Original Article © 2004 Blackwell Publishing Ltd 103 Blackwell Science, LtdOxford, UKCCHDChild: Care, Health and Development0305-1862Blackwell Publishing Ltd, 20032003302103111Original ArticlePaedi- atric cancer, social support, siblingsM. Barrera et al . Correspondence: Maru Barrera, Department of Psychology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada E-mail: maru.barrera@sickkids.ca Original Article The role of emotional social support in the psychological adjustment of siblings of children with cancer M. Barrera, C. F. Fleming and F. S. Khan The Hospital for Sick Children, Toronto, Canada Accepted for publication 17 November 2003 Abstract Background Siblings of children with cancer are at risk for reduced emotional support. The role of emotional social support in the psychological adjustment of siblings of paediatric cancer patients was examined, in the context of age and gender. Methods The sample consisted of two groups of siblings of children being treated for cancer: siblings referred for behaviour problems (n = 47) and a comparison group of non-referred siblings (n = 25). Forty-two were female, and 30 were male. The mean age was 10.31 years (SD = 2.71). Siblings completed measures of depression, anxiety, behaviour, and emotional social support. One parent of each sibling completed measures of sibling’s behaviour and anxiety. Results Siblings who reported more social support endorsed significantly fewer symptoms of depression, anxiety, and fewer behaviour problems, and their parents reported less anxiety and fewer behaviour problems than siblings who reported lower social support. Parents of referred siblings reported significantly more behaviour problems than parents of non-referred siblings. Referred adolescent females reported significantly higher depression scores and were perceived as more anxious than referred adolescent males and non-referred adolescent females. Non-referred younger siblings with high social support were perceived by their parents as having the fewest behaviour problems. Conclusions High level of social support appears to play a protective role in psychological adjustment of siblings of paediatric cancer patients, with age and gender as modifying factors. Although not all siblings develop behaviour or emotional problems, it is critical to identify those who do in order to intervene accordingly. Keywords siblings, paediatric cancer, social support, psychological adjustment Introduction Paediatric cancer can have detrimental effects on the psychological well-being of all family members. Numerous studies have investigated the psychoso- cial impact of paediatric cancer on patients and their parents (e.g. Eiser et al. 2000 for a review; Kazak et al. 1994). The psychological adjustment of healthy siblings to paediatric cancer has received less attention. Several factors have been considered to play an important role in sibling psychological adjustment. These include family resources, indi- vidual sibling attributes such as age and gender, and severity of the illness of the child with cancer (Murray 2000b; Barrera et al. 2002). Siblings expe- rience family separations and disruptions of daily