Assessing structural models of neighborhood and family sociodemographic characteristics and their relations with externalizing psychopathology.

Externalizing psychopathology has been found to have small to moderate associations with neighborhood and family sociodemographic characteristics. However, prior studies may have used suboptimal operationalizations of neighborhood sociodemographic characteristics and externalizing psychopathology, potentially misestimating relations between these constructs. To address these limitations, in the current study we test different measurement models of these constructs and assess the structural relations between them. Using a population-representative sample of 2,195 twins and siblings from the Georgia Twin Study and data from the National Neighborhood Data Archive and 2000 U.S. Census, we assessed the fit of competing measurement models for family sociodemographic, neighborhood sociodemographic, and neighborhood environment characteristics. In structural models, we regressed a general externalizing dimension on different operationalizations of these variables separately and then simultaneously in a final model. Latent variable operationalizations of family sociodemographic, neighborhood sociodemographic, and neighborhood environment characteristics explained no more variance in broad externalizing psychopathology than other operationalizations. In an omnibus model, family sociodemographic characteristics showed a small association with externalizing psychopathology, while neighborhood sociodemographic and environmental characteristics did not. Family sociodemographic characteristics showed small associations with neighborhood sociodemographic and environmental characteristics, and neighborhood sociodemographic characteristics were moderately associated with neighborhood environment. These findings suggest that family sociodemographic characteristics are more associated with the development of broad externalizing psychopathology in youth than neighborhood sociodemographic characteristics and neighborhood environment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sibling adjustment to diabetes and educational needs: A literature review.

ABSTRACT: As cases of type 1 diabetes mellitus (T1DM) increase, so do their impact on sibling relationships. This literature review of four databases from 2010 to 2024 discusses findings from five studies and the themes that emerged: education needs and family functioning. Improvements in family-centered care and education are needed for siblings of children with T1DM.

Response to psychotic experiences: Impact of personality traits on perceived levels of distress.

BACKGROUND: This study examined the influence of personality traits on (subclinical) positive symptom distress in patients with a psychotic disorder, their unaffected siblings and healthy controls. METHODS: Data were obtained from the Genetic Risk and Outcome of Psychosis study (GROUP), a Dutch longitudinal multicenter cohort study. Data from 140 patients, 216 unaffected siblings and 102 healthy controls was available for baseline levels of Five Factor Model personality traits and frequency and distress due to psychotic experiences three years later, assessed with the Community Assessment of Psychic Experience questionnaire. Main effects of all five personality traits on symptom distress were investigated as well as moderating effects of Neuroticism, Extraversion and Openness on positive symptom frequency and positive symptom distress. Age, gender, symptom frequency and IQ were controlled for. RESULTS: In both patients and siblings, the observed main effects of Neuroticism and Openness on (subclinical) positive symptom distress three years later either lost significance or had a very small effect size when controlling for covariates, mainly due to the correction for the effect of positive symptoms on personality traits at baseline. In both groups, levels of Openness at baseline moderated the association between positive symptom frequency and positive symptom distress three years later, in the direction that higher levels of Openness were associated with weaker associations between positive symptom frequency and - distress, even when covariates were controlled for. DISCUSSION: The level of Openness to Experiences influences the perceived distress from (subclinical) positive symptoms in both patients and siblings.

Development of a blueprint for sibling psychosocial services: A nationwide study.

