title: Psychological health in siblings who lost a brother or sister to cancer 2 to 9 years earlier.
abstract: BACKGROUND
  The objective of this study was to assess long-term psychological distress in siblings who lost a brother or sister to cancer 2 to 9 years earlier, as compared with a control group of non-bereaved siblings from the general population.
  
  
  METHODS
  During 2009, we conducted a nationwide follow-up study in Sweden by using an anonymous study-specific questionnaire. Siblings who had lost a brother or sister to cancer between the years 2000 and 2007 and also a control group of non-bereaved siblings from the general population were invited to participate. The Hospital Anxiety and Depression Scale (HADS) was used to measure psychological distress, and to test for differences in the ordinal outcome responses between the groups, we used Wilcoxon-Mann-Whitney rank-sum test.
  
  
  RESULTS
  Among the bereaved siblings, 174/240 (73%) participated and 219/293 (75%) among the non-bereaved. Self-assessed low self-esteem (p = 0.002), difficulties falling asleep (p = 0.005), and low level of personal maturity (p = 0.007) at follow-up were more prevalent among bereaved siblings. However, anxiety (p = 0.298) and depression (p = 0.946), according to HADS, were similar.
  
  
  CONCLUSIONS
  Bereaved siblings are at increased risk of low self-esteem, low level of personal maturity and difficulties falling asleep as compared with non-bereaved peers. Yet, the bereaved were not more likely to report anxiety or depression.
authors.affiliation: Division of Women's and Child's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden. Alexandra.Eilegard@ki.se
authors.forename: Alexandra
authors.initials: A
authors.lastname: Eilegård
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.forename: Tommy
authors.initials: T
authors.lastname: Nyberg
authors.forename: Ulrika
authors.initials: U
authors.lastname: Kreicbergs
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001601:Bereavement; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D009369:Neoplasms; D012649:Self Concept; D035781:Siblings / Q000523:psychology*; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult