The Association Empathy has with Depressive Symptoms, Resilience, and Posttraumatic Growth

doi:10.21203/rs.3.rs-4994462/v1

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The Association Empathy has with Depressive Symptoms, Resilience, and Posttraumatic Growth

https://doi.org/10.21203/rs.3.rs-4994462/v1

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Empathy explains one’s ability to understand and feel the emotional experiences of another person. Because it helps relating to others, typically people assume empathy is a good quality to have; however, this may be debatable. The current study investigates the relationships empathy may have with the varying ways individual adjust or react psychologically following highly stressful life experiences, namely depressive symptoms, resiliency, and posttraumatic growth. College students (N = 403) participated in an online study and completed a series of scales assessing these variables. Results of hierarchical regression analyses revealed that, after controlling for confounding variables, empathy was not associated with resiliency, but was positively associated with both posttraumatic growth and depressive symptoms. The results highlight the double-edged sword effect of empathy, such that being empathic toward others could increase depressive feelings while also increasing a sense of personal growth, and yet, it may not contribute to the perceived ability to bounce back or recover after adversity. Future research should elucidate the independence between resilience and empathy, and investigate ways to prevent highly empathetic individuals from experiencing depressive effects, in addition to assisting them to grow, as a certain level of depressive symptomatology may indicate healthy adaptation after experiencing trauma.

Biological sciences/Psychology

Biological sciences/Psychology/Human behaviour

empathy

trauma

depressive symptoms

resilience

posttraumatic growth

personality

Empathy explains one’s ability to perceive, understand, and be sensitive to the emotional experiences of another person that aids in their ability to relate to others, form bonds, and foster meaningful relationships [1, 2]. Studies have established the importance of empathy in the development of adaptive social behaviors such as caring for others [3], partaking in more prosocial acts [4, 5] and less prejudicial behaviors [6, 7]. Empathy is also vital for interpersonal development [8, 9]. Being empathic has been associated with successful social interactions [10], along with increased longevity [11], life and relationship satisfaction [12], self-efficacy [13], and psychological well-being [14]. Moreover, being empathic is not only beneficial to the empathizer, but to the target receiving the empathetic response, as it can provide social support and relieve distress that the target may be experiencing [15, 16]. Empathic ability is particularly important for the treatment given by mental health professionals (e.g., social workers, substance abuse counselors, and psychotherapists) [17, 18, 19]. Additionally, for physicians, empathic ability can affect their patient health outcomes and adherence to treatment [20, 21]. Due to these findings, empathy has traditionally been viewed as a positive characteristic to foster and further develop across one’s lifespan.

Empathic ability is a multidimensional construct [22, 23] comprised of three primary components: cognitive (i.e., understanding the psychological and emotional states of others), affective (i.e., experiencing the emotional states of others), and motor (i.e., synchronizing body language to mirror/match others). For example, deficits in affective, but not cognitive empathy, have been associated with certain dark personality traits [24]. Individuals with impairments in affective empathy are also more likely to exhibit aggression and antisocial behavior [25]. On the other hand, deficits in cognitive, but not always affective empathy, have been associated with certain neuropsychiatric disorders such as autism spectrum disorders (e.g., Asperger’s syndrome) [26] and obsessive-compulsive disorder [27]. These findings have led researchers to develop empathy training interventions [28, 29, 30, 31, 32, 33], and their effectiveness has been established. For example, physicians and nurses that have improved their empathetic ability through training programs tend to demonstrate increases in patient satisfaction [34]. Psychological concerns in caregivers of older people decreased through empathy training that was focused on improving cognitive empathy [35]. However, as much as developing empathic ability can be beneficial to both the empathizer and their target, researchers have begun to explore the ways in which it could potentially be harmful or negatively affect the lives of the empathizer and society.

Empathizing with another can produce costly outcomes such as empathic distress, pain perception, and susceptibility for psychiatric disorders [36]. Experiencing negative emotions through the observation of someone else’s suffering while being unable to help or relieve their suffering, known as empathic distress, is strongly associated with the avoidance of subsequent emotional social interactions where similar feelings may arise for the empathizer [37]. Researchers have identified that perceiving pain in others can activate the same process in the perceiver [38, 39, 40]. Moreover, when someone has a high empathic disposition, the potential for them to neglect their own needs becomes more likely due to their excessive care for others which can be harmful to them physically and psychologically [41]. These findings made researchers realize that some psychiatric illnesses such as depression could be better understood through the examination of empathy [42]. Schreiter and colleagues (2013), for example, suggested that depression is associated with empathic distress and deficits in cognitive, but not affective empathy, meaning that depressed individuals may particularly struggle with wanting to both help and avoid others [43]. Although other studies have also explored the “double-edged sword” effect of empathy [44, 45], a relationship between empathy and depression were equivocal [46]. They also revealed that affective, but not cognitive empathy, was significantly related to depression severity [46], and may be the cause for such equivocal findings reported in previous literature. In comparison to healthy adults, individuals with persistent and recurring depression have higher levels of affective empathy [47]; thus, the affective components of empathy might constitute a risk factor for depression.

