title: Psychological Well-Being and Family Environment of Siblings of Children with Life Threatening Illness.
abstract: BACKGROUND
  The psychological well-being of siblings of children with life threatening illness remains largely uncharted. Pediatric cancer research suggests that a supportive family environment may protect the psychological well-being of siblings.
  
  
  OBJECTIVE
  We hypothesized that (1) siblings of pediatric palliative care patients would show clinical/behavioral scores that were elevated but that rates of serious psychopathology would be comparable to the general population of children their age; and (2) higher family functioning scores would be associated with lower clinical scores and higher adaptive scores for these siblings.
  
  
  METHODS
  We conducted an observational study with families in which a patient receiving palliative care had one or more siblings between the ages of 6 and 11. Parents completed the Behavioral Assessment System for Children, Second Edition (BASC-2) to assess the siblings' psychological well-being and the Family Assessment Device (FAD) to assess the family environment.
  
  
  RESULTS
  Twenty-four parents reported data for 30 siblings. Only three siblings scored in the clinical range on a BASC-2 composite clinical scale, and 11 siblings scored in the at-risk range on one or more composite scales. Higher FAD scores predicted significantly higher externalization composite clinical scores (7.54, 95% CI: 1.12, 13.97, p < 0.05) and significantly higher behavioral composite scores (7.88, 95% CI: 1.55, 14.21, p < 0.05).
  
  
  CONCLUSIONS
  Siblings of pediatric palliative care patients are not experiencing lower psychological well-being than the general population. The prediction that a positive family environment would be associated with higher levels of psychological health was supported.
authors.affiliation: 1 Nationwide Children's Hospital , Columbus Ohio.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Humphrey
authors.affiliation: 2 The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Hill
authors.affiliation: 2 The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Carroll
authors.affiliation: 3 Widener University , Chester, Pennsylvania.
authors.forename: Mary
authors.initials: M
authors.lastname: Rourke
authors.affiliation: 2 The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
authors.forename: Tammy I
authors.initials: TI
authors.lastname: Kang
authors.affiliation: 2 The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
mesh_terms: D002648:Child; D002652:Child Behavior / Q000523:psychology*; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology*; D015143:Philadelphia; D035781:Siblings / Q000523:psychology*; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*