The role of siblings in children’s mental health

siblings mental healthWhen you were young(er), did you also engage in personality predictions with your peers based on order in the family? For example, that the oldest of three siblings would be the bossiest and the youngest the most spoiled? Almost everyone (90% of us) have one or more siblings. And we know they play an important role in our lives.

Scientists in the Netherlands have now combined international research examining siblings’ role in children’s mental health. This is an innovative step, since there is quite a lot of research on parenting but not so much on siblings. Moreover, the authors state that the sibling relationship is “one of the most neglected relationships in psychological research and practice.” Also in the child traumatic stress area, I think siblings are still overlooked.

For a meta-analysis, it is necessary to choose very specific study topics in order to be able to combine studies statistically. In this case, the researchers have looked at the association between sibling relationship quality and child psychopathology. In particular, they have combined data regarding:

  • Sibling warmth (e.g. intimacy, affection, support, companionship, closeness);
  • Sibling conflict (e.g. arguing, fighting, aggression, hostility, negativity, coercion), and
  • Differential treatment (perceived unequal parenting behaviour towards them

on the one hand, and

  • Internalizing problems and
  • Externalizing problems

on the other.

Based on attachment theory, social learning theory and social comparison theory, the research team expected to find the following:

  1. A significant negative relation between sibling warmth and child psychopathology, with a stronger effect for internalizing than for externalizing problems
  2. A significant positive relation between sibling conflict and child psychopathology, with a stronger effect for externalizing problems
  3. A significant positive relation between parental differential treatment and child psychopathology, with a stronger effect for externalizing problems

In addition, they hypothesized that the effects would be stronger for same-sex siblings and for siblings closer in age, because these sibling pairs would be more similar and thus, influence each other more strongly. And they expected larger effects for children than for adolescents, because the latter tend to be less focused on family and more on peers.

The researchers conducted a systematic search involving the databases PsychInfo and ERIC, reference lists of the included studies, and more recent studies that cited the included studies (forward referencing). They applied a number of selection criteria and made sure that only independent data were incorporated in each effect size. They included both cross-sectional and longitudinal studies. In case of the latter, they chose data that were closest related in time. The paper does not give details on the number of abstracts that were retrieved or on how the team ensured inter-rater reliability of the information entered, but does describe that they systematically coded the studies and contacted the authors for missing information.

The analysis involved calculation of effect sizes for the 6 associations according to a random effects model, a test of heterogeneity of the effect (whether there were differences within the effect sizes that may be explained by study characteristics), moderator analyses (to subsequently test the specific influence of study characteristics), and tests to see whether there may be a publication bias (with stronger effects being published whereas zero effects end up in the ‘file drawer’).

The research team located 34 eligible studies, which reported on 12,257 participants. These children were predominantly (75%) white Caucasian. Ages ranged from 4 to 16 years old and the mean age difference between siblings was 2.8 years. In short, this is what the analyses revealed:

Siblings Effect SizesAll effects showed heterogeneity of the studies, which turned out to be variably related to the gender of the siblings, the age difference, and the developmental period of the participants. In addition, more recent studies tended to report smaller effects.

This meta-analysis shows that sibling relationship quality is indeed related to children’s mental health. It is important to keep in mind that the authors included cross-sectional data. We can’t conclude on the direction of the effect: it is possible that children’s mental health influences the sibling relationship as well as the other way around.

Sibling conflict stood out as an important correlate of children’s mental health, both for internalizing and externalizing problems. The authors give a number of explanations, including the fact that children may learn negative behaviour by fighting with their siblings and that ‘bad is stronger than good’; negative events may have more impact than positive events.

The authors conclude:

Our results indicate that the sibling context is important when considering maladjustment. Children and adolescents with warmer and less conflictive sibling relationships show significantly less problem behaviour, as well as children and adolescents who experience less differential treatment.

In addition to the overwhelming evidence of the impact of parent-child and marital relationships on child and adolescent development, the present meta-analysis is a reminder that the sibling relationships warrants more attention in research as well as in clinical settings.

What are your thoughts on this topic? In particular in relation to traumatic stress, do we involve siblings enough in mental health care, and do we know enough about them?

This article has appeared on The Mental Elf blog. Main reference: Buist KL, Deković M, & Prinzie P (2013). Sibling relationship quality and psychopathology of children and adolescents: a meta-analysis. Clinical psychology review, 33 (1), 97-106 PMID: 23159327

7 thoughts on “The role of siblings in children’s mental health

  1. Siblings of children with special needs have received little
    attention in the occupational therapy literature. However, siblings play an
    important role in the development of children with special needs. Siblings are
    also at risk for problems of emotional adjustment that have an impact on their
    own well-being as well as the well-being of the family. The research on siblings
    of special needs children is reviewed and followed by a description of the
    Ottawa Children’s Treatment Centre sibling programme.

  2. being one of four siblings I understand that there is a big role that siblings play to one another as far as mental health and overall happiness. When one sibling suffers from a mental health disorder there is a much higher risk for the other children to have it or develop it. Also siblings can make the disorder worse or better just from the type of interaction the siblings have. Awesome post. Can’t wait to see more.

  3. This was very interesting, the role of siblings definitely does effect childrens mental health. Children with positive sibling interaction would be more likley to have better mental health.
    It makes since due to the fact that if one of the children that came from a family with conflicting sibling relationships develops a mental health disorder, it will increase the chances of all the siblings greatly.

  4. would love to see data/ studies on this as relates to children that have been removed from biological parents/ home due to deplorable circumstances,– only for {said} parent to have additional children, and DFCS not remove them. Sometimes those children are also removed, other times, more often than not, the parent is given a “clean slate” to mess up again on another child, and that new child is left in home, in which most often the circumstances have not changed. The whole concept of keeping sibling groups together, and how those children growing up cope / turn out {the nature vs. nurture part} based on whether the sibling groups remain separate and the parent is given (yet) another chance, or whether all effort is made to keep the sibling groups together. Seems that too often the adults get cut the breaks and millions of chances, while the poor kids just suffer without advocates. We find ourselves in this very situation. Rescuing children from sure and certain fate, is a tireless, expensive, exhausting, frustrating process— all with no guarantees.

  5. Appropriate controls are difficult. While it may be true that children with warm , non-conflictive relationships have less behavior issues, it may also be true that children with fewer behavior issues tend to have warmer, less conflictive relationships with their siblings! I know it is anecdotal, but I have seen both played out with the same child at different stages of their life!

  6. Here is the thing. A good relationship between siblings does not occur naturally. It’s up to the parents to build it. It’s very hard work but this study is proof that it pays off.

  7. Great article… another fascinating case study about sibling interaction and/or trauma is To Soften the Blow by Lynnie Vessels, if anyone has read it. It’s a truly amazing book and offers the best insight into coping with trauma and the importance of family after a traumatic event.

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