BACKGROUND: Siblings of youth with cancer have heightened risk for poor long-term psychosocial outcomes. Although sibling psychosocial care is a standard in pediatric oncology, this standard is among those least likely to be met. To address barriers to providing sibling services, a blueprint for systematic psychosocial screening and support of siblings was developed based on feedback from a national sample of psychosocial providers. PROCEDURE: Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N = 27) of various disciplines working in US pediatric cancer centers, varied in size, type, and extent of sibling support. Interviews queried providers' suggestions for the future of sibling psychosocial care and impressions of a blueprint for sibling service delivery, which was iteratively refined based on respondents' feedback. Interviews were analyzed using applied thematic analysis. RESULTS: Based on existing literature and refined according to providers' recommendations, the Sibling Services Blueprint was developed to provide a comprehensive guide for systematizing sibling psychosocial care. The blueprint content includes: (i) a timeline for repeated sibling screening and assessment; (ii) a stepped model of psychosocial support; (iii) strategies for circumventing barriers to sibling care; and (iv) recommendations for how centers with varying resources might accomplish sibling-focused care. The blueprint is available online, allowing providers to easily access and individualize the content. Providers indicated enthusiasm and high potential utility and usability of the blueprint. CONCLUSIONS: The Sibling Services Blueprint may be a useful tool for systematizing sibling psychosocial care, promoting wider availability of sibling-focused services, and addressing siblings' unmet needs.

Association of Very Low Birth Weight Infants With Parental and Sibling Mental Health Care Usage.

BACKGROUND AND OBJECTIVES: Parents and siblings of very low birth weight, premature infants are at risk for poor mental health outcomes with increased mental health care usage. Knowledge regarding mental health care use patterns could guide interventions. METHODS: This retrospective cohort study included US families with commercial insurance coverage from a single carrier. Neonates born at ≤30 weeks' gestational age or with a birth weight <1500 g were identified by insurance claim data between July 1, 2015, and June 30, 2016. Each case neonate family was matched with up to 4 control families. RESULTS: The study included 1209 case and 1884 control neonates (with 134 deaths among only the case neonates [11.1% of cases]); 2003 case and 3336 control parents (mean [SD] age, 34.6 [5.4] years; 2858 [53.5%] female); and 884 case and 1878 control siblings (mean [SD] age, 6.8 [5.5] years; 1375 [49.8%] female). Compared with controls, more case parents used mental health care over the first year after birth hospitalization discharge. Higher usage was observed for bereaved case parents soon after their child's death. A smaller proportion of bereaved case siblings received mental health care compared with controls. Although nonbereaved case parents returned toward the proportion of use observed in controls, nonbereaved case female siblings, bereaved case female and male siblings, and bereaved male parents experienced continued differences. CONCLUSIONS: Understanding and meeting the mental health care needs of parents and siblings of very low birth weight premature neonates can be guided by these findings, including elevated and prolonged needs of bereaved parents and siblings.

The feeding siblings questionnaire (FSQ): Development of a self-report tool for parents with children aged 2-5 years.

Over the last decade, there have been repeated calls to expand the operationalisation of food parenting practices. The conceptualisation and measurement of these practices has been based primarily on research with parent-child dyads. One unexplored dimension of food parenting pertains to the evaluation of practices specific to feeding siblings. This study describes the development and validation of the Feeding Siblings Questionnaire (FSQ) - a tool designed to measure practices in which siblings are positioned as mediators in parents' attempts to prompt or persuade a child to eat. Item development was guided by a conceptual model derived from mixed-methods research and refined through expert reviews and cognitive interviews. These interviews were conducted in two phases, where parents responded to the questionnaire primarily to test i) the readability and relevance of each item, and ii) its overall feasibility. The instrument was completed by 330 parents (96.1% mothers) in Australia with two children aged 2-5 years, and repeated by 133 parents (40.3%) two weeks later. Exploratory factor analysis was performed on baseline data. Internal consistency and test re-test reliability of the subsequent subscales were examined. Construct validity was assessed through comparisons with existing measures of food parenting practices and child eating behaviours. The final FSQ scale included 22 items, reflecting five food parenting practices: sibling competitiveness, active sibling influence, threatening unequal division of food, sibling role modelling, and vicarious operant conditioning. Internal consistency and test re-test reliability estimates were high, and there was some evidence of convergent construct validity. While its factor structure should be confirmed in a different sample, the FSQ offers a novel tool for assessing, monitoring, and evaluating feeding interactions beyond those confined to the parent-child dyad.

From classroom to life: Gender differences in the persistent effect of learning disabilities on adult depressive symptoms.

