When a brother or sister dies: what the research shows about bereaved siblings

The death of a brother or sister is a common childhood bereavement worldwide. Across 43 lower-income countries surveyed, roughly one young woman in three has had a sibling die^[1]. In the Nordic countries, whose national registers can follow every child for decades, children whose sibling died have higher death rates in later life than other children^[2]. Yet no country we found routinely counts these children, and support for them is uneven.

When a child dies, attention rightly turns to the parents. The brothers and sisters are often in the same house, grieving someone who shared their bedroom, their jokes and their family history, while the adults around them grieve too. This study is about those children. It sits alongside the library's studies of children whose parent has died; a sibling's death is a different bereavement, and its figures should not be read across to parental death. The strongest long-term evidence comes from Nordic registers and a Canadian population database, used here as worked cases.

Sibling death is common, and most common where child mortality is highest

No country we found routinely counts how many children have a brother or sister die. The numbers come from child death statistics, models and surveys.

The scale starts with child deaths. The World Health Organization estimates that 4.9 million children died before their fifth birthday in 2024, 2.3 million of them in the first 28 days of life, and that the annual total has stayed at roughly 4.8–4.9 million since 2022^[4]. Sub-Saharan Africa alone accounted for 2.8 million of those deaths, 58% of the total^[4]. These are modelled estimates, and many of the children who died had brothers and sisters.

Demographic and Health Surveys of 352,930 women aged 15 to 34 in 43 countries across Africa, Asia, and Latin America and the Caribbean found that, on average, roughly one-third reported that a sibling had died. In several African countries, particularly those affected by conflict and war, the figure reached 40–50%. Most recalled a death during their own lifetime, often in late childhood or early adolescence^[1].

In high-income countries child deaths are far rarer, but sibling bereavement is not unusual. In England and Wales in 2024 there were 2,318 deaths of babies under one year old and 918 deaths of children aged 1 to 15^[5]; deaths of older teenagers and young adults add to that. In the United States, a model combining household size with national death statistics estimated that an average of 61,389 children a year had a sibling die in 2012–2015, about 0.0832% of children each year^[3]. Over a whole childhood that adds up: two US survey data sets found that between 5% and 8% of children with at least one sibling had experienced a sibling's death^[6]. These are estimates from models and surveys; no national statistics office we found publishes a count of bereaved siblings.

Mental health problems rise after a sibling dies, especially in the first years

Grief is a normal response to a death, not an illness, and most bereaved siblings do not develop a mental disorder. But on average, rates of diagnosed problems rise.

The clearest short-term evidence comes from Manitoba, Canada, where researchers matched the 7,243 siblings of every child who died in the province in 1984–2009 with 21,729 siblings whose brother or sister had not died^[7]. In the two years after the death, bereaved siblings had higher rates of physician-diagnosed mental disorders, even after taking account of mental illness that existed before. Among those aged 13 and over, 25% were diagnosed with a mental disorder in those two years, against 17% of controls. For children under 13, the rise in depression from before to after the death was more than seven-fold (adjusted relative rate 7.25, 95% CI 3.65–14.43)^[7]. Older siblings also had twice the rate of suicide attempts of controls (adjusted relative rate 2.01). The authors note that bereaved siblings already had higher rates of alcohol and drug use disorders before the death, but conclude that pre-existing problems and social disadvantage do not fully account for the rise^[7]. Suicidal behaviour never has a single cause; most bereaved young people do not attempt suicide, and support and treatment help.

A Dutch cohort that followed 2,230 adolescents gives a similar picture, although it groups sibling and parental deaths together. The 131 young people (5.9%) whose parent or sibling had died reported more internalising problems, such as anxiety and low mood, in the two years after the death than their peers did, after taking account of their earlier problems. The researchers found 22% new clinically relevant cases among the bereaved, against 5.5% among the non-bereaved^[8].

