Behavior Problems, Self-Esteem, and Prosocial Behavior in Siblings of Children With Chronic Physical Health Conditions: An Updated Meta-Analysis

Abstract

Objective: Chronic physical health conditions (CPHC) of children affect the whole family. The aim of the present meta-analysis was to compare levels of internalizing, externalizing, and total problems as well as self-esteem/positive self-concept and prosocial behavior of the healthy siblings with children from families not affected by CPHC and test norms, respectively.

Methods: A systematic search for literature was conducted using the electronic data bases CINAHL, PsycInfo, PubMed, PSYNDEX, and Web of Science. In total, results from 216 studies were included in random-effects meta-analyses that had been published or made available online before February 15, 2022.

Results: Healthy siblings of children with CPHC had elevated levels of internalizing (g = .18 standard deviation units), externalizing (g = .13), and total behavior problems (g = .22), and effect sizes were found to be small to very small. While levels of self-esteem did, on average, not vary between healthy children with and without a sibling with CPHC or test norms (g = .08), higher levels of prosocial behavior were found in the healthy siblings of children with CPHC (g = .18). In addition, some moderating effects of kind of CPHC and its intrusiveness as well as mortality risk, country, sociodemographic equivalence of the compared groups, and year of publication were identified.

Conclusions: It is concluded that CPHC of a child can have negative as well as positive effects on psychosocial outcomes of healthy siblings. Psychosocial interventions are recommended for healthy siblings at elevated risk for psychological problems.

Keywords: chronic health condition; chronic illness; healthy sibling; meta-analysis; psychosocial outcomes.