Despite the well-established link between adolescent learning disabilities (LD) and mental health, little is known about its long-term consequences. This study examines the relationship between adolescent LD and adult depressive symptoms, with a focus on gender differences and underlying mechanisms. Using a sibling sample from the National Longitudinal Study of Adolescent to Adult Health (N = 3,414), this study estimated sibling fixed effects models to account for unobserved family-level characteristics such as genes and early childhood family and social context. Sobel mediation analyses were conducted to examine social-psychological mechanisms, including the student-teacher relationship, the student-student relationship, and a sense of school belonging. LD in adolescence was positively associated with depressive symptoms in adulthood (b = 0.823, p < 0.05). This association remained robust when controlling for unobserved family-level confounders as well as educational attainment in adulthood. Gender-stratified models showed that only the association for women is statistically significant (b = 1.935, p < 0.05), and its magnitude is nearly three times that of the association for men. Sobel mediation tests indicate that a decline in a sense of school belonging mediates approximately 17% of the association between adolescent LD and adult depressive symptoms. This study's findings suggest that LD in adolescence is associated with an increase in depressive symptoms in adulthood, particularly in women, and a low sense of school belonging may be a potential mediator. Implementing interventions to improve the school integration of girls with LD could be an effective means of improving their long-term mental health.

Using emulated clinical trials to investigate the risk of being diagnosed with psychiatric ill health following the cancer diagnosis of a sibling.

BACKGROUND: The sibling bond is often the longest relationship in an individual's life, spanning both good and bad times. Focusing on the latter, we investigated whether a cancer diagnosis in one adult sibling is predictive of psychiatric illness in the other, and if any such effect differs according the 'sociodemographic closeness' between the siblings in terms of sex, age, education, marital status and residence. METHODS: We used hospital records to identify psychiatric diagnoses (2005-2019) in a Swedish total-population cohort born in 1953, and cancer diagnoses (2005-2017) in their full siblings. By means of emulated clinical trials, the cohort member's risk of a diagnosis within two years following a first exposure (or non-exposure) to a sibling's cancer was analyzed through Cox regression. RESULTS: Exposed cohort members had a higher risk of psychiatric diagnosis than unexposed (HR = 1.15; CI: 1.08-1.23), with men displaying a higher risk (1.19; CI: 1.09-1.31) than women (HR = 1.11; CI: 1.01-1.22). Sub-analyses of the exposed group showed that women with a cancer-stricken sister had a higher risk of adverse psychiatric outcomes (HR = 1.31; CI: 1.07-1.61) than women with a cancer-stricken brother. Furthermore, unmarried cohort members ran a higher risk, both when the cancer-stricken sibling was married (HR = 2.03; CI: 1.67-2.46) and unmarried (HR = 2.61; CI: 2.16-3.15), than in cases where both siblings were married. No corresponding difference were detected for 'closeness' in age, education and residence. CONCLUSIONS: In line with theories of linked lives, our findings suggest that negative events in one sibling's life tend to 'spill over' on the other sibling's wellbeing, at least during the 15-year-long period leading up to retirement age.

Associations between the number of siblings, parent-child relationship and positive youth development of adolescents in mainland China: A cross-sectional study.

BACKGROUND: Positive development plays an important role in youth when dealing with stressful circumstances. According to the resource dilution theory, adolescents with or without siblings may receive different levels of emotional and material resources from their parents. The purpose of this study is to examine the association between the positive development of adolescents in China today with their family characteristics such as the number of siblings. METHODS: A total of 2072 junior high and senior high school students (13 to 18 years old) in Chengdu, Sichuan, China, were investigated by cluster sampling. The Chinese Positive Youth Development scales (CPYDs) were used to measure positive youth development. The generalized linear model was used to explore the relationships among the number of siblings, parent-child relationships and positive youth development. RESULTS: Adolescents from only-child families had better performance on positive development (H = 21.87, P < 0.001) and better relationships with parents (H = 15.1, P < 0.05). The positive development of male and female adolescents does not significantly differ in families with different numbers of siblings. The generalized linear model showed that a positive parent-child relationship is positively correlated with adolescent positive development (P < 0.05). CONCLUSION: Positive youth development is not only associated with the number of siblings but also other modifiable familial factors. The positive relationship between parents and adolescents is of great practical value in daily life to improve youth development, and this might be the real lesson the resource dilution theory tells.

