The current study sought to examine the high school experiences of young adults who lived with a sibling with depression during adolescence. Participants described their complex relationships with school. Many claimed that school gave them an escape from the chaotic reality at home. Studies support the idea that siblings of people with mental health problems experience a heightened sense of responsibility and vigilance during a critical developmental stage [9, 16, 17, 20]. The present study suggests that participants may seek refuge in the school environment as a protective measure against potential harm, alienation, shame, thereby restoring a sense of normalcy [25]. This concealment strategy can serve as a boundary-enhancing mechanism, consolidating and preserving the integrity of the family unit against outside influences. Studies among siblings of people with mental disorders describe how much they need independent activities that are unrelated to their involvement at home and do not involve their siblings [40, 41].
At the same time as feeling that school is a place to hide, they also report fantasizing that school serves as a place where they can find comfort. According to Winnicott [42], “It is a joy to be hidden and a disaster not to be discovered.” The study participants used school as a place of refuge where they could ignore their problems at home and not have to deal with them. Yet their wish to be discovered did not come true. This finding is consistent with research conducted among siblings and parents of children with mental disorders and chronic illnesses [43]. Studies show that although many teachers are willing to take responsibility for caring for students’ mental health, they may lack knowledge about the symptoms and strategies to effectively manage them [44].
In the current study, participants behaved quietly and appeasingly and avoided conflict at school. According to Bowen [31], participants adopted behaviors characterized by fusion in order to survive in their family situation. That is, they internalized the needs of others to the point of self-destruction. Habits adopted by the participants at home, such as avoiding telling others about their feelings and denying personal needs, also characterized their behavior at school. As a result of similar patterns at school and at home, study participants were not the center of attention in either location.
In addition, they may have felt a sense of responsibility and a need to help their family instead of adding to their problems by causing academic problems. [45]. One explanation is that because they were good and quiet students and did not cause problems at school, the school staff were concerned about other things [46]. Another explanation is that school staff members who have to deal with such problems face the circumstances in their personal world. Encountering such stories can trigger memories, trigger an emotional flood and lead to feelings of helplessness, thereby engendering distancing and avoidance behaviors [30].
In the current study, participants described their fears that their friends would find out about their sibling with depression. This finding is consistent with findings from previous studies showing that family members of people with mental illness try to avoid disclosing their marital status due to shame, fear of being stigmatized, and fear of negative consequences. [14, 28]. The literature contains much evidence showing that people dealing with mental illness are not the only ones who face negative societal stigmas. Family members also have to deal with negative labeling or what the literature calls “stigma by association” [14, 47], according to which family members are responsible for the illness of their loved one and even consider themselves guilty. Family members who internalize and believe this stigma report high levels of psychological distress, low self-esteem, and low self-esteem [14, 47].
A healthy dose of shame helps people protect themselves through deterrence and creates the right balance of self-exposure [14]. But when the feeling of shame becomes strong, complex, and takes over other feelings, it has a negative and deterring effect. [49]. Among victims’ families, shame “shatters” the set of family expectations and sometimes even the image of the “ideal” family [48, 49]. Many times such people feel that “a stranger cannot understand this”. Fear of reactions that are judgmental, intrusive and critical, as well as those that are overly curious to the point of “voyeurism” make it difficult to trust someone and reveal the “secret” [48, 49]. In extreme cases, the family unit can become socially isolated.
In this study, the few participants who were able to share their story with someone else felt significant relief. Growing up with a sibling who has depression can have a profound impact on an adolescent’s school experience. On the one hand, having a sibling with depression can increase awareness and empathy for mental health issues and encourage an adolescent to prioritize self-care and seek support when needed. On the other hand, living with a sibling with depression can also bring stress and anxiety into an adolescent’s life, lead to distraction, and hinder academic achievement. Moreover, these adolescents may feel pressured to provide ongoing support to their siblings and maintain family dynamics, which may affect their own mental health and school success. The burden of caring for children with chronic illnesses usually falls on parents and siblings, who must balance the health needs of the affected child with other commitments. A meta-analysis of siblings of children with chronic illnesses showed that they were at risk for several negative effects [50]. They may find that their parents give them less time and attention. Such disruptions in family life can affect the psychosocial well-being of all family members and thus have an impact on the seeking of health services.
On the other hand, growing up with a sibling with a mental illness has been shown to have many positive effects, such as developing tolerance, sensitivity, the ability to work independently, high self-esteem and leadership skills. [6, 51]. This growth as a result of stressful situations is known as post-traumatic growth, where people find meaning in difficult experiences and find that their personal abilities have improved compared to their pre-crisis situation [52]. In fact, the study participants, faced with traumatic life realities, were able to grow, distilling the advantages of the crisis that befell their family and discovering new strengths within themselves.
When depression occurs in a family, family members often experience it as an extreme and destabilizing event [14]. Mental illness shares the characteristics of both chronic and acute conditions, posing a threat to personal and family integrity and causing emotional distress. Nevertheless, this experience can also lead to growth and strengthening of individuals and the entire family. During adolescence, teenagers want to feel “like everyone else” and use school and friends as a refuge from difficulties at home [21]. Professionals must approach these people with great sensitivity and recognize their different needs.
Consequences
The results of the current study have implications for school psychologists, counselors, and social workers. These professionals need to understand that growing up with a sibling who has depression can potentially affect an adolescent’s school experience. Therefore, they should strive to create a safe and inclusive classroom environment, encourage open communication, and provide a non-judgmental space for students to express their feelings and experiences. They need to be mindful of the emotional well-being of these students, checking in on them regularly and providing them with resources and support if they are struggling. They should strive to foster a sense of community and connectedness, encourage students to form supportive relationships with their peers, and provide opportunities for them to connect with others who may have similar experiences. Each student is unique and each should be treated with compassion and understanding. By providing support and resources, professionals can help students deal with the challenges that come with growing up with a sibling who has depression, and thus encourage their academic and personal growth. In addition, it is important for professionals to maintain contact with parents and the whole family as a system and pay special attention to adolescents living with a sibling with depression.
Limits
To our knowledge, no other published study has examined the experiences and insights of young adults who lived with a sibling with depression during adolescence. The methodological strength of the study lies in the construction of a homogeneous group that includes clear inclusion criteria, specifically the siblings of those suffering from one disorder, unlike studies that include different mental disorders.
However, the study has several limitations. Due to the nature of qualitative research, the sample size of this study was limited. Additionally, this study focused on a specific group of participants who had a sibling affected by depression as adolescents. Therefore, the results cannot be generalized to their experiences later in life. Another limitation is that the study used a convenience sample of individuals who self-identified as having a sibling with depression.
The study was conducted during a period when the COVID-19 pandemic in Israel was waning. However, the pandemic may have affected the emotional state of the participants as well as the educational teams they described. Furthermore, the study focused on the participants themselves. To obtain a more comprehensive picture, we recommend that the perspectives of parents, siblings affected by depression, and educational teams are also explored. Furthermore, to preserve confidentiality, we refrained from asking for the names of schools or the identities of staff members. It is possible that some of the participants attended the same school as their affected sibling, although we did not verify this. However, we included a broad national sample of participants. Finally, many factors were unexplored in this study, including the effects of age, gender, family structure, which would be of interest to explore in future research.