Perceived control as a potential protective factor for suicidal thoughts and behaviors in cancer patients and survivors : a systematic review with meta-analysis

Abstract

Objective: Individuals affected by cancer have an elevated risk of experiencing suicidal crises. Aligning established suicide theories with social-cognitive theories, perceived control and related constructs emerge as potential protective factors for suicidal thoughts and behaviors in cancer patients. As perceived control is potentially modifiable, it holds great potential for prevention and intervention efforts. We aimed to comprehensively synthesize the evidence on perceived control and its link with suicidal thoughts and behaviors in cancer patients.

Methods: The search term and procedures were registered in PROSPERO (CRD42023391048). We systematically searched the databases PubMed/MEDLINE, CINAHL, PsycInfo, Web-of-Science Core Collection, Cochrane Library, adding a grey literature search. In addition to the narrative review, pooled effect sizes, moderation and subgroup analysis were calculated.

Results: The systematic search yielded 1986 original reports of which 36 were included in the systematic review and 25 in the meta-analysis. Demoralization, help-/hopelessness, and self-efficacy were the most commonly studied facets of control, showing a relatively large, pooled correlation with suicidal ideation overall (r = 0.45, [95% CI = 0.38–0.52], Q = 346.15, p < 0.01, I2 = 91.2%) and across operationalisations (demoralisation: r = 52; hopelessness: r = 45; self-efficacy: r = 0.40). Moderation analyses revealed no effect of cancer stages; but more directly cancer-associated variables (demoralisation, hopelessness) were more closely related to suicidal ideation (QM = 5.40, p = 0.02) than general self-efficacy.

Conclusion: The findings underscore the pivotal role of perceived control in shaping severe distress in cancer patients. More studies are needed examining perceived control in a narrower sense