Losing a parent in adulthood can have a huge impact on mental health, and new research suggests having a sibling may ease that burden, something we’re only just beginning to understand.
Study: Number of siblings and psychotropic medication purchases surrounding parental death in adulthood: A population-wide cohort study in Finland. Image credit: PeopleImages/Shutterstock.com
recent Journal of Epidemiology and Community Health The study conducted a national cohort study to examine whether having siblings was associated with differences in psychotropic drug purchases before and after a parent’s death.
Adult bereavement and mental health
The death of a parent is an important stressful life event that affects both mental and physical health. Although the negative mental health effects of losing a parent during childhood and adolescence have been widely studied, research on how parental loss affects adult offspring remains limited. This difference is particularly striking given that as life expectancy increases, especially in high-income countries, parental death most often occurs after children are middle-aged.
Bereavement among adults is consistently associated with negative mental health outcomes, with evidence showing that the immediate aftermath of a parent’s death is associated with increased rates of psychotropic medication use and the onset of depressive symptoms and psychological distress. Furthermore, increased suicide rates and alcohol-related mortality rates have been recorded in this population.
Although the death of a parent in adulthood is most commonly associated with short-term mental health impairment, long-term effects have been observed, especially when the death was sudden or unexpected. Conversely, if a parent experiences chronic illness or frailty before death, caregiver burden and unexpected grief can begin to impact a child’s mental health long before the parent’s death.
Despite the knowledge of the various factors that shape the outcome of bereavement, the role of siblings remains poorly understood. Siblings not only share the experience of losing a parent, but they can also support each other and share the practical responsibilities of end-of-life care. Whether sibling size is associated with the mental health consequences of parental death is an understudied question, but one that becomes increasingly important as family size shrinks and fewer people are left to shoulder these burdens.
Assessing the influence of siblings on the psychological impact of parental loss in adulthood.
The current study investigated whether sibship size was associated with changes in psychotropic medication use following parental death. The authors used administrative data on the entire Finnish population from 1987 to 2019 and focused on individuals aged 35 to 55 from 2006 to 2016, an age group in which parental bereavement is common but not yet universal.
Parents’ date of death was obtained from Statistics Finland’s cause of death register. Individuals with missing data or whose parents died before age 35 or before 2006 were excluded. We formed a synthetic control group of individuals who did not experience a parental death between 2006 and 2016 and were assigned a comparison date.
The study cohort was limited to adults aged 0–3 years. Full biological siblings who were living and residing in Finland at the time of the parent’s death or death Comparison date. Sibling sex and birth order were also obtained from Statistics Finland’s longitudinal population file. The final sample size was 1,368,619 maternal deaths and 1,041,981 paternal deaths, experienced by 12.5% and 22.6%, respectively.
Psychotropic drug use was assessed in the 3 years before and after the parent’s death using the Finnish Prescription Drug Register, which records prescription drugs dispensed in pharmacies.
Sibling size influences psychotropic drug use after parental loss
After the mother’s death, a clear gradient in the number of siblings appeared. The fewer siblings the child had, the stronger the peak in psychotropic drug purchases in the year following the death of the mother. The increase rate for only children was the largest at 5.1 percentage points, followed by 4.3 percentage points for those with one sibling, 3.5 percentage points for those with two siblings, and 2.6 percentage points for those with three siblings.
Of note, the difference in number of siblings was already evident in the year before maternal death: 2.8 percentage points for only children, 2.2 percentage points for those with one sibling, 2.0 percentage points for those with two siblings, and 1.0 percentage points for those with three or more siblings, and decreased significantly within the first year after death.
After a father’s death, drug purchases increased only in the following year, the increase was smaller than after a mother’s death, and it did not vary by sibling size. Among women, paternal death did not result in a difference in sibship size over the 6 years of follow-up.
However, for maternal deaths, only children showed the largest increase, followed by deaths of one sibling, two siblings, and three siblings. All peaked in the year the mother died and declined significantly by the second year. For men, differences in sibship size were small and confidence intervals widely overlapped.
A more detailed timing analysis using 6-month intervals confirmed that drug purchases peaked shortly after parental death, and that differences in sibship size were consistent with the primary results. Analysis by drug subtype showed that the slope of sibling size was consistent across all subtypes, but that anxiolytics, hypnotics, and sedatives peaked more sharply around parental death than antidepressants.
Birth order could not explain the gradient in sibship size. Medication increases before and after maternal death were similar for children born earlier and later within each sib size group.
Cause of death analysis revealed a clear pattern. Dementia-related parental death was associated with persistently increasing drug use throughout follow-up, with no gradient in sibship size. Cancer-related maternal death showed the strongest sibling gradient, with purchases increasing sharply in the year before death for mothers with fewer siblings. Deaths from external causes, such as accidents and suicide, peaked in all sib groups, but wide confidence intervals meant no clear differences were observed.
Parental death order had little effect on the gradient of sibling ship size. The only exception was children whose mothers died first, which showed a clear pattern. Still, a gradient in sibling relationships with respect to maternal death was evident, regardless of whether the mother was the first or last parent to die.
Having fewer siblings increases the use of psychotropic drugs after a parent’s death
The current study highlights a clear pattern in which fewer siblings have more siblings. Observed increases in psychotropic drug purchases before and after the death of a parent. Siblings may act as a potential buffer, for example by sharing the burden of caregiving or providing emotional support during life’s most difficult transitions. This effect is particularly pronounced among only children and women, and is most pronounced after the death of the mother.
However, purchases of psychotropic medications reflect both mental health status and treatment-seeking behavior, and the observed gender differences may be related in part to gendered help-seeking patterns rather than just differences in underlying distress. Furthermore, as an observational study, the results may be influenced by unmeasured confounders such as family background and parental health status.
As family sizes continue to shrink in aging societies, more adults will face the loss of a parent without their support networks, highlighting the potential importance of understanding social support structures during bereavement, but these findings are based on Finnish data and may not be fully generalizable to other settings.
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Reference magazines:
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Lukkonen. J., Pitkanen. J. et al. (2026) Number of siblings and psychotropic medication purchases surrounding parental death in adulthood: A population-wide cohort study in Finland. Journal of Epidemiology and Community Health. Toi: 10.1136/jech-2025-224775. https://jech.bmj.com/content/early/2026/03/23/jech-2025-224775