Sibling Violence and Bullying Behaviors in Peers: The Mediational Role of Self-Esteem.

In the context of the existing research on families, sibling violence is a less explored area. However, it has seemingly received more attention recently, and it can assume a relevant role in understanding the maladaptive behavior of youngsters and bullying. Additionally, adolescents involved in bullying and self-esteem are associated with disruptive violence inside the family context. This study's sample consisted of 286 students, aged between 12 and 17 years, from both sexes. This study intends to explore the association between sibling violence and bullying behavior in peers and the mediator effect of self-esteem. The measures for data collection were a demographic questionnaire, the Social Exclusion and School Violence Questionnaire, The Revised Conflict Tactics Scales (Portuguese version for siblings), and the Rosenberg Self-Esteem Scale. The results show a negative effect between negotiation in the sibling relationship (victimization) and social exclusion and verbal aggression related to bullying behavior. Self-esteem represents a total and negative mediator in this connection. Our results also show a variety of indirect outcomes amongst the negotiation dimension, psychological aggression and injury between siblings, and the social exclusion and verbal aggression dimensions (on the aggression and victimization scales). The results will be discussed according to the attachment theory but considering the importance of affective bonds with siblings as a predisposing factor to an adaptive development course.

What challenges do siblings of children with chronic disorders express to their parents? A thematic analysis of 73 sibling-parent dialogues.

PURPOSE: The study explored challenges experienced by siblings of children with chronic disorders, as expressed by siblings in parent-child dialogues. DESIGN AND METHODS: Seventy-three parent-child dialogues (M duration = 28.6 min) were analyzed using qualitative thematic analysis. The dialogues took place within the SIBS group intervention for siblings and parents of children with chronic disorders. The siblings (aged 8 to 14 years) had brothers and sisters with autism spectrum disorders, ADHD, rare disorders, cerebral palsy, or severe mental health disorders. The data are from session 5 in the SIBS intervention, in which the siblings are to express their wishes about family-related challenges (e.g., desired changes) to their parents. The parents are encouraged to listen, explore, and validate the child's perspective before discussing solutions. RESULTS: Most of the family-oriented challenges the siblings expressed were related to the diagnosis of the brother or sister with a disorder. Four main themes were identified: (1) Family life (e.g., limitations in family activities); (2) The diagnosis (e.g., concerns about the future); (3) Violence; and (4) Important relationships. CONCLUSION: The siblings experienced challenges and difficult emotions in interactional processes in which the diagnosis affected family life and relationships. The study adds a new dimension to the field by identifying siblings' expressed challenges based on parent-child dialogues. PRACTICE IMPLICATIONS: Identified themes can guide how parents should meet and address siblings' needs, how health care providers inform and support parents in doing so, and emphasize the relevance of interventions targeting family-level risk and resilience factors.

Mental Disorders Among Adolescents and Young Adults With Cancer: A Canadian Population-Based and Sibling Cohort Study.

