Publication
Coping as a mediator between family stressors and behavioural adjustment in siblings of children with progressive life-limiting conditions: a multilevel longitudinal study
Tay J, Widger K, Stremler R, Pole J · BMC pediatrics · 2026
BACKGROUND: Siblings of children with progressive life-limiting conditions face elevated emotional and behavioural risks. Although multiple family stressors are known, how cumulative stress shapes sibling adjustment is unclear. This study examined how illness-related family stressors affect sibling behavioural outcomes and whether active versus passive coping strategies are associated with these relationships. METHOD(S): We conducted secondary analysis of longitudinal data from the Charting the Territory (CTT) study, examining 70 siblings (aged 7-18 years) from 58 families with a child diagnosed with progressive life-limiting conditions. Families were categorized into two treatment-duration groups based on time since first seeking medical treatment for the ill child (<= 1 year vs. > 1 year). Using multilevel exploratory factor analysis, we empirically derived a latent "Siblings' Stressor" construct from nine potential variables. Multilevel mediation models examined relationships between Siblings' Stressor, coping strategies (Kidcope), and three behavioural outcomes (Child Behaviour Checklist): internalizing, externalizing, and total behaviour problems across baseline (defined as each family's first assessment wave at study enrollment), 6-month, and 12-month assessments. RESULT(S): The Siblings' Stressor construct comprised parental stress, anxiety, depression, and caregiving burden. Significant direct effects emerged between Siblings' Stressor and all behavioural outcomes. Coping associations differed by treatment-duration group. For internalizing problems, active coping provided consistent protection across early (<= 1 year: -.052, 95% CI [-.103, -.001]) and longer-term families (> 1 year: -.109, 95% CI [-.121, -.097]), while passive coping demonstrated risk effects. However, for externalizing and total behaviour problems, active coping showed different associations by treatment-duration group, being protective in early-treatment families (<= 1 year) and positively associated with externalizing (.048, 95% CI [.021, .075]) and total behaviour problems (095, 95% CI [.053, .136]) in longer-treatment families (> 1 year). Passive coping was linked to elevated externalizing and total behaviour problems in both groups, with particularly strong associations in families within their first year of treatment. CONCLUSION(S): Parental psychological distress and caregiving burden were associated with sibling adjustment across all behavioural outcomes, with coping strategies showing differential patterns by treatment-duration group. Active coping was related to fewer internalizing difficulties, while passive coping was associated with elevated risk. These findings support family-centred approaches that address parental mental health and promote developmentally appropriate coping strategies across the illness trajectory.Copyright © 2026. The Author(s).
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