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Psychosocial impact of pediatric BMT on siblings
1Pacific Graduate School of Psychology, Palo Alto, CA 94303, USA.
Insights
Pediatric bone marrow transplantation (BMT) significantly impacts siblings, with donors experiencing more anxiety and nondonors facing school issues. Post-traumatic stress is common in both groups of siblings.
Area of Science:
- Pediatric Hematology/Oncology
- Child Psychology
- Family Systems Theory
Background:
- Bone marrow transplantation (BMT) is a standard treatment for pediatric life-threatening disorders.
- Limited research exists on the psychosocial impact of BMT on siblings of pediatric patients.
- Siblings face unique stressors due to multiple family members undergoing medical procedures.
Purpose of the Study:
- To investigate the psychosocial effects of BMT on donor versus nondonor siblings of pediatric patients.
- To identify specific psychological and behavioral differences between sibling donors and nondonors.
- To assess the prevalence of post-traumatic stress symptoms in siblings.
Main Methods:
- Systematic investigation comparing psychosocial outcomes in donor and nondonor siblings.
- Assessment of anxiety, self-esteem, adaptive skills, school problems, and post-traumatic stress.
- Analysis of data from surviving pediatric BMT patients' siblings.
Main Results:
- Sibling donors exhibited significantly higher anxiety and lower self-esteem than nondonors.
- Nondonor siblings reported significantly more school-related problems.
- Approximately one-third of siblings in both groups experienced moderate post-traumatic stress symptoms.
Conclusions:
- BMT profoundly affects siblings' home and school lives, with post-traumatic stress being a notable component.
- The psychosocial adjustment of siblings is crucial and warrants further investigation.
- Increased emotional support and targeted interventions are needed for siblings undergoing BMT.
Abstract:
Although bone marrow transplantation (BMT) has become standard therapy for many life-threatening disorders of childhood, there is little research on the psychosocial impact of BMT on siblings of children undergoing BMT. Such siblings face issues common to any family with a chronic illness. However, the psychological impact on the family is intensified because two family members, usually children, are subjected to intrusive medical procedures. Investigators had earlier noted that sibling donors may be at risk for behavioral problems and anxiety, while nondonors may experience ambivalent feelings of disappointment and relief. It was suggested that psychosocial stages of BMT may parallel the medical transplant process, with high levels of stress experienced pre-BMT, during hospitalization, and post-discharge. Our own group has recently conducted more systematic investigations on the psychosocial effects of BMT on donor vs nondonor siblings of surviving pediatric BMT patients. We found that sibling donors showed significantly more anxiety, lower self-esteem, and more adaptive skills in school than nondonors. Nondonors, on the other hand, showed significantly more school problems. One third of the siblings in each group reported a moderate level of post-traumatic stress. Taken together, our research indicates that BMT affects the life of the child at home and at school and that post-traumatic stress symptomatology is a component of the psychological reaction in siblings. The psychosocial adjustment of siblings is a critical area of investigation in BMT populations. Parents need to know that the BMT process affects every member of the family system, and both parents and professionals need to direct more emotional support and attention to siblings. Studies are needed that focus on interventions designed to reduce levels of sibling psychosocial maladjustment. The psychosocial developmental model of post- traumatic stress disorder is a viable theoretical model that may be used to guide future research.