The research team, led by Hacer Kabakoğlu of Hatay Mustafa Kemal University and Rabia Arpacı of Hitit University, surveyed 415 university students aged 18 to 28 at a university in southern Türkiye. Participants were recruited through convenience sampling, and the study was designed as a descriptive and correlational investigation rather than a clinical trial. Each student completed a battery of standardized instruments: a personal information form, the Suicide Probability Scale, the Basic Psychological Needs Scale, the Meaning in Life Scale, and the Life Engagement Scale. The researchers then analyzed the data using descriptive statistics, Pearson correlation, and multiple regression analysis to determine how strongly each psychological factor predicted suicide probability, both alone and in combination.

The average scores painted a picture of a population under measurable strain. Participants scored 137.66 plus or minus 25.09 on the total basic psychological needs measure, 46.60 plus or minus 10.34 on meaning in life, 24.03 plus or minus 4.46 on life engagement, and 75.15 plus or minus 14.96 on suicide probability. While these are group averages rather than individual diagnoses, the statistical relationships between them were unambiguous. All of the associations between basic psychological needs, meaning in life, life engagement, and suicide probability were significant at the p less than 0.001 level, meaning the probability that these links arose by chance alone is extremely small.

The regression analysis delivered the study’s headline result. Taken together, basic psychological needs, the search for meaning, the presence of meaning, and life engagement explained 46.6 percent of the total variance in suicide probability, corresponding to an adjusted R-squared of 0.466. In practical terms, this means that nearly half of the differences in suicide risk between students could be statistically accounted for by these four psychological variables. Within that model, life engagement and basic psychological needs emerged as the strongest individual predictors, suggesting that how actively a student invests in their goals and how well their fundamental psychological needs are satisfied matter more, in this sample, than the more abstract question of whether life feels meaningful.

The concept of basic psychological needs comes from self-determination theory, a widely influential framework in psychology that holds that human beings have three innate requirements for healthy functioning: autonomy, the sense that one’s actions are self-chosen; competence, the sense that one is capable and effective; and relatedness, the sense of being connected to and cared for by others. When these needs are chronically frustrated, the theory predicts, people become vulnerable to a cascade of psychological difficulties, including diminished motivation, alienation, and despair. The present findings align with that prediction in a particularly consequential domain, showing that need frustration is tightly coupled with elevated suicide probability in young adults navigating the pressures of university life.

Meaning in life, the second pillar of the study, is typically divided into two distinct components, and the researchers measured both. Presence of meaning refers to the extent to which a person feels their life already has significance and direction, while search for meaning refers to the active effort to find or build that significance. The two are not simply opposites. A student can be actively searching without yet feeling any sense of purpose, or can feel a settled sense of meaning without much ongoing reflection. The inclusion of both dimensions in the regression model allowed the team to assess whether the feeling of meaning and the hunt for it carry different weights in relation to suicide risk, and both contributed to the overall explanatory power of the model.

Life engagement, the strongest predictor alongside basic psychological needs, captures something related but distinct: the degree to which a person commits to and invests energy in the goals and activities that matter to them. A student may report that life has meaning in the abstract yet still drift through their days without genuine commitment, and the data suggest that this behavioral dimension of purposeful living is where the protective effect is most visible. Engagement, in this sense, functions as the bridge between believing life matters and actually living as though it does. Its prominence in the model implies that interventions aimed simply at talking students into feeling that life is meaningful may fall short unless they also help students build concrete, absorbing commitments.

The authors frame these results as a contribution to understanding the current state of suicide probability among university students, identifying the factors associated with it, and developing effective psychosocial interventions to prevent suicidal behavior. That framing matters, because the study is correlational by design. It cannot establish that unmet needs or low engagement cause suicidal thinking, only that they move together with a strength and consistency that makes causal hypotheses plausible and testable. Longitudinal and intervention studies would be needed to confirm the direction of the arrows, but the size of the explained variance gives such studies a clear target.

