Social alienation among people with bladder cancer: A combined structural equation modeling and fuzzy-set qualitative comparative analysis

Objective People with bladder cancer may experience social alienation, which is associated with adverse psychosocial outcomes. This study investigates the complex factors and configurations associated with this condition. Methods In this single-center cross-sectional study, 260 patients with bladder cancer from a Chinese tertiary hospital completed measures of family resilience, peer support, psychological distress, negative social expectations, and social alienation. Data were analyzed using two analytical approaches integrating structural equation modeling and fuzzy-set qualitative comparative analysis. Results SEM showed that family resilience(Estimate = -0.337, P = 0.001) and peer support (Estimate = -0.284, P = 0.022) were negatively associated with social alienation, whereas psychological distress (Estimate = 0.137, P = 0.049) and negative social expectations (Estimate = 0.278, P = 0.004) were positively associated with social alienation. Psychological distress and negative social expectations contributed to several indirect associations. The fsQCA identified no single necessary condition (all necessity consistencies < 0.90) and six configurations associated with high social alienation (overall solution consistency=0.911, overall solution coverage=0.54; configuration consistencies=0.951-0.96), grouped into two broad profiles characterized by limited socioeconomic resources with negative social expectations, or psychological distress with limited expressive peer support. Conclusions Social alienation among patients with bladder cancer is characterized by multiple combinations of interpersonal and psychological conditions. These findings may inform profile-based assessment and the development of supportive-care hypotheses, but longitudinal and intervention studies are required before causal or treatment conclusions can be drawn.