Losing a parent hits harder with fewer siblings

By Dr. Priyom Bose, Ph.D.Reviewed by Lauren HardakerApr 3 2026

Losing a parent in adulthood can take a measurable toll on mental health, and new research suggests that having siblings may ease that burden in ways we are only 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

A recent Journal of Epidemiology and Community Health study conducted a national cohort study to examine whether having siblings is associated with differences in psychotropic medication purchases before and after parental death.

Adult Bereavement and Mental Health

Parental death is a significant stressful life event that affects both mental and physical well-being. While the adverse mental health consequences of losing a parent during childhood or adolescence have been extensively studied, research on how parental loss affects adult offspring remains limited. This gap is particularly notable given that, with increasing life expectancy, parental death most commonly occurs when offspring are in middle or older age, especially in high-income countries.

Adult bereavement has been consistently linked to negative mental health outcomes, with evidence showing that the period immediately following parental death is associated with increased rates of psychotropic medication use, as well as the onset of depressive symptoms and psychological distress. In addition, an increased rate of suicide and alcohol-related mortality has been documented in this population.

Although parental death in adulthood is most commonly associated with short-term mental health disruption, prolonged effects have been observed, particularly when the death was sudden or unexpected. Conversely, when a parent experiences chronic illness or frailty prior to death, caregiver burden and anticipatory grief may begin affecting offspring's mental health well before the loss itself.

Despite the range of factors known to shape bereavement outcomes, the role of siblings remains poorly understood. Siblings not only share the experience of parental loss but can also provide mutual support and divide the practical responsibilities of end-of-life care. Whether sibship size is associated with mental health outcomes around parental death is an understudied question, and one that grows more relevant as declining family sizes leave these burdens to fewer people.

Assessing Siblings' Influence on the Psychological Impact of Parental Loss in Adulthood

The current study examined whether sibship size is associated with changes in psychotropic medication use surrounding parental death. The authors used administrative data on all Finnish residents from 1987 to 2019, focusing on individuals aged 35–55 during 2006–2016, an age range where parental loss is common but not yet universal.

Parental death dates were obtained from Statistics Finland’s Cause of Death Register. Any individuals with missing data or whose parents died before age 35 or before 2006 were excluded. Individuals who did not experience parental death during 2006–2016 formed a synthetic control group with assigned comparison dates.

The study cohort was restricted to adults with 0–3 full biological siblings alive and residing in Finland at the time of parental death or the comparison date. Sibling sex and birth order were also obtained from Statistics Finland’s longitudinal population files. The final sample size was 1,368,619 for mothers’ deaths and 1,041,981 for fathers’ deaths, with 12.5 % and 22.6 % experiencing each, respectively.

Psychotropic medication use was assessed three years before and after parental death using the Finnish Prescription Medication Register, which captures prescribed medications dispensed at pharmacies.

Sibship Size Shapes Psychotropic Medication Use Following Parental Loss

Following the mother’s death, a clear sibship size gradient emerged: fewer siblings corresponded to a stronger peak in psychotropic medication purchases in the year after loss. Only children showed the largest increase, at 5.1 percentage points, compared with 4.3 percentage points among those with one sibling, 3.5 percentage points among those with two siblings, and 2.6 percentage points among those with three siblings.

Notably, sibship-size differences were already apparent in the year preceding maternal death, with 2.8 percentage points for only children, 2.2 for those with one sibling, 2.0 for those with two siblings, and 1.0 for those with three or more siblings, and largely reduced within a year of the loss.

After the father’s death, medication purchases rose only in the immediate year following the loss, a smaller increase than seen with maternal death, and did not vary by sibship size. Among women, paternal death produced no sibship size differences across the 6-year follow-up.

For maternal death, however, only children showed the largest increase, followed by those with one sibling, two siblings, and three siblings. All peaked in the year of maternal death and largely attenuated by the second year. Among men, sibship-size differences were small, with confidence intervals broadly overlapping.

Finer-grained timing analyses using 6-month intervals confirmed that medication purchases peaked immediately after parental death, with sibship size differences consistent with the main findings. Analyses by medication subtype showed that anxiolytics, hypnotics, and sedatives peaked more sharply around parental death than antidepressants, though the sibship size gradient was consistent across all subtypes.

Birth order did not explain the sibship size gradient: medication increases around maternal death were nearly identical for earlier- and later-born offspring within each sibship size group.

Cause-of-death analyses revealed distinct patterns. Dementia-related parental deaths were associated with persistently elevated medication use throughout follow-up, with no sibship size gradient. Cancer-related maternal deaths showed the strongest sibship gradient, with purchases rising sharply in the year before death among those with fewer siblings. Deaths from external causes, such as accidents or suicide, produced peaks across all sibship groups, though wide confidence intervals precluded clear differences.

The parental death order had little bearing on the sibship-size gradient. The one exception was only children whose mother died first, who showed a distinct pattern. Even so, the sibship gradient for maternal death remained evident regardless of whether the mother was the first or last parent to die.

Fewer Siblings, Greater Psychotropic Medication Use After Parental Death

The current research underscores a clear pattern: the fewer siblings a person has, the greater the increase in psychotropic medication purchases observed surrounding a parent’s death. Siblings may serve as a potential buffer, for example, by sharing caregiving burdens and providing emotional support during one of life’s most difficult transitions. The effect is especially pronounced among only children and women, and is sharpest after maternal death.

However, psychotropic medication purchases reflect both mental health status and treatment-seeking behavior, and the observed sex differences may partly relate to gendered help-seeking patterns, rather than differences in underlying distress alone. Additionally, as an observational study, the findings may be influenced by unmeasured confounding factors such as family background or parental health.

As family sizes continue to shrink across aging societies, more adults will face parental loss without that support network, highlighting the potential importance of understanding social support structures during bereavement, although these findings are based on data from Finland and may not fully generalize to other settings.

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