One of the protective factors against stress and depression is resilience [48, 49], which is, like empathy, typically viewed as a “good quality” to have. Resilience is defined as the ability to bounce back, or recover, from adversity [50]. Resilient individuals often hold optimistic and positive attitudes, are cognitively flexible, can regulate emotions, and thus are unlikely to get depressed even after experiencing adversity [51, 52]. Given the consistent and strong negative relationships between resiliency and depression (e.g., [53]), it is plausible to assume empathy, especially through its affective aspects, may suppress resiliency. In fact, highly resilient individuals were less likely to be emotionally empathic [54]. However, this is debatable, because some studies have indicated that empathy led to a higher level of resiliency, although via emotional intelligence [55]. Another study demonstrated that resiliency and empathy were positively related to each other [56]. Knowing that depression and resilience are opposite ends of a single scale, these results seem contradictory. One potential reason is that the relationship between resilience and empathy may not be the opposite of the relationship between depression and empathy, as the “cognitive” capacity that empathic ability is comprised of could help people to be resilient [57]. Another study supported this notion by reporting that cognitive empathy, but not affective empathy, was associated with resilience [58]. A second reason may be due to the lack of considering other variables, such as personality. One study [59], for instance, that examined the association between the Big Five personality traits and resilience, found that a large percentage of variance within resiliency were explained by personality (i.e., resilience was significantly related to higher levels of openness, conscientiousness, extraversion, agreeableness, and lower levels of neuroticism/emotional stability). Therefore, it is crucial to take personality into consideration, when examining the relationships among empathy, depression, and resiliency.

Knowing the established negative relationships between resiliency and neuroticism, an interesting observation can be made by analyzing another construct known as posttraumatic growth or PTG. PTG is a sense of personal growth one recognizes after struggling with a highly stressful life event [60]. Unlike resiliency, the relationship between PTG and neuroticism remains equivocal [61, for review]. Moreover, PTG may often coexist with depression, demonstrating a unique relationship when compared to resiliency, even though both PTG and resilience are considered positive post-traumatic outcomes. However, the more growth an individual has experienced following trauma (i.e., increased social support and being more compassionate or connected to others), the more likely they are to be empathetic towards them [60, 62], which appears to suggest a different association that resiliency may present with empathy.

Current Study

Taken together, the current study focuses on three ways individuals may react and adapt (i.e., depressive symptoms, resilience, and PTG) after they face adverse experiences in their lives and examines their respective relationships with empathy to shed light on the multiple roles empathy may play. Specifically, the current study investigates the relationships empathy has with depressive symptoms, resilience, and PTG after controlling for their known predictors (i.e., demographics and personality characteristics). We hypothesized that empathy would positively be associated with depressive symptoms and PTG, but not resiliency. Also, given the advantage of an additional personality factor that was proposed based on the Big Five, known as the HEXACO personality model [63], the current study investigates the effects of HEXACO (i.e., honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, and openness to experience) personality traits on depressive symptoms, resilience, and PTG.

Participants and Procedure

The sample consisted of 403 undergraduate students at a midwestern university in the US with a mean age of 20.22 (SD = 3.92, range = 18–50). The majority were female (78.2%). Approximately 53.1% identified as White, 15.1% as African American, 13.9% being of Middle Eastern heritage or descent, 10.4% as Asian, and 7.5% identified as mixed race or other. Additionally, 8.2% of the sample reported being of Hispanic, Latino, or Spanish origin.

Participants were recruited through a university’s subject pool and received course credit upon completion. All participants completed the informed consent form and then responded anonymously to a 30-minute online survey with questionnaires assessing their demographics, personality, depressive symptoms, resiliency, traumatic experiences, and PTG. After the participants provided their age, the presentation order of the measures was counterbalanced to avoid any order effects. All procedures were performed in accordance with the principles stated in the Declaration of Helsinki and approved by the university’s institutional review board (IRB-FY2023-215). Inclusion criteria included being 18 years of age or older and completing more than 75% of the survey. Data were analyzed using SPSS 28.