The study also carries practical implications for universities and mental health services. Screening tools that assess psychological need satisfaction, meaning, and engagement could help identify students at elevated risk before acute symptoms appear, and campus programs that foster autonomy, competence, and connection, such as mentorship schemes, collaborative projects, and structured goal-setting support, map directly onto the strongest predictors identified here. The researchers note that their findings may guide the development of such psychosocial interventions, and the specificity of the results makes that guidance unusually concrete: bolster life engagement and meet basic psychological needs, and the statistical model suggests suicide probability should fall.

Published open access in BMC Psychology, the study was approved by the Hatay Mustafa Kemal University Ethics Committee and conducted in accordance with the Declaration of Helsinki, with written and verbal informed consent from all participants. It received no specific external funding, and the authors declare no competing interests. As suicide rates among young adults continue to rise, research of this kind shifts the question from the dramatic and the acute to the everyday and the structural, asking not only what pushes a person to the edge but what, in the fabric of ordinary psychological life, holds them back from it. The answer emerging from this work is that the weight of existence becomes unbearable most often when basic needs go unmet, meaning remains unfound, and life goes unlived with full commitment.

Subject of Research: Psychological predictors of suicide probability among university students

Article Title: The unbearable weight of existence: The effect of basic psychological needs, meaning in life and life engagement on suicide probability

Article References: Kabakoğlu, H., & Arpacı, R. (2026). The unbearable weight of existence: The effect of basic psychological needs, meaning in life and life engagement on suicide probability. BMC Psychology. https://doi.org/10.1186/s40359-026-05666-0

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05666-0

Keywords: suicide probability, basic psychological needs, meaning in life, life engagement, self-determination theory, university students, mental health, BMC Psychology, regression analysis, psychosocial intervention, young adults, suicide prevention

Breast cancer is the second most common cancer among women in the United States, with an estimated 310,720 new cases in 2024 alone, and it remains the second-leading cause of cancer-related mortality in women. While survivorship brings physical, emotional, and cognitive challenges for all patients, rurality adds structural, socioeconomic, and environmental barriers that urban patients rarely face. Rural survivors often must travel hours for treatment, live in areas with limited broadband access, and contend with a scarcity of mental health professionals. Studies consistently show that rural breast cancer survivors report higher levels of anxiety and depression than their urban counterparts, and evidence suggests they may experience poorer prognoses despite lower incidence rates, a persistent inequality in cancer survivorship.

Expressive writing, first pioneered by psychologist James Pennebaker and colleague Sandra Beall in 1986, asks participants to write continuously for at least 15 minutes about their deepest thoughts and feelings surrounding traumatic life events. Decades of research have linked the practice to improved emotional well-being, reduced psychological distress, and enhanced quality of life among cancer survivors, particularly those with low emotional support. Yet, as the researchers point out, nearly all prior studies analyzed the written essays themselves. None had asked rural survivors, in their own words, what the experience of expressive writing actually felt like or how it fit into their cancer journeys. The new study was designed to fill that gap.

The interviews drew from a parent randomized controlled trial conducted between October 2021 and April 2022, in which rural breast cancer survivors were assigned either to write about their deepest thoughts and feelings about cancer or to write about neutral topics. The intervention spanned six weeks, with three writing tasks scheduled two weeks apart; participants could type or write by hand, and follow-up questionnaires were collected at one, three, and six months. For the qualitative follow-up, the research team invited participants from the expressive writing arm to complete semi-structured interviews of 45 to 60 minutes each, 13 conducted via Zoom and one in person, during November and December 2023. The mean age of interviewees was 54.71 years, most identified as White, three identified as Hispanic, and cancer stages ranged from stage I to stage III.

Using an inductive thematic analysis, guided by principles of reflexivity, the team identified six interrelated themes. The first, rural-specific challenges, confirmed the structural weight these women carry. One 62-year-old survivor with stage III disease described slow internet connections that hampered virtual care, while another recounted a weekly drive of three and a half to four hours to reach her treatment center. More unexpectedly, rural community dynamics itself created barriers: in towns of a few hundred people, privacy is scarce. One 67-year-old participant from a town of 235 residents said she avoided local disclosure because everybody knows her and neighbors are, in her words, terrible gossips. The writing intervention, conducted privately at home, sidestepped that social constraint entirely.

