A previous review on the prevalence of psychopathology in siblings of children with mental health problems (MHPs) suggested that these siblings are at increased risk of a broad range of psychopathologies. No disorder-specific risk could be identified. It may be that a different approach to understanding mental health is needed. The following paper aimed to explore if using a dimensional approach could provide greater clarity and insight into the mental health of these siblings by conducting a similar systematic review using dimensional data on the psychosocial functioning of siblings of children with MHPs. An electronic search of publications from 1990 to 2011 identified 29 articles. The findings show that while mean sibling scores on internalising problems, externalising problems, social problems were in the normal range compared to standardised norms, siblings of children with MHPs scored poorer than control children and a greater proportion of siblings scored in the borderline/clinical range compared to children in the general population. Particular areas of functional impairments identified were delinquent behaviour, somatic complaints, anxious/depressed behaviour, and social problems. Effect sizes were moderate to large. Findings on symptom scores with categorical underpinnings were inconsistent. Implications for the debate between dimensional and categorical approaches are discussed and guidelines for future research are outlined. Implications for clinical treatment for siblings are highlighted.