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.

'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.

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.

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).

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.

Child hyperactivity, mother-child negativity, and sibling dyad negativity: A transactional family systems approach.

Attention-deficit/hyperactivity disorder (ADHD) is among the most common mental disorders in children and adolescents. While most studies in this field have focused on the genetic and neurobiological underpinnings of the disorder, research focusing on the family environment as a critical context contributing toward the manifestation and maintenance of child ADHD symptoms is still less extensive. Therefore, the aim of this study was to examine longitudinal and bidirectional associations between child hyperactivity, mother-child negativity, and sibling dyad negativity. Data were analyzed of up to 4,429 children from the Avon Longitudinal Study of Parents and Children, a nationally representative prospective birth cohort study in the United Kingdom, at three time points (T1-T3, children aged 4, 7, and 8 years). At baseline (T1, n = 4,063), the child sample (98.8% White ethnic background) composed of 51.6% males. Child hyperactivity symptoms, mother-child negativity, and sibling dyad negativity were examined based on maternal reports. The random intercepts cross-lagged panel model was adopted to parcel out between-family differences from within-family fluctuations and test bidirectional associations. On the between-family level, families with higher child hyperactivity reported higher mother-child and sibling dyad negativity. On the within-family level, unidirectional spillover processes between sibling dyad negativity and mother-child negativity as well as between mother-child negativity and child hyperactivity emerged. Future work in the area of child hyperactivity should implement a transactional family systems approach incorporating both parent-child and sibling subsystems. Interventions to reduce negative interactions between parents and hyperactive children may offer promising improvements in child symptoms and thus alleviate family burden. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neural correlates of face processing among preschoolers with fragile X syndrome, autism spectrum disorder, autism siblings, and typical development.

The current study examined patterns of event-related potential (ERP) responses during a face processing task in groups of preschoolers uniquely impacted by autism spectrum disorder (ASD), including (1) children with ASD; (2) children with fragile X syndrome (FXS); (3) children with familial risk for ASD, but without a diagnosis (i.e., ASIBs); and (4) a low-risk control (LRC) group. Children with FXS have a high incidence of ASD diagnoses, but there have been no studies of the ERP response to faces in children with FXS and little work focused on children with ASD who have cognitive impairment. The current study examined children's ERP responses to faces and houses in four groups: LRC (N = 28, age = 5.2 years), ASIB (N = 23, age = 5.5 years), FXS (N = 19, age = 5.82 years), and ASD (N = 23, age = 5.5 years). The FXS and ASD groups were characterized by the presence of cognitive impairment. Pictures of upright and inverted faces and houses were presented while recording EEG with a 128-channel system. The N170 occurred at about 200 ms post stimulus onset, was largest on the posterior-lateral electrodes, and was larger for faces than houses. The P1 and N170 ERP components were larger for the FXS group than for the other three groups. The N170 ERP amplitude for the ASD and ASIB groups was smaller than both the LRC and FXS groups, and the LRC and FXS groups had the largest N170 responses on the right side. No difference was found in N170 latency between groups. The similarity of the ASD and ASIB responses suggest a common genetic or environmental origin of the reduced response. Although children with FXS have a high incidence of ASD outcomes, they differed from ASD and ASIB children in this study. Specifically, the children with FXS were hyperresponsive to all stimulus types while the ASD and ASIB groups showed attenuated responses for specific stimuli.

Birth-order effects on risk taking are limited to the family environment.

Why is the empirical evidence for birth-order effects on human psychology so inconsistent? In contrast to the influential view that competitive dynamics among siblings permanently shape a person's personality, we find evidence that these effects are limited to the family environment. We tested this context-specific learning hypothesis in the domain of risk taking, using two large survey datasets from Germany (SOEP, n = 19,994) and the United States (NLSCYA, n = 29,627) to examine birth-order effects on risk-taking propensity across a wide age range. Specification-curve analyses of a sample of 49,621 observations showed that birth-order effects are prevalent in children aged 10-13 years, but that they decline with age and disappear by middle adulthood. The methodological approach shows the effect is robust. We thus replicate and extend previous work in which we showed no birth-order effects on adult risk taking. We conclude that family dynamics cause birth-order effects on risk taking but that these effects fade as siblings transition out of the home.

Parenting of siblings in Latinx families during middle childhood.

Parents' management of their children's sibling relationships, or sibling-focused parenting, has substantial theoretical and practical importance but is rarely studied. This study's goals were to describe dimensions of sibling-focused parenting and to examine sociocultural resources and challenges as potential correlates among Latinx mothers and fathers in 262 families with two children in middle childhood. Families were recruited from 11 public elementary schools, and caregivers (248 mother figures; 118 father figures) participated in a home visit and phone interviews at the onset of the study. Sibling-focused parenting included three dimensions: positive guidance (10 items), nonintervention (four items), and authoritarian control (five items). Parents rated positive guidance as their most frequent strategy, and comparisons of mothers and fathers from the same families revealed that mothers engaged in more sibling-focused parenting overall than fathers. Regarding correlates, mothers' familism values and mothers' and fathers' family cohesion reports were associated with more positive guidance and mothers' cohesion was negatively related to nonintervention in sibling conflicts. For mothers only, parenting stress was linked to all three dimensions of sibling-focused parenting-negatively to guidance and positively to authoritarian control and nonintervention; maternal depressive symptoms were positively linked to authoritarian control. Economic hardship was not a significant correlate of any dimension. Findings suggest that sibling-focused parenting is a key domain of parenting in need of further research. (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.

