Abstract

Siblings of children with chronic disorders (herein siblings) have heightened risk of developing mental health problems. Mental health problems are a major cause of disability among children and adolescents, leading to significant societal costs. Most sibling studies have examined group differences in risk and focus on sibling mental health outcomes rather than investigating individual -and family-level variables on a range of sibling outcomes. Although the Health Personnel Act (§ 10a) imposes duty on Norwegian health care professionals to provide information and support to caregivers and siblings of people with health care needs, there are still no unified evidence-based approach to inform health care workers on how to enact this duty for siblings. Consequently, there are large differences in how, when -or if at all, siblings are supported. Research that aims to understand the complex risk and protective factors for siblings is needed to develop effective and evidence-based preventive interventions. This thesis is focused on understanding the relationship between risk and protective factors associated with sibling psychosocial adjustment and includes three peer-reviewed and published studies. Paper 1 is a systematic review of social support for siblings of children with neurodevelopmental disorders. My co-authors and I found that social support is a potential key protective or risk factor depending on its level, however there were large differences in how social support was measured and defined across the included papers. In Paper 2 my co-authors and I explored the relationships between risk and protective factors for sibling psychosocial adjustment in a proposed family model. We found paternal mental health and parent-sibling communication quality to be associated with siblings' psychosocial adjustment. In Paper 3 my co-authors and I evaluated the initial outcomes of a manualized parent-sibling preventative intervention in a cluster randomized controlled trial (SIBS-RCT). The initial result showed no statistically significant effects. However, small effect sizes in favor of SIBS are promising for improvements in parent-sibling communication and sibling mental health and signals the need for further refinement of the program, to investigate mechanisms of effect and to target subgroups of siblings at heightened risk. Collectively, the result from the papers in this thesis stresses the importance of enhancing sibling social support, supporting parent-sibling communication and fathers’ roles in families with childhood chronic disorders as these factors may be important for sibling psychosocial adjustment. Suggested clinical recommendations include assessment of individual family members experiences and roles to better target sibling risk factors.