllability of psychiatric symptoms reduce expectations of future involvement.