title: Bereavement after sibling death: a population-based longitudinal case-control study.
abstract: The objective of this study was to examine mental disorders and treatment use among bereaved siblings in the general population. Siblings (N=7243) of all deceased children in the population of Manitoba, Canada who died between 1984 and 2009 were matched 1:3 to control siblings (N=21,729) who did not have a sibling die in the study period. Generalized estimating equations were used to compare the two sibling groups in the two years before and after the index child's death on physician-diagnosed mental disorders and treatment utilization, with adjustment for confounding factors including pre-existing mental illness. Analyses were stratified by age of the bereaved (<13 vs. 13+). Results revealed that, in the two years after the death of the child, bereaved siblings had significantly higher rates of mental disorders than control siblings, even after adjusting for pre-existing mental illness. When comparing the effect of a child's death on younger versus older siblings, the rise in depression rates from pre-death to post-death was significantly higher for siblings aged under 13 (p<0.0001), increasing more than 7-fold (adjusted relative rate, ARR=7.25, 95% CI: 3.65-14.43). Bereaved siblings aged 13+ had substantial morbidity in the two years after the death: 25% were diagnosed with a mental disorder (vs. 17% of controls), and they had higher rates of almost all mental disorder outcomes compared to controls, including twice the rate of suicide attempts (ARR=2.01, 95% CI: 1.29-3.12). Siblings in the bereaved cohort had higher rates of alcohol and drug use disorders already before the death of their sibling. In conclusion, the death of a child is associated with considerable mental disorder burden among surviving siblings. Pre-existing health problems and social disadvantage do not fully account for the increase in mental disorder rates.
authors.affiliation: Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.|Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.|Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.|Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.
authors.forename: James M
authors.initials: JM
authors.lastname: Bolton
authors.affiliation: Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Au
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.|Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.
authors.forename: Dan
authors.initials: D
authors.lastname: Chateau
authors.affiliation: Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.
authors.forename: Randy
authors.initials: R
authors.lastname: Walld
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.|Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.affiliation: Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Enns
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.|Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Martens
authors.affiliation: Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.|Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.|Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.
authors.forename: Laurence Y
authors.initials: LY
authors.lastname: Katz
authors.affiliation: Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Sarvesh
authors.initials: S
authors.lastname: Logsetty
authors.affiliation: Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.|Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.|Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
keywords: Sibling; bereavement; depression; epidemiology; mental disorder; suicide
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