Document Type



Doctor of Philosophy (PhD)



First Advisor's Name

Dorothy Brooten, PhD

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

JoAnne Youngblut, PhD

Third Advisor's Name

Jean Hannan, PhD

Fourth Advisor's Name

Timothy Page, PhD


siblings' death, Health of surviving sibling, treatment costs

Date of Defense



Death of a child is a very painful experience for parents and remaining siblings who experience physiological and emotional symptoms as described by the parents. There are few reports from the remaining siblings on their physical and emotional health and even less data on their treatments and associated health care costs after sibling loss. The purpose of this study in children who have lost a sibling in the NICU/PICU, ER or those who have been sent home on technology dependent equipment to die, is to compare parents’ and children’s perceptions of the surviving sibling’s health, identify factors related to these perceptions, and describe treatments for the sibling’s physical and mental health at 2 and 4 months after a sibling’s death. Sixty four surviving siblings and their parents reported on the siblings’ mental and overall health. Available treatment charges (visits to the emergency room, physician office, hospitalization, and any health services (mental & physical) since the sibling death were collected from bills and insurance receipts. Cause of child death (acute or chronic) was collected from the deceased child’s hospital record. The relationship between parent and sibling’s perception of the surviving sibling’s health, and anxiety and depression at 2 and 4 months post the death were measured using the Children’s Depression Inventory and the Spence Anxiety Scales. Data were analyzed using: T-Tests, ANOVA, Pearson correlations, frequencies and descriptive statistics. Findings indicated that at 2 and 4 months parent’s perceived their surviving siblings’ health to be better than the child perceived his/her health to be. At 4 months fathers rated the siblings’ health compared to their peers lower than the siblings. Greater child anxiety was related to lower father’s ratings of the child’s health now and compared to peers. Treatments and charges increased from 2 months to 4 months with males having more treatments than females. The majority of the treatments consisted of routine physician visits, non-routine physician visits, emergency room/urgent care visits and counseling. Study findings can help guide healthcare providers and educators in identifying those children that are at high risk for negative health effects after the death of a sibling.





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