How Growing Up with a Sibling with Schizophrenia Shapes a Life
The quiet struggles of those who stand in the shadows of schizophrenia.
When schizophrenia enters a family, it doesn't affect just one person. While significant attention rightly focuses on the individual diagnosed, a silent ripple effect extends to their brothers and sisters. These siblings often face unique life course challenges that can shape their mental health across decades. Recent research reveals that the very experience of growing up with a brother or sister with schizophrenia may itself create vulnerabilities, increasing the risk for depressive symptoms in ways we are only beginning to understand 1 .
For decades, science has recognized that siblings of individuals with schizophrenia face elevated mental health risks. This was often attributed primarily to shared genetic susceptibility. While genetic factors do play a role, emerging research suggests the story is more complex 1 .
The chronic strains associated with coping with a brother or sister's schizophrenia may significantly heighten the risk of depressive symptoms 1 .
Schizophrenia typically emerges in late adolescence, meaning many siblings are in their formative years when their brother or sister develops psychosis.
Siblings may be young adults embarking on independent lives when their sibling begins showing symptoms, disrupting their own life goals.
These experiences can challenge core belief systems and create enduring emotional wounds. The need to cope with the illness may interfere with the sibling's social development during critical years.
Many siblings are required to take on parenting responsibilities—a phenomenon known as parentification 1 .
These early life course burdens associated with an emerging illness represent a potentially significant pathway to adult depression.
Siblings of individuals with schizophrenia often carry burdens that extend beyond family dynamics into their broader social world. Many report perceptions of being stigmatized by their community, which research has linked to higher levels of depressive symptoms 1 5 .
This sense of being devalued or judged compounds the isolation that many siblings experience.
During childhood and adolescence, having a sibling with schizophrenia often means having less time to make friends due to family responsibilities and feeling isolated from after-school activities like sports or clubs 1 . This early social disruption can establish patterns that reverberate into adulthood, limiting the development of robust social networks that typically provide buffering against life's stresses.
To understand how these life course challenges translate into depression risk, a revealing study examined 41 siblings of individuals with schizophrenia, recruited from a larger study of schizophrenia neurobiology 1 5 .
Researchers employed a multifaceted approach to uncover what factors might contribute to depressive symptoms in these siblings. Participants completed a self-administered questionnaire and a neuropsychological test battery 1 .
The study examined several potential contributors to depression:
Depressive symptoms were measured using the Center for Epidemiological Studies-Depression scale (CES-D), a 20-item instrument that rates the frequency of depressive symptoms over the past week 1 .
The findings provided compelling evidence that life course experiences significantly impact mental health outcomes. After accounting for gender and cognitive function, early life course burdens and current subjective burdens explained additional variance in depressive symptoms 1 .
Key predictors of higher depressive symptoms included:
Surprisingly, one factor emerged as protective: Taking on adult responsibilities while growing up was associated with fewer depressive symptoms in adulthood (β= -.36, p<.01) 1 5 . This suggests that finding ways to contribute meaningfully within the family system, when not excessive, may foster resilience.
| Factor | Impact on Depressive Symptoms | Statistical Significance |
|---|---|---|
| Perceived stigma from community | Increase | β=.37, p<.01 |
| Negative impact on childhood social life | Increase | β=.39, p<.01 |
| Taking on adult responsibilities during upbringing | Decrease | β= -.36, p<.01 |
This research aligns with a larger body of evidence. A recent systematic review and meta-analysis published in 2023, which synthesized data from 62 studies and 3,744 siblings, found that siblings of people with mental illness experience mild range depressive symptoms (15.71%) .
of siblings experience depressive symptoms
Notably, the analysis revealed that siblings of people with schizophrenia spectrum disorders experience greater depressive symptoms than siblings of people with other types of mental illness . This suggests there may be something particularly challenging about schizophrenia specifically, as opposed to mental illness in general.
| Sibling's Diagnosis | Level of Depressive Symptoms in Siblings |
|---|---|
| Schizophrenia Spectrum Disorders | Higher |
| Other Mental Illnesses | Lower |
The quality of sibling relationships plays a crucial role in the wellbeing of both individuals. Research shows that sibling relationships in adulthood can be described along three dimensions: warmth, conflict, and rivalry 4 .
Perceived closeness and support between siblings
Disagreements and quarrels within the relationship
Competition for parents' attention and resources
When one sibling has schizophrenia, these dynamics become more complex. A 2020 study exploring determinants of sibling relationship quality found that for nonclinical siblings, relationship quality could be predicted by typical factors like family structure characteristics 4 . However, for those with a sibling diagnosed with schizophrenia, disease-related variables such as symptom severity and frequency of treatment had to be included to accurately predict feelings of conflict within the relationship 4 .
This suggests that the symptoms displayed by the ill sibling directly fuel relationship conflicts. Healthy brothers and sisters may have limited understanding of these symptoms, leading to frustration and tension 4 .
The same study noted that relationships between sisters tend to be more intense—characterized by both greater warmth and more conflict—than relationships between brothers 4 .
| Relationship Dimension | Definition | Impact in Schizophrenia |
|---|---|---|
| Warmth | Perceived closeness and support | May be affected by symptoms and care demands |
| Conflict | Disagreements and quarrels | Strongly influenced by symptom severity |
| Rivalry | Competition for parents' attention | May decrease due to illness demands |
Understanding the sibling experience requires specialized assessment tools. The following table highlights key measures used in this field of research:
| Research Tool | Function | Application in Siblings Research |
|---|---|---|
| Center for Epidemiological Studies-Depression Scale (CES-D) | Measures frequency of depressive symptoms over past week | Quantifies depressive symptomatology in siblings 1 |
| Adult Sibling Relationship Questionnaire (ASRQ) | Assesses relationship quality across warmth, conflict, and rivalry dimensions | Evaluates how schizophrenia affects sibling relationship dynamics 4 |
| Devaluation of Consumer Families Scale | Measures extent to which responders perceive families are stigmatized by community | Assesses subjective burden related to mental illness stigma 1 |
| Objective Caregiver Burden Scale | Quantifies extent of instrumental support provided to sibling | Measures practical caregiving demands placed on siblings 1 |
These findings carry important implications for mental health practice. They suggest that supporting siblings' mental health requires addressing both current burdens and historical challenges that may have originated during their formative years 1 .
Mental health service providers and psychoeducation programs would benefit by considering these factors when developing family-based interventions 1 5 . Specifically, support might include:
What emerges from this research is a picture of remarkable resilience alongside significant vulnerability. Siblings of individuals with schizophrenia navigate complex emotional terrain—balancing loyalty, responsibility, and their own need for autonomy and wellbeing.
By recognizing the unique life course challenges these individuals face, we can begin to develop targeted supports that honor their experiences and promote their mental health across the entire lifespan. Their story, often untold, deserves both our scientific understanding and our compassionate response.