Aims
Psychological distress is highly prevalent among individuals with brain tumours and often persists across the illness trajectory. Existing models do not adequately capture the multilevel mechanisms underpinning distress or inform targeted clinical intervention. This study aimed to develop a comprehensive, clinically actionable framework to explain distress trajectories and risk of suicidal ideation in brain tumour populations.
Methods
A multilevel theoretical framework was developed through integration of established psychological, neurobiological, and oncology models. Five interrelated processes were identified: illness related identity disruption, social isolation, chronic uncertainty, neurological impairment, and employment and financial stress. These processes were conceptualised across interacting neurobiological, psychological, interpersonal, socioeconomic, and service system levels. The framework draws on Mishel’s Uncertainty in Illness Theory and incorporates contemporary models of suicidality, including the Integrated Motivational Volitional model and Interpersonal Theory of Suicide to define mechanisms linking distress to suicidal ideation [1–3].
Results
The framework conceptualises distress as a dynamic process shaped by non linear and reciprocal interactions across levels. Neurological impairment functions as a core constraint influencing identity, social participation, and employment [4]. Distress drivers vary across illness phases, with uncertainty dominating early stages, functional impairment during treatment, and social and financial stressors influencing longer term outcomes [5]. The model identifies clinically actionable intervention targets, including structured uncertainty communication, early neuropsychological and rehabilitation support, routine screening for social isolation and financial toxicity, and theory informed suicide risk assessment targeting defeat, entrapment, belongingness, and burdensomeness mechanisms [2,3].
Conclusions
This framework provides a novel, clinically translatable model for understanding distress in brain tumour populations. It supports development of targeted, multidisciplinary, and scalable supportive care pathways and has implications for psycho oncology practice, suicide prevention, and health service design.