Losing a parent is more difficult with fewer siblings

Losing a parent in adulthood can have a significant impact on mental health, and new research suggests that having a sibling may ease that burden in ways we are just beginning to understand.

Study: Number of siblings and psychotropic medication purchase around parental death in adulthood: a population-wide cohort study in Finland. Image Credit: PeopleImages/Shutterstock.com

a fresh Journal of Epidemiology and Community Health The study conducted a national cohort study to examine whether having a sibling was associated with differences in the purchase of psychotropic medications before and after a parent’s death.

Adult bereavement and mental health

The death of a parent is a significant stressful life event that affects both mental and physical well-being. While the adverse mental health consequences of losing a parent during childhood or adolescence have been extensively studied, research on how parental loss affects adult offspring is limited. This difference is particularly notable because with increasing life expectancy, parents typically die when offspring are in middle or older age, especially in high-income countries.

Adult bereavement has been consistently linked to negative mental health outcomes, with evidence showing that the period immediately following a parent’s death is associated with increased rates of psychotropic medication use as well as the onset of depressive symptoms and psychological distress. Additionally, increased suicide and alcohol-related mortality have been reported in this population.

Although parental death in adulthood is usually associated with short-term mental health disruption, longer-term effects have been observed, especially when the death was sudden or unexpected. In contrast, when a parent experiences chronic illness or frailty before death, the burden of caregiving and anticipated grief may begin to affect the mental health of the offspring even before the loss.

Despite the range of known factors that shape the outcomes of bereavement, the role of siblings is poorly understood. Siblings not only share the experience of a parent’s loss but can also provide mutual support and share the practical responsibilities of end-of-life care. Whether sibling size is associated with mental health outcomes around the death of a parent is an understudied question, and one that becomes more relevant as decreasing family size results in fewer people bearing this burden.

Assessing the influence of siblings on the psychological impact of parental loss in adulthood.

The present study examined whether sibship size is associated with changes in psychotropic medication use around the death of a parent. The authors used administrative data on all Finnish residents from 1987 to 2019, focusing on individuals aged 35–55 during 2006–2016, an age range where parental loss is common but not yet universal.

Dates of death of parents were obtained from the cause-of-death register of Statistics Finland. Excluded are any individuals for whom data are missing or whose parents died before the age of 35 or before 2006. Individuals who did not experience the death of a parent during 2006–2016 formed a synthetic control group with fixed comparison dates.

The study group was limited to adults ages 0-3 Full biological siblings alive and living in Finland at the time of the parents’ death comparison date. Siblings’ sex and birth order were also obtained from the longitudinal population files of Statistics Finland. The final sample size was 1,368,619 for mothers’ deaths and 1,041,981 for fathers’ deaths, with 12.5% ​​and 22.6% experiencing each, respectively.

Psychotropic medication use was assessed in the three years before and after the parents’ death using the Finnish Prescription Medication Register, which captures prescribed medications dispensed in pharmacies.

Siblings shape psychotropic medication use after parent’s death.

After the mother’s death, a clear sibship size gradient emerged: fewer siblings corresponded to a stronger peak in psychotropic medication purchasing in the year following the loss. Only children saw the largest increase of 5.1 percentage points, while children with one sibling saw an increase of 4.3 percentage points, children with two siblings increased by 3.5 percentage points and children with three siblings increased by 2.6 percentage points.

In particular, differences in sibling size were already evident in the year before maternal death, 2.8 percentage points for only children, 2.2 for those with one sibling, 2.0 for those with two siblings, and 1.0 for those with three or more siblings, and diminished substantially within a year of the loss.

Following paternal death, drug purchases increased immediately after the loss, a smaller increase than maternal death, and did not differ by sibling size. In women, there was no difference in sibling size over a 6-year follow-up period after paternal death.

However, in terms of maternal deaths, the largest increase was seen in only children, followed by deaths of one sibling, two siblings and three siblings. These peaked in the year of maternal death and declined substantially by the second year. In males, the difference in sibling size was smaller, with confidence intervals overlapping widely.

Fine-grained time analysis using a 6-month interval confirmed that drug purchasing peaked shortly after parental death, consistent with the main findings that there were differences in sibship size. Analysis by medication subtype showed that anxiolytic, hypnotic, and sedative medications peaked more rapidly around parental death than antidepressant medications, although the gradient of sibship size was consistent across all subtypes.

Birth order did not explain sibship size fluctuations: the increase in medication around maternal death was approximately the same for first- and later-born offspring within each sibship size group.

Analysis of causes of death revealed distinct patterns. Dementia-related parental death was associated with steadily increasing medication use during follow-up, with no sibship size gradient. The strongest sibship gradient was seen in cancer-related maternal death, with purchases in the year before death increasing more rapidly among those with fewer siblings. Deaths from external causes, such as accidents or suicide, peaked in all sibling groups, although wide confidence intervals prevented clear differences.

The order of death of parents had little effect on the sibship-size gradient. The only exception were children whose mothers had died earlier, who showed a different pattern. Nevertheless, the sibship gradient for maternal death remained apparent regardless of whether the mother was the first or last parent to die.

Fewer siblings, more psychotropic medication use after parental death

Current research outlines a clear pattern: The fewer siblings a person has, the more likely they will be An increase in the purchase of psychotropic medications was observed after the death of a parent. Siblings can serve as a potential buffer, for example, by sharing the burden of care and providing emotional support during one of life’s most difficult transitions. Its effects are particularly pronounced in children and women, and are most intense after maternal death.

However, psychotropic medication purchasing reflects both mental health status and treatment-seeking behavior, and the observed gender differences may be partly related to gender-based help-seeking patterns rather than differences in underlying distress alone. Additionally, as an observational study, the findings may be influenced by uncertain factors such as family background or parents’ health.

As family size shrinks in aging societies, more adults will face the loss of a parent without that support network, highlighting the potential importance of understanding social support structures during bereavement, although these findings are based on data from Finland and may not be fully generalizable to other settings.

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