This article is more than 5 years old. Information may no longer be current.
Sibling death in childhood may increase risk for early mortality
An individual whose sibling dies during childhood has an increased risk for short-term and long-term mortality, according to results of a population-based study.
The risk is even greater if siblings were close in age and of the same sex, the study suggests.
“Health care professionals should be aware of children’s vulnerability after experiencing sibling death, especially for same-sex sibling pairs and sibling pairs with close age,” Yongfu Yu, PhD, from Aarhus University Hospital in Denmark, said in a press release. “Social support may help to reduce the level of grief and minimize potential adverse health effects on the bereaved individuals.”
Bereavement caused by the death of a close relative is one of the most severe life events and may cause tremendous amounts of grief. Estimates show that approximately 8% of individuals in the U.S. experienced a sibling death during childhood, but the consequences and severity of bereavement for the survivors are largely unknown.
“Sibling relationship tends to be the longest and the most intimate in family, thus the death of a sibling can be a devastating life event, especially when this event happens at early ages,” Yu said. “However, to our knowledge, no study has investigated the effects of sibling death in childhood on subsequent mortality in bereaved siblings with a long follow-up time.”
Therefore, the researchers linked national registries in Denmark and Sweden, and included more than 5 million Danish and Swedish children who survived the first 6 months of life for evaluation in this study. Poisson regression analysis was used to determine mortality rate ratio of an individual whose sibling died during his or her childhood (aged younger than 18 years).
The death of a sibling was experienced by 55,818 individuals in childhood (1.1%; 51.5% boys, 48.5% firls). The median age of sibling death was 7 years (interquartile range, 3.3-12.1).
Over a follow-up of 37 years, 534 individuals in the bereavement group and 25,591 in the nonbereavement group died.
Individuals in the bereavement group had a 71% increased risk for mortality from all causes compared with individuals who did not experience the death of a sibling. The all-cause mortality risk was 1.71 (95% CI, 1.57-1.87). Individuals in the bereavement group had increased all-cause mortality if siblings died of disease (MRR = 1.72; 95% CI, 1.55-1.90) or an external cause (MRR = 1.65; 95% CI, 1.40-1.94). In addition, individuals in the bereavement group who died had excessive deaths from disease (MRR = 1.94; 95% CI, 1.70-1.21) and external cause (MRR = 1.55; 95% CI, 1.36-1.76). The association was even stronger if siblings had the same cause of death (disease: MRR = 2.16; 95% CI, 1.87-2.49; external cause: MRR = 1.91; 95% CI, 1.54-2.37).
The increased risk for mortality after a sibling’s death was observed throughout follow-up, irrespective of age at bereavement and type of death. However, the highest risks for mortality were found within the first year after a sibling’s death (MRR = 2.51; 95% CI, 1.79-3.54), among same-sex sibling pairs (MRR = 1.92; 95% CI, 1.70-2.18) and siblings close in age (MRR = 1.94; 95% CI, 1.58-2.37).
“It should be recognized that the increased mortality might only represent the tip of the iceberg effects,” Yu said. “Therefore, the increased mortality risk may indicate substantial negative impacts on health, family resources, social life and well-being of the bereaved populations.”
The study by Yu and colleagues highlights the vulnerability of surviving siblings to mental health and premature death, according to James M. Bolton, MD, from the department of psychiatry, University of Manitoba, Canada and colleagues.
“Unfortunately, the health interests of bereaved family members are often neglected,” Bolton and colleagues, who were not involved with the study, wrote in an editorial. “This potential barrier in service delivery requires recognition by clinicians. Health care professionals should consider the needs of the entire family system and extend care when appropriate to those left to grieve the death.” – by Melinda Stevens
Disclosures: Yu and colleagues report no relevant financial disclosures. Bolton reports no relevant financial disclosures. One researcher reports a consultant role for UpToDate and stocks in Johnson and Johnson.
