title: The mediating effects of family functioning on psychosocial outcomes in healthy siblings of children with sickle cell disease.
abstract: BACKGROUND
  Children with siblings coping with chronic illness experience stresses and disruptions in daily life as families work together to care for the affected child. Research suggests that children and adolescents with sickle cell disease (SCD) may be at risk for adjustment problems, impaired psychosocial functioning, and reduced quality of life. These potential stressors affect the child with SCD as well as their caregivers and other family members. This study examined the role of family functioning on the psychosocial functioning of healthy siblings of children with SCD.
  
  
  METHODS
  Participants were 65 healthy African-American siblings of children with SCD with a mean age of 11.19 years (range: 7-16) and their primary caregiver. Caregivers completed questionnaires assessing family functioning and child adjustment including demographic surveys, the Family Relations Scale (FRS), and the Child Behavior Checklist (CBCL).
  
  
  RESULTS
  Increased number of emergency room visits (β = -0.28, P < 0.05) predicted poor psychosocial adjustment in siblings. Family functioning mediated this effect (β = 0.27; P < 0.05). High levels of family expressiveness (total score, r = -0.34; P < 0.01), support (total score, r = -0.54; P = 0.001), and low levels of family conflict (total score, r = 0.41; P < 0.001) were associated with improved adjustment among healthy siblings of children with SCD.
  
  
  CONCLUSIONS
  Awareness of the possible negative psychosocial outcomes of living with a sister or a brother with SCD is important for clinicians. In particular, interventions that focus on family expressiveness, support, and conflict are indicated for this population.
authors.affiliation: Keck School of Medicine, University of Southern California, Department of Anesthesiology, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. jgold@chla.usc.edu
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Gold
authors.forename: Marsha
authors.initials: M
authors.lastname: Treadwell
authors.forename: Lina
authors.initials: L
authors.lastname: Weissman
authors.forename: Elliott
authors.initials: E
authors.lastname: Vichinsky
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000523:psychology*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005190:Family / Q000523:psychology*; D005260:Female; D006262:Health; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011788:Quality of Life; D035781:Siblings / Q000523:psychology*; D012917:Social Adjustment; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D016896:Treatment Outcome