The second theme centered on emotion regulation and adaptive coping. Survivors described expressive writing as a cathartic outlet, a safe and private space to release frustrations they could not voice to anyone. One 32-year-old stage III survivor said the writing helped her release frustrations she could not openly talk about, while another explained that when she cannot talk to anybody, she writes it down to let it go. Beyond venting, participants used the pages as a problem-solving tool, identifying stressors, examining what made situations more stressful, and thinking through strategies to get through them. One participant noted the writing was particularly important for managing lingering memory problems from chemotherapy, suggesting the practice served cognitive as well as emotional functions.

The remaining themes mapped closely onto the post-traumatic growth framework, the well-established model describing positive psychological change after trauma across five domains: personal strength, improved relationships, new possibilities, appreciation of life, and spiritual growth. Survivors reported personal strength through meaning-making, describing how writing helped them summarize and better understand what had happened to them, reframe their diagnosis in a resilient light, and even find hope and love within a traumatic experience. The researchers emphasize that trauma alone does not produce post-traumatic growth; deliberate rumination, the kind of structured narrative reconstruction that expressive writing facilitates, is considered a strong precursor of growth.

Interpersonal benefits emerged just as clearly. Participants said writing helped them recognize that others were going through the same thing, validating their feelings and reducing the profound isolation of rural survivorship. A notable subtheme of altruism also appeared: several women framed their participation as a way to help someone else facing breast cancer, echoing research showing that survivors often develop increased empathy and altruistic behavior after cancer. Others described renewed purpose, expressing a desire to be needed and to contribute meaningfully rather than simply be taken care of, and a heightened appreciation for life, from gratitude for simply being alive and having a choice to renewed appreciation for physical abilities like walking that were once taken for granted. Spiritual growth, by contrast, was mentioned by only one participant and did not emerge as a pervasive theme, consistent with surveys identifying spiritual change as the least pronounced growth domain.

The authors caution that their findings come with limitations. The sample consisted of intervention completers who agreed to be interviewed, which may bias results toward participants who enjoyed the writing and found it beneficial; dissenting voices may be underrepresented. Social desirability concerns, the homogeneity of the largely White, digitally connected, female sample, and the retrospective, self-reported nature of the accounts all constrain generalizability. Meta-analyses of expressive writing across cancer populations have found small or null pooled effects, warning against overgeneralizing its efficacy. Still, the researchers argue that rural survivors, a subgroup facing heightened disclosure constraints and scarce psychosocial resources, may be precisely the population that benefits most from targeted expressive writing interventions emphasizing post-traumatic growth.

The practical implications are considerable. Because expressive writing is low-cost, private, and scalable, it can reach women whom geography, stigma, and infrastructure leave behind. The authors recommend that future virtual interventions account for the rural digital divide by offering low-bandwidth or offline options with phone-based follow-up, embedding writing tasks in patient portals, and integrating in-person care where feasible. Future studies should triangulate interviews with essay content and objective biomarkers to clarify the mechanisms linking writing to growth. For now, the testimony of these 14 women makes a compelling case that the page can be a powerful place: a private room of one’s own where rural survivors can release what they cannot say aloud, rewrite their trauma into meaning, and discover strength, connection, and gratitude on the other side of cancer.

Subject of Research: Expressive writing as a psychosocial intervention promoting post-traumatic growth among rural breast cancer survivors

Article Title: Navigating rural challenges and promoting posttraumatic growth via expressive writing: a qualitative study among rural breast cancer survivors

Article References: Xu, Y. A., Choi, E., Wong-Meli, C. C. Y., Borjas, M., Fei, F., Mann, S., Jin, W., Dawkins-Moultin, L., Lun, D., & Lu, Q. (2026). Navigating rural challenges and promoting posttraumatic growth via expressive writing: a qualitative study among rural breast cancer survivors. Supportive Care in Cancer, 34(10), Article 965. https://doi.org/10.1007/s00520-026-11204-w

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11204-w

Keywords: expressive writing, rural health, breast cancer, cancer survivors, post-traumatic growth, qualitative research, psychosocial intervention, cancer disparities, emotion regulation, telehealth, survivorship care, Navigating