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.

Short report: Siblings of children with neurodevelopmental disorders, a phenomenological perspective on parental perception.

BACKGROUND: Siblings, typically developing brothers and sisters of children with neurodevelopmental disorders (NDD), are at risk for long-term psychosocial difficulties. OBJECTIVE: The present study aims at obtaining an in-depth insight on the lived experience of siblings of children with NDD through their parents' perspective. METHODS: Seven mothers and three fathers who signed up their sibling children (12-15 years) to a peer-support intervention participated in a semi-structured videoconference interview according to the Interpretative Phenomenological Analysis (IPA) qualitative approach. Interviews were conducted by trained personnel and independently coded. RESULTS: Thematic analysis highlighted three core themes and twelve sub-themes: "The complexity of the fraternal relationship" (three sub-themes), "Growing up with diversity" (six sub-themes), and "Me as a sibling" (three sub-themes). CONCLUSIONS: The study provides insight on parents' perception of the lived experience of their sibling children, thus spreading awareness on the everyday difficulties families with a child with NDD may encounter. WHAT THIS PAPER ADDS: The present study contributes to the scarce literature on the lived experience of siblings of children with NDD, and notably it is one of the few qualitative studies on the topic which makes use of an IPA interviewing style. This methodological choice allowed for an in-depth understanding of siblings' strengths and struggles as perceived by their own parents, and of how their brother/sister's condition impacted on their family role, socio-emotional development and personality. Recounting siblings' experiences contributes in spreading awareness on the everyday difficulties siblings and their families face when cohabitating with a child with NDD.

Sibling Relationship and Behavioral Adjustment in Families of Disabled Children: Cross-Lagged Associations.

Cross-lagged panel designs were used to examine longitudinal and potential (bi)directional relationships between primary caregiver reported sibling relationship quality and the behaviors of children with intellectual disability (n = 297) and their closest in age siblings. The behavioral and emotional problems of the child with intellectual disability positively predicted sibling conflict over time. When accounting for control variables, this relationship was no longer present. Sibling warmth positively predicted the prosocial behaviors of the child with intellectual disability over time. When accounting for control variables, both sibling warmth and sibling conflict positively predicted the prosocial behaviors of the child with intellectual disability over time. Future research directions and clinical implications are discussed.

Influence of hearing loss on sibling relationships: Perspectives of the normal hearing sibling.

BACKGROUND: Sibling relationships, one of the most extended relationships in life, contribute to an individual's social and emotional development. However, this relationship may be influenced if one sibling has a hearing loss. OBJECTIVES: This study explored the influence of a hearing loss on the sibling relationship by gaining the perspectives of the sibling with normal hearing. METHOD: Adopting a phenomenological research design, semi-structured online interviews were conducted using Zoom and WhatsApp with nine participants who have siblings with hearing loss. RESULTS: Hearing loss may significantly impact the normal hearing sibling's quality of life, affecting their psychological and social well-being, familial and peer relationships and overall experiences. Personal development, independence, maturity and closer sibling bonds were some of the positive influences reported by the participants. Attendance to aural rehabilitation therapy sessions, knowledge of hearing loss, personalities and household living arrangements positively influenced the relationship between siblings. The lack of attendance to aural rehabilitation sessions resulted in communication difficulties between siblings. CONCLUSION: There is a need to include siblings in aural rehabilitation and family engagements related to the child with hearing loss to provide a holistic and more effective rehabilitation and adjustment process.Contribution: This study aimed to improve family-centred intervention as it is focussing on the siblings' perspectives of the hearing loss. Furthermore, previous studies have generally focussed on adults and not much research has been conducted surrounding the sibling relationship.

Supporting the Family After the Death of a Child or Adolescent.

Whether death occurs in the context of a chronic illness or as the sudden loss of a previously healthy infant, child, or adolescent, the death of a child is a highly stressful and traumatic event. Psychosocial support for families after the death of a child embodies core medical values of professional fidelity, compassion, respect for human dignity, and promotion of the best interests of a grieving family. The pediatrician has an important role in supporting the family unit after the death of a child through a family-centered, culturally humble, trauma-informed approach. This clinical report aims to provide the pediatrician with a review of the current evidence on grief, bereavement, and mourning after the loss of a child and with practical guidance to support family caregivers, siblings, and the child's community. Pediatricians have an important role in helping siblings and helping families understand sibling needs during grief. Ways for pediatricians to support family members with cultural sensitivity are suggested and other helpful resources in the community are described.

Psychological health of mothers and siblings of children with autism spectrum disorders during COVID-19 pandemic: new evidence in Italian families.

