Perceived burdensomeness and suicidal ideation in cancer patients: A theoretical network perspective

Although cancer is associated with elevated rates of suicidal ideation, not all individuals affected by this disease are equally vulnerable. This heterogeneity suggests other, including psychological factors may play a critical role in shaping risk. However, research has rarely examined suicidal ideation in cancer patients through the lens of established suicide theories. This study addresses this gap by investigating theory-derived psychological risk and protective factors, which are derived from the Interpersonal Theory of Suicide (IPTS), the Integrated Motivational-Volitional Model of Suicidal Behavior (IMV) and cancer-specific suicide theories.

In total, 618 cancer patients from various settings completed questionnaires assessing sociodemographic and cancer-associated characteristics as well as perceived burdensomeness/thwarted belongingness (IPTS), defeat/entrapment (IMV), primary and secondary control. Multiple network analyses were conducted, exploring the structure and interplay of these factors and their relation to suicidal ideation - independently for each theory as well as a combined overall network.

Suicidal ideation was reported by 11.74 % of participants. All core risk factors of the IPTS and IMV were (indirectly) associated with suicidal ideation, with perceived burdensomeness being the only variable with a direct link. Perceived burdensomeness also accounted for most of suicidal ideation's variance (44.63 %; 95 %CI: 17.87, 68.57). Primary and secondary control acted as protective factors.

Perceived burdensomeness forms the bridge between the psychological burden of cancer and suicidal ideation and should therefore be assessed in routine screenings and targeted in psychosocial interventions. Secondary control strategies hold great potential to buffer against adverse emotional states and dysfunctional cognitive biases.