PURPOSE: To compare the cumulative incidence of mental disorders among adolescents and young adults (AYAs) diagnosed with cancer with the general population and their unaffected siblings. METHODS: A retrospective, population-based, matched cohort design was used to investigate the impact of cancer diagnosis on mental disorders among individuals age 15-39 diagnosed between 1989 and 2019. Two cancer-free cohorts were identified: matched population-based and sibling cohorts. Outcomes included incidence of mood and anxiety disorders, substance use disorders, suicide outcomes, psychotic disorders, and any of the preceding four categories within 5 years of cancer diagnosis. Competing risk regression was used to estimate adjusted subhazard ratios (aSHR) and 95% CIs. RESULTS: Among 3,818 AYAs with cancer matched to the population-based cancer-free cohort, individuals with cancer were more likely to be diagnosed with incident mental disorders than those without cancer; the risk was highest immediately after a cancer diagnosis and decreased over time with aSHR [95% CI] for mood and anxiety disorders at 0-6 months (11.27 [95% CI, 6.69 to 18.97]), 6-12 months (2.35 [95% CI, 1.54 to 3.58]), and 12-24 months (2.06 [95% CI, 1.55 to 2.75]); for substance use disorders at 0-6 months (2.73 [95% CI, 1.90 to 3.92]); for psychotic disorders at 0-6 months (4.69 [95% CI, 2.07 to 10.65]); and for any mental disorder at 0-6 months (4.46 [95% CI, 3.41 to 5.85]), 6-12 months (1.56 [95% CI, 1.14 to 2.14]), and 12-24 months (1.7 [95% CI, 1.36 to 2.13]) postcancer diagnosis. In sibling comparison, cancer diagnosis was associated with a higher incidence of mood and anxiety and any mental disorder during first 6 months of cancer diagnosis. CONCLUSION: AYAs with cancer experience a greater incidence of mental disorders after cancer diagnosis relative to population-based and sibling cohorts without cancer, primarily within first 2 years, underscoring the need to address mental health concerns during this period.

'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.

Experiences of Awe and Gratitude and Related Triggers Among Religious Brothers and Sisters: Findings from a Cross-Sectional Study in Germany.

A cross-sectional survey among religious brothers and sisters (n = 250) with their specific lifestyle and related spiritual practices stated moments of awe perceptions. They responded to both the Awe/Gratitude scale and to free text fields to substantiate their quantitative responses. Qualitative content analysis of their free text responses resulted in six main categories of awe triggers: (1) Nature, (2) Special Moments, (3) Transcendence Perceptions, (4) Religious practices, (5) Distinct People, and (6) Aesthetics, Art and Culture. Awe perceptions can be an immediate feeling and the outcome of a process of reflection in response to admiration, inspiration, and elevation. As these perceptions are related to psychological well-being and prosocial behaviors, their training can generate positive effects on quality of life.

Parental differential warmth, hostility, and sibling differences in internalizing and externalizing behavior problems: A meta-analysis.

Parental differential treatment (PDT) of siblings is associated with differences in children's behavioral adjustment. The current meta-analysis examined the extent to which associations between relative PDT and sibling differences in behavior problems differ by type of parenting behavior (i.e., differential hostility vs. differential warmth) and type of behavior problems (i.e., differential externalizing vs. internalizing behavior problems). In September 2021, we systematically searched APA PsycInfo and Web of Science, yielding 2,259 unique hits with 19 eligible publications reporting on 215 effect sizes from 13 unique samples. The overall association between relative PDT (i.e., receiving less warmth and more hostility than one's sibling) and sibling differences in behavior problems was small but significant. Associations were stronger for differential hostility compared to differential warmth and for differential externalizing compared to differential internalizing behavior problems. Particularly marked was the finding that siblings who received more hostility from their parents showed higher levels of externalizing behavior problems. Future research investing in further dismantling the association between within-family PDT and sibling differences in adjustment is warranted to better understand why parents treat siblings differentially and to guide family support initiatives. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

'No one else understands', 'I wouldn't want to pity myself over something that's not really my problem': siblings' experiences of their adolescent brothers and sisters' inpatient treatment for mental health difficulties.

BACKGROUND: Family life is disrupted when a child experiences mental health difficulties. This can have long-standing effects on sibling relationships. This study explores the lived experiences of young people who have an adolescent sibling hospitalised for treatment of a mental health difficulty. METHOD: Semi-structured interviews of 45-60 min were conducted to explore the experiences of 10 siblings (6 sisters/4 brothers aged 13-22) of nine patients (5 sisters/4 brothers aged 15-17) receiving treatment for a mental health difficulty in a child and adolescent inpatient unit (IPU). Interpretative phenomenological analysis was used to analyse the data. RESULTS: Two superordinate themes were identified: 'Who am I if I'm not supporting them?' and 'On the fringes: actively involved but from the outside'. The interplay of these two super-ordinate themes was found to influence the five sub-ordinate themes: 'Confusion and disbelief', 'Don't worry about me, focus on them.', 'Powerless when I need to be powerful.', 'Helping or hindering- what is this place??' and 'Knowledge is power.' CONCLUSION: Siblings described experiencing conflicting and confusing emotions which may impact their attendance in IPU and engagement in siblings' treatment. Siblings of adolescents in inpatient treatment for mental health difficulties may be at increased risk of experiencing psychological distress. The mental well-being of siblings must be borne in mind by child and adolescent inpatient services supporting families in crisis.