Measures

Empathy. The Toronto Empathy Questionnaire (TEQ; [64]; 𝝰 = .86) was used to measure empathy. TEQ is a commonly used measure assessing global empathy (e.g., emotional comprehension and sympathetic physiological arousal). The participants rated the frequency that a set of 16 statements encompassing various attributes related to the theoretical facets of empathy are considered true for them (e.g., “When someone else is feeling excited, I tend to get excited too” or reverse statements, “Other people’s misfortunes do not disturb me a great deal”) on a scale ranging from 0, “never,” to 4, “always.” Total scores were used with higher scores indicating greater levels of empathy.

Personality. The 60-item HEXACO Personality Inventory (HEXACO-60; [63]) was used to assess the six dimensions of the personality traits: Honesty-Humility, Emotionality, Extraversion, Agreeableness, Conscientiousness, and Openness to Experience. The HEXACO-60 contains 10 items per dimension that were rated on a 5-point Likert scale ranging from 1, “strongly disagree,” to 5, “strongly agree.” Mean scores for each dimension were calculated. Cronbach’s alpha 𝝰 ranges from .71 (Honesty-Humility) to .80 (Extraversion).

Depressive Symptoms. The Patient Health Questionnaire-9 was used to assess depressive symptoms (PHQ-9; [65]; 𝝰 = .89). PHQ-9 is a widely used 9-item measure of depressive symptoms and severity. Participants reported how often in the past two weeks they have been bothered by the following problems (e.g., “little interest or pleasure in doing things” or “feeling tired or having little energy”). The items are scored on a scale ranging from 0, “not at all,” to 3, “nearly every day.” Higher total scores indicate greater depressive symptomology.

Resiliency. The Brief Resilience Scale (BRS; [66]; 𝝰 = .82) which consists of 6 items (e.g., “I tend to bounce back quickly after hard times”) was rated on a 5-point Likert scale ranging from 1, “strongly disagree,” to 5, “strongly agree.” Mean scores were calculated with higher scores indicating higher levels of resiliency.

Traumatic Events. Participants completed a trauma checklist where they indicated which out of 14 potentially traumatic events (e.g., “natural disaster,” “death of a loved one,” “COVID-19,” etc.) they had experienced in the last five years and identified which event impacted them the most [67, 68].

Posttraumatic Growth. The PTG Inventory-Short Form (PTGI-SF; [69]; 𝝰 = .89) was used to measure the participants’ level of perceived PTG as a result of the traumatic event that most impacted them (e.g., “I changed my priorities about what is important in life”). For 10 items, the participants indicated the degree to which each change had occurred for them on a 6-point Likert scale ranging from 0, “not at all,” to 5, “very great degree.” Mean scores were calculated. Participants that did not identify a single most impactful trauma event (n = 49) were excluded when analyzing the data using PTGI-SF scores.

Overall, participants (N = 403) demonstrated similar levels of empathy (n_male = 85, M_male = 44.32, SD_male = 7.51; n_female = 302, M_female = 47.59, SD_female = 9.24) that has been reported in literature (e.g., M_male = 43.46–44.45; M_female = 44.62–48.93; [64]). Participants reported relatively low levels of depressive symptoms (M = 8.52, SD = 6.13), moderate levels of PTG (M = 3.37, SD = 1.05) and moderate levels of resilience (M = 3.14, SD = 0.74). As shown in Table 1, positive correlations were found between empathy and PTG (r = .38, p < .01), honesty-humility (r = .35, p = .01), emotionality (r = .38, p = .01), extraversion (r = .16, p = .01), agreeableness (r = .30, p = .01), conscientiousness (r = .38, p = .01), and openness to experience (r = .20, p = .01).

