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

This meta-analysis examines the psychosocial outcomes of healthy siblings (HS) of children with chronic physical health conditions (CPHC), defined as physical conditions lasting at least three months that require ongoing healthcare and interfere with functioning. Analyzing data from 216 studies involving 18,619 HS, the study found small but significant elevations in internalizing, externalizing, and total behavior problems compared to siblings without CPHC or normative data, while self-esteem/positive self-concept did not differ significantly. Notably, HS exhibited higher levels of prosocial behavior. Moderator analyses revealed that intrusive CPHC affecting daily life and elevated mortality risk were associated with greater psychological problems in HS, with stronger effects observed in developing countries and older studies. The findings suggest that certain groups of HS, particularly those with siblings affected by cancer, cerebral palsy/spina bifida, epilepsy, and other specified CPHCs, may benefit from targeted psychosocial screening and interventions, while also highlighting opportunities for promoting positive sibling outcomes such as prosocial behavior.