BACKGROUND AND AIM: Psychological challenges are well recognized in families with a child with Autism Spectrum Disorders (ASD). Instead, less is known about the effects of traumatic scenarios, such as COVID-19, on the psychological health of these families. The main aim of this research was to study the psychological health of both mothers and typically developing (TD) siblings of children with ASD during the COVID-19 pandemic. Second, we investigated the relationship between the mothers' psychological resources and their children psychological well-being. METHODS: The sample included 52 mothers and their children: 15 with one child with ASD and at least one TD child (aged 4-14) (ASD-siblings group) and 37 with one or more TD child (aged 4-14) (TD control group). The data were collected through an online platform; four standardized questionnaires (GAD-7, BDI-II, CD-RISC 25 and CBCL) were administered. RESULTS: The analyses revealed more internalizing and total behavioral symptoms in the siblings of children with ASD, compared to TD control group. Regarding the mothers, we did not find differences in depression and anxious symptoms between the two groups. However, the results reported a lower level of resilience in the mothers of children with ASD relative to mothers of TD children. Finally, the psychological well-being of the TD children was associated with the level of mothers' anxiety only in the ASD-siblings group. CONCLUSIONS: Overall, our data show that the COVID-19 outbreak may had been particularly challenging for families of children with ASD, and highlight the importance of intensifying psychological support to families.

Neurocognitive and self-reported psychosocial and behavioral functioning in siblings of individuals with neurodevelopmental conditions: a study using remote self-administered testing.

OBJECTIVE: This study compared and explored the neurocognitive profiles of siblings of persons with and without neurodevelopmental conditions (NDCs) and associations between objective test performance and self-reported psychosocial functioning. METHODS: Siblings of persons with and without NDCs (64 NDC and 64 control siblings; mean age 19.88 years, range 11-27 years, 73.44% female, 75.78% White Caucasian) completed self-report questionnaires and self-administered computerized neurocognitive tests of executive functioning (EF). Using Bayesian analyses, we examined cross-sectional associations between self-reported psychosocial functioning and cognitive test performance, and predictors of EF over 15 months. RESULTS: NDC siblings had poorer working memory, inhibition, attention, and shifting compared to controls, as measured by experimental paradigms on the backward Corsi span, N-Back 2-back task, Stop Signal Task, Sustained Attention to Response Task, and the Wisconsin Card Sorting Test (effect size δ ranging 0.49 to 0.64). Bayesian cross-sectional networks revealed negative emotion reactivity and working memory difficulties were central to the NDC sibling network. Over 15 months, poorer EF (k low test scores) was predicted by negative emotion reactivity, sleep problems, and anxiety, over and above effects of age and subclinical autistic and ADHD traits. Siblings of autistic individuals and persons with fetal alcohol spectrum disorder had higher rates of neurocognitive and psychiatric difficulties than other NDCs and controls (Bayes factors >20). CONCLUSIONS: Neurocognitive difficulties were associated with transdiagnostic vulnerability to poorer wellbeing in NDC siblings. These findings demonstrate the feasibility of remote online cognitive testing and highlight the importance of individualized prevention and intervention for NDC siblings.

NDC siblings had poorer attention and executive functioning across five experimental paradigms compared to controls.NDC siblings had poorer self-reported psychological, emotional and behavioral functioning compared to controls.Siblings of autistic persons and FASD had diffuse cognitive and self-reported functioning difficulties compared to other NDCs and controls.Baseline self-reported negative emotion reactivity and sleep problems predicted objective EF difficulties in NDC siblings after 15 months.

Associations between parental depression, communication, and self-worth of siblings bereaved by cancer.

A child's death from cancer may increase the risk for poor self-worth in bereaved siblings. Furthermore, bereaved parents may experience depressive symptoms and communicate differently with their surviving children. However, limited research has examined family factors associated with self-worth in bereaved siblings. Thus, we examined: (a) differences in parental depressive symptoms, parent-child communication, and sibling self-worth between bereaved and nonbereaved families and (b) indirect effects of parental depressive symptoms and communication quality on the association between bereavement and sibling self-worth. Bereaved parents and siblings were recruited 3-12 months after a child's death from cancer. Bereaved (n = 72) and nonbereaved families of classmates (n = 58) completed home-based questionnaires upon enrollment (T1), and 48 bereaved and 45 nonbereaved families completed 1-year follow-up (T2). Relative to controls at T1 and T2, bereaved mothers, but not fathers, reported more depressive symptoms. Bereaved siblings reported poorer maternal and similar paternal communication, and similar levels of self-worth compared to controls. Both cross-sectional and longitudinal serial mediation models for mothers were significant. Bereaved mothers were at greater risk for depressive symptoms, which adversely affected sibling self-worth over time through disrupted mother-child communication. The father sample was limited, but the cross-sectional model was nonsignificant. Mothers and fathers may grieve differently and may require different therapeutic approaches. Family-centered interventions should target bereaved mothers' emotional adjustment and communication to enhance sibling self-worth. Additionally, clinicians should bolster other sources of support for bereaved siblings to promote adaptive outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).