Longer-term register studies find smaller but lasting differences. Among 701,270 people born in Sweden in 1973–1982, men whose sibling died in childhood were more likely to receive psychiatric care as young adults (hazard ratio 1.17 after adjustment). For women, the overall association was no longer statistically significant once family circumstances were taken into account (hazard ratio 1.07), though women whose sibling died during their adolescence did have a raised risk (1.19)^[9]. The authors suggest that family-related psychosocial conditions shared by siblings may account for the link. In Norway, among 556,593 people born in 1969–1979, those whose sibling died before age 30 used primary care more in mid-life (incidence rate ratio 1.11), including for psychological problems (1.17). The strongest link was between a sibling's death by suicide and later psychological problems (1.53)^[10].

Together, these studies suggest a rise that is sharpest soon after the death and smaller decades later. For children whose parent has died, see the library's study of mental health after a parent's death.

The long shadow: health and survival decades later

The Nordic registers can follow every bereaved sibling into middle age. The largest study linked national registers in Denmark and Sweden for more than five million children from 1973. Of the 55,818 whose sibling died in childhood (at a median age of seven), the death rate during up to 37 years of follow-up was 1.71 times that of other children^[2]. The ratio was highest in the first year after the death (2.51), and higher when the siblings were the same sex or close in age^[2].

Part of that excess could reflect what siblings share, such as genes or hardship at home. The Danish and Swedish study found the highest ratios when both siblings died of the same cause^[2]. A separate Swedish study of 717,723 people born in 1973–1982 adjusted for social and demographic factors and for parents' psychosocial problems. It still found a death rate from age 18 to between 31 and 40 that was 1.39 times that of non-bereaved siblings (a hazard ratio), and 1.71 times for those whose sibling died when they were aged 12 to 18^[11]. In that study the excess was found where siblings died of the same causes, not of different causes, which may point to shared family risks^[11].

Physical health shows a similar, modest pattern. Among 2,098,659 people born in Denmark in 1978–2018, those whose sibling died in childhood or early adulthood had a 17% higher risk of early-onset cardiovascular disease (hazard ratio 1.17). In absolute terms, by age 41 about 1.96% of bereaved people had been diagnosed, against 1.35% of others^[12]. The increase was seen whether or not the sibling had died of heart disease. Most bereaved siblings had not developed heart disease by that age.

Development and schooling are affected too. Two US data sets linked a sibling's death to fewer years of schooling and weaker adult socioeconomic outcomes, with sisters far more affected than brothers^[6]. A later US study found large initial effects on children's cognitive and non-cognitive outcomes that faded over time, and found that parents' emotional support for surviving children declined after the death^[13]. That describes a family under great strain, not a failing of parents. For the parallel evidence after a parent's death, see the library's study of physical health and mortality.

How the death happens, and whether siblings are included, makes a difference

Much of the detailed research comes from childhood cancer. It suggests that what happens around the death matters to siblings for years.

A nationwide Swedish survey reached 174 young adults (a 73% participation rate) whose brother or sister died of cancer in 2000–2007, when they were aged 12 to 25. Siblings who felt that the death had not been peaceful had 9.86 times the odds of reporting unresolved grief years later, and those given limited information in the last month of life had 5.96 times the odds^[14]. In the same group, 26% of siblings who were not satisfied with how much they had been able to talk about their feelings during that last month reported anxiety, against 11% of those who were^[15]. These odds ratios come from a small survey with wide confidence intervals; the direction, not the exact size, is the finding.

Sudden deaths in hospital point the same way. A Florida study followed 132 children whose brother or sister died in a neonatal or paediatric intensive care unit or an emergency department. Over the following 13 months, 43% had elevated anxiety scores and 6% elevated depression scores. Anxiety and depression were lower among children who had seen their sibling in hospital before or after the death, or who had attended the funeral^[16]. Separately, a small survey of 58 people whose sibling had died of cancer about 12 years earlier found that anxiety, depression and illicit drug use rose in the year after the death and then returned to earlier levels^[17]. These are associations, not proof of cause: families who include children may differ in other ways.

