Does sibling status affect your mental health?

Does a child’s likelihood of experiencing a mental health concern depend on their birth order or the number of siblings they have? That might be the case, according to a recent study using Epic data.

Researchers studied well-child anxiety screenings of nearly 183,000 children born between 2009 and 2016, adjusting for age, race, history of mental health disorders, and mother’s history of anxiety or depression. The data suggested a 48% greater likelihood of being diagnosed with anxiety by the 8-year pediatrician wellness appointment for children born first compared to those born second or later. Children without siblings compared to those born second or later had a 42% greater likelihood of anxiety.

Additionally, an only child is 38% more likely to be diagnosed with depression than those with at least one sibling. Firstborns were 35% more likely to have depression than those born second or later.

“This makes practical sense – a child who has the ‘full’ attention of adults around them is more likely to have subtle changes in their behavior noted and brought up as a concern,” says Dr. Jean Burr, an adolescent medicine physician at Advocate Children’s Hospital. “That ‘only’ child typically has all the pressures of parental/adult expectations. Many studies have shown correlation between birth order versus only-child status and academic achievement. Concern about needing to meet expectations to receive praise and love from adults could certainly set a child up for anxiety or depression.”

Dr. Burr notes the way the data was collected does not provide any insight into the severity of anxiety or depression.

“While it might be more likely for a firstborn or only child to have diagnosed anxiety or depression, all humans are at risk,” she says. “Individual attention to the mental health of all kids is more important than focusing on birth order. If your child is avoiding school, certain places, people or situations, please talk with them and consider getting advice from their pediatrician. Mental health is health.”

If you or someone you know is exhibiting signs of emotional distress, call or text the suicide & crisis lifeline at 988.    

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