Meaning Making and Personal Loss in Well Siblings of Adults with Serious Mental Illness
Jaclyn E. Leith, Samantha R. Jesse, Patricia R. Herman, & Catherine H. Stein
Department of Psychology, Bowling Green State University
Abstract
Using a sample of 103 adult siblings, the present study examined the role of personal loss, meaning
making coping, and self-care attitudes in understanding siblings reports of stress-related growth and
current and future caregiving towards their adult siblings with serious mental illness. Findings indicate
that personal loss was the strongest predictor of well siblings’ reports of current caregiving and
ambivalent attitudes towards care. Meaning-making coping contributed to the prediction of stressrelated growth and balanced attitudes towards care. Directions for community research and action are
discussed.
Introduction
Caregiving Among Siblings

Community psychologists have studied the impact of the mental health system on adults with
serious mental illness and their families

Parents have been traditionally regarded as the main source of care and support for adults
with mental illness (Lively, Friedrich, & Rubenstein, 2004).

Well siblings are increasingly asked to assume caregiving responsibilities , especially as parents
age, but have greater freedom define their involvement (Marsh & Dickens, 1997)

Relatively little is known about well sibling experiences regarding their role as caregivers.
Loss and Meaning Making

Personal loss may be indicative of distress and may act as a pathway toward greater
involvement and growth (Lukens et al, 2006).

Losses for well siblings due to mental illness include grief over the loss of a sense of self and
future, previous roles and routines, and prior relationships.

Meaning making efforts may also be salient among well siblings and help to foster adaptive
outcomes (Park et al., 2008)

A better understanding of the loss and coping experiences of well siblings can help to create
community interventions that capitalize on family strengths.
The Present Study
The present study investigated the contribution of meaning-making and personal loss in predicting
variation in well siblings’ reports of caregiving for their sibling with a mental illness, perceptions of
personal growth, and attitudes about self vs. sibling care.
Hypotheses: Personal loss was hypothesized to predict the largest variance in criterion measures, above
and beyond the contributions of meaning-related coping processes.
Method
Procedure

Institutional Review Board approval

Online study

Well siblings answered questions about ill siblings

287 sites contacted; 167 expressed interest in forwarding the study announcement via email
Recruitment

Phone call and email announcements made to the following resources:

Support groups (e.g., National Alliance on Mental Illness)

Online sibling support networks

Newsletters on mental illness

Relevant websites (e.g., schizophrenia.com) and associated messages boards
Method
Sample

103 well siblings of adults with serious mental illness:
Participants: Women (79%); Caucasian (90%); late 30s; Bachelors or advanced degree (63%); No
affiliation with support groups (62%)
Sibling with Mental Illness: Men (64%); late 30s; some college (43%); Schizophrenia or Schizoaffective
(64%); diagnosed 5+ years (70%); Parent as primary caregiver (60%)
Measures

Personal Loss due to Mental Illness (Stein, et al., 2005)
Adapted for well-siblings to measure the personal, relationship, and psychosocial
losses reflected in having confronted the challenges of mental illness




Meaning Making
Emotional Processing (Carver, Scheier, & Weintraub, 1989)

Assessed attempts to understand one’s emotional reactions to having a sibling
with serious mental illness
Positive Reappraisals (Stanton, Kirk, Cameron, Danoff-Burg, 2000)

Measured attempts to see the illness in a more positive light
Current Caregiving (Jewell, 1997)
Assessed current emotional support, assistance with basic needs, and symptom
management provided by well siblings
Future Caregiving (Jewell, 1997)
Assessed intentions to provide caregiving in the future
Stress-Related Personal Growth (Cohen, Hettler, & Pane, 1998)
Short -form (15 items); assessed ways that siblings believe they have experienced
personal growth and other positive changes
Self and Sibling Care (Jewell, 1999)
Attitudes toward self-care vs. sibling care; assessed the extent to which well siblings prioritize
their personal needs over the needs of their ill sibling; Subscales: Ambivalence, Balance, and
Self-Focus
Results
Regression Analyses






Caregiving
Hierarchical regressions significantly predicted well siblings current caregiving (F(9, 99) = 4.93, p
< .001), but not intentions to care.
After accounting for demographic characteristics, illness severity, and meaning-making (Steps
1-3), greater personal loss (β = .30, p < .01; ΔR2 = .06) significantly predicted greater engagement
in current caregiving (R2 = 33).
Growth
When predicting well siblings stress-related growth, the overall regression model was
significant F(9, 99) = 3.10, p < .01.
Positive reappraisals (β = .32, p < .01), but not emotional processing, accounted
significant variance in predicting growth (ΔR2 = .08; R2 = 24).
The addition of reports of personal loss (Step 4) did not statistically improve the
prediction of growth.
Self and Sibling Care
When predicting self and sibling care, overall models for ambivalence (F(9, 98) = 6.28, p < .001),
balance (F(9, 99) = 2.31, p < .05), and self-focus (F(9, 98) = 2.72, p < .01) subscales were
significant.
 Positive reappraisals were the only significant predictor of balanced attitudes (β = .35,
p < .01; ΔR2 = .08; R2 = 16).
Results (cont.)

Self and Sibling Care
Personal loss accounted for variance in the prediction of ambivalence (β =.63, p < .01; ΔR2 =
.27; R2 = 39) and self-focus (β = -.23, p < .05; ΔR2 = .04; R2 = 22) toward self and sibling care, after
partialling out the effects of Steps 1 – 3. See table below.
Discussion

Summary of Research Findings
Findings highlight the important role that perceived personal loss due to mental illness and
meaning making coping contribute to well siblings’ reports of caregiving and personal growth.










Loss experiences appear to be more salient among well siblings who are active caregivers
within their family of origin and report greater ambivalence about their caregiving role.
Loss may also be crucial to the development of ambivalent or detached sibling commitment
styles (Stein, et al., 2005; Dixon, 1997).
Well siblings reports of reappraising their sibling’s mental illness in a positive light is related to
feelings of personal growth and a balanced attitude toward self-care versus sibling care.
Limitations
Relatively small, predominately female, Caucasian sample of well siblings
Well siblings who are active in their ill siblings lives may be overrepresented
Results should be interpreted with caution given large number of independent variables
measured and relatively small sample size
Implications for Community Research and Action
Increased understanding of sibling needs, feelings of loss, and coping strategies are imperative
to securing support for families coping with mental illness of loved ones.
Greater understanding may also help to create community interventions that enhance family
strengths and increase valued social roles for well siblings.
Mental health agencies, support groups, and professionals should help to provide services for
and build alliances with adult well siblings, particularly when governmental resources are not
adequate to address the needs of the mentally ill (Hatfield & Lefley, 2005; Horowitz & Reinhard,
1995).
Mental health professionals or support group facilitators can help to teach family members
effective ways to communicate needs to well siblings (Lefley & Hatfield, 1999).
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