Grief itself can be long. A 2026 meta-analysis of young people bereaved by cancer pooled self-reported prolonged grief-related symptoms and found them in 59% after a sibling's death and 28% after a parent's death^[18]. Only five studies were pooled, the measures varied a great deal, and none used diagnostic interviews, so these figures describe grief symptoms, not cases of prolonged grief disorder. The library's study of prolonged grief disorder in children explains the difference.

Long-term outcomes are often good. In a large US study of 4,558 adult siblings of people who had survived childhood cancer for at least five years, the 733 whose brother or sister later died reported what the authors called excellent psychosocial health in the long term: 6.5% had depressive symptoms. Their risk of depression was still 1.53 times that of non-bereaved siblings, a difference the authors call marginal^[19]. Raised risk and resilience sit side by side.

What the evidence asks of us

The evidence does not support treating every bereaved sibling as a future patient. It does support making sure these children are seen, and that help is there when needed.

• Count and notice bereaved siblings. No country we found publishes regular figures on how many children have a sibling die. A US survey of neonatal units found that most respondents reported having “no individual responsible” for telling surviving siblings' own doctors about a death (52% of units with palliative care teams involved, and 100% of the rest); the authors recommend formal communication so those doctors are informed^[20].
• Include siblings in end-of-life care. England's NICE guideline on end-of-life care for children asks professionals to be aware that siblings will need support to cope with their brother's or sister's condition and death, and with the effects of their parents' grief, and that this may include social, practical, psychological and spiritual support^[21]. The Swedish and Florida findings on information, communication and saying goodbye point the same way^[14][16].
• Fund support beyond the hospital. A 2020 systematic review found 23 studies of bereavement care for siblings under 18; most support reached children whose sibling had died of cancer, through group sessions or weekend camps run mainly by unpaid staff^[22]. In France, 21 hospital paediatric palliative care teams (91% of those approached) described limited staff, facilities and funding, and distance, as frequent obstacles; 28% offered group support^[23].
• Build the evidence. Trials are rare. One German randomised trial of an online writing programme for 86 bereaved siblings aged 16 to 65 found clinically significant improvement in depression in 34%, against 10% of a waiting-list group^[24]. A 2025 review found very few studies of adolescents bereaved by a sibling's suicide, and even fewer of support for them^[25]. Funders could close these gaps, including for deaths outside hospital and in lower-income countries.

Schools and services supporting a bereaved sibling can draw on the wider evidence in the library's study of what helps bereaved children.

Language: this piece uses plain words such as “died” rather than euphemisms, because they are clearer. Where it discusses suicide, it follows the Samaritans’ media guidelines.

Why we're publishing this

Children whose brother or sister has died are rarely counted, rarely the focus of services and rarely studied in their own right. We publish this so that children's hospices, palliative care teams, neonatal units, schools and childhood bereavement charities can make the case for those children with figures they can check. The case is theirs; the data supports it.

How to read this data

The figures come from different kinds of study and different countries, and are not directly comparable. WHO's child death figures are modelled estimates; the ONS figures are registered deaths. The US bereaved-sibling figure is a model, not a count. The one-in-three figure comes from surveys of women in 43 lower-income countries and includes some deaths before the respondent was born. The long-term outcome figures come from national registers in Denmark, Sweden and Norway and a population database in Manitoba, Canada; they are large and complete but can adjust only for what registers record. Rate ratios, hazard ratios and odds ratios are relative measures: when an outcome is rare, a raised ratio still means most bereaved siblings are unaffected. The cancer and intensive care studies are small and from a few high-income countries. There is little outcome evidence from lower-income countries, where sibling death is most common.

Use this data

Free to cite with attribution to Understanding Bereavement. Charities, schools, services and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This study summarises published research about groups of people for general information. It is not medical advice or bereavement support, and it cannot describe or predict anything about an individual child or family. If you are worried about a child or about yourself, please speak to a GP or another qualified professional.

Sources

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