Sibling support exchange in late adulthood moderates the long-term impact of childhood neglect on psychological outcomes.

Objectives: Sibling relationships are often the longest-lasting and serve as a source of support and comfort for many older adults. The current study examined the moderating effect of sibling support exchange in the association between childhood maltreatment and mental health outcomes.Method: Using data from the Wisconsin Longitudinal Study (WLS), we analyzed a sample of older adults whose selected sibling was alive across the three data collections (baseline N = 4,041). Longitudinal multilevel regression models were estimated.Results: Key results showed that a history of neglect was associated with decreased psychological well-being, and all three forms of childhood maltreatment were related to increased depressive symptoms. We also found that sibling support exchange mitigated the negative mental health effects of childhood neglect.Conclusion: Our findings suggest that siblings may be uniquely positioned to support older adults who grew up in a neglectful family environment. Older adults may be encouraged to promote resilience by strengthening their sibling relationships.

Observation of Early Social Interactions in Sibling Dyads: A Systematic Review.

Sibling relationships provide unique social experiences that can vary across the lifespan. Early sibling social interactions (ESSI) have been associated with children's own relationship and developmental outcomes, highlighting the essential role that sibling encounters play, even from a young age. Understanding how these social exchanges occur and unfold and the range of opportunities they provide can shed light on critical aspects of early childhood development and family life. However, the methodological approach used in studying ESSI can influence our understanding of these early experiences. This systematic review aims to delineate the methodological framework adopted in observational studies of ESSI. Through a systematic search of psychology and domain-general databases until March 2023, we focused on studies that addressed bidirectional naturalistic interactions in young sibling dyads (at least one child aged 0-36 months). Of the 713 articles screened, only 63 met the inclusion criteria. Findings regarding three main issues are examined, including sample characteristics, study designs and procedures, and sibling interactive behaviours targeted. Previous research has focused on a diverse range of sibling behavioral exchanges, including cues of children's social skills and relationship quality within mainly ecological contexts. However, limitations in representativeness and standardization have been identified. Future studies should incorporate sequential analyses to fully comprehend the interactive nature of early sibling social encounters.

Healthy siblings' perspectives about paediatric palliative care: A qualitative systematic review and meta-synthesis.

BACKGROUND: Siblings of children requiring palliative care are often forgotten and overlooked, as the focus tends to be on the ill child and their parents. Limited knowledge of non-bereaved siblings' perspectives makes it challenging to provide appropriate support for them. A review of existing literature is thus needed to better understand the experiences of these siblings and to identify research gaps that may require further examination. AIM: To consolidate the available qualitative evidence on the perspectives of non-bereaved healthy siblings regarding paediatric palliative care. DESIGN: A qualitative systematic review using a meta-synthesis approach was conducted. DATA SOURCES: Six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until October 2022. The search included qualitative and mixed-method studies that reported the perceptions and associations of siblings of patients receiving paediatric palliative care. Data were synthesised using thematic analysis. RESULTS: Eleven studies were included. The overarching theme of the review would be 'A walking shadow: Living in the darkness shaped by the dying sibling', and three key themes and nine subthemes were identified from the included articles: (1) Changing family dynamics; (2) Impact on school and socialisation and (3) Psychological impact and coping. CONCLUSION: Siblings demonstrated negative psychological impacts and were affected by changing family structure and relationships. However, socialisation with society, and varied coping skills such as cognitive coping and using distraction techniques, were significant for siblings to go through this journey and even led to some positive outcomes for them.