Table 1

*Means, Standard Deviations, and Correlations among Study Variables*
	M	SD	Range	1	2	3	4	5	6	7	8	9	10	11	12
1. Age	20.22	3.92	18–50	-
2. Sex			1–2	− .18***	-
3. Honesty-Humility	3.31	0.62	1–5	.13*	.11*	-
4. Emotionality	3.43	0.64	1–5	− .12*	.40**	.09	-
5. Extraversion	3.09	0.58	1–5	.07	− .11*	− .08	− .14**	-
6. Agreeableness	3.15	0.58	1– 5	.00	− .07	.33**	− .04	.13*	-
7. Conscientiousness	3.53	0.57	1–5	.04	.11*	.32**	.11*	.15*	.13**	-
8. Openness	3.23	0.61	1–5	.07	.04	.20**	− .01	.04	.11*	.22**	-
9. Empathy	46.87	8.98	0–64	.07	.15**	.35**	.38**	.16**	.30**	.38**	.20**	-
10. Depression	8.52	6.13	0–27	− .06	.15**	− .08	.24**	− .40**	− .13*	− .11*	.08	.07	-
11. Resilience	3.14	0.74	1–5	.08	− .18**	.03	− .49**	.41**	.10	.18**	.02	.01	− .27**	-
12. PTG	3.37	1.05	0–5	.02	.08	.10	.06	.31**	.20**	.23**	.09	.38**	− .06	.12*	-
Note. Sex was dummy coded as 0 = “Male” and 1 = “Female.”
* p < .05, p < .01, * p < .001.

A series of hierarchical regression analyses were then performed to explain the variances in depressive symptoms, resilience, and PTG, with Step 1 including age, sex (0 = male, 1 = female), and 6 dimensions of personality, and Step 2 including empathy.

The results for depressive symptoms (Table 2) found the overall model was significant, F(9, 337) = 12.54, p < .01, with an adjusted R² = .23. The initial model was also significant, F(8, 338) = 12.91, p < .01, with an adjusted R² = .22. In Step 2, the model was significantly improved (R² change = .02, p < .01). In addition to the negative associations that honesty-humility and extraversion had with depressive symptoms, openness and empathy showed positive contribution, indicating that higher levels of empathy were associated with higher levels of depressive symptoms, after controlling for the demographics and personality traits.

Table 2

*Hierarchical Regression Model Explaining Depressive Symptoms*
Model	Predictors	B	SE	Beta	CI	F	Adjusted R²
1	Age	.02	.08	.01	[-.13, .18]
	Sex	1.33	.76	.09	[-.17, 2.83]
	Honesty-Humility	-1.22	.55	− .12*	[-2.30, − .14]
	Emotionality	1.45	.51	.15**	[.44, 2.45]
	Extraversion	-3.60	.48	− .38***	[-4.55, -2.65]
	Agreeableness	− .32	.53	− .03	[-1.37, .73]
	Conscientiousness	− .64	.57	− .06	[-1.76, .48]
	Openness	1.24	.50	.12*	[.27, 2.22]	12.91***	.22
2	Age	.01	.08	.01	[-.15, .17]
	Sex	1.33	.76	.09	[-.16, 2.81]
	Honesty-Humility	-1.54	.56	− .16**	[-2.63, − .45]
	Emotionality	.75	.57	.08	[-.36, 1.86]
	Extraversion	-3.86	.49	− .40***	[-4.82, -2.90]
	Agreeableness	− .69	.55	− .07	[-1.76, .39]
	Conscientiousness	-1.00	.58	− .09	[-2.14, .14]
	Openness	1.05	.50	.10*	[.07, 2.02]
	Empathy	.12	.04	.17**	[.04, .21]	12.54**	.23
Note. B = unstandardized regression coefficient; SE = standard error, CI = confidence interval * p < .05, p < .01, * p < .001.

The results for resiliency (Table 3) found the overall model was significant, F(9, 341) = 24.49, p < .01, with an adjusted R² = .38. The initial model was also significant, F(8, 342) = 26.88, p < .01, with an adjusted R² = .37. In Step 1, emotionality negatively contributed (β = − .47, p < .01), and extraversion (β = .29, p < .01) and conscientiousness (β = .22, p < .01) positively contributed. When empathy was added in Step 2, the model was not significantly improved (R² change = .01, p = .06), indicating that empathy did not make additional contribution toward explaining resiliency.

Table 3

*Hierarchical Regression Model Explaining Resilience*
Model	Predictors	B	SE	Beta	CI	F	Adjusted R²
1	Age	.00	.01	.01	[-.01, .02]
	Sex	.06	.08	.04	[-.10, .22]
	Honesty-Humility	.03	.06	.03	[-.08, .14]
	Emotionality	− .54	.05	− .47***	[-.64, − .43]
	Extraversion	.33	.05	.29***	[.23, .43]
	Agreeableness	− .01	.06	− .01	[-.12, .11]
	Conscientiousness	.28	.06	.22***	[.16, .39]
	Openness	− .09	.05	− .07	[-.19, .02]	26.88***	.37
2	Age	.00	.01	.01	[-.02, .02]
	Sex	.06	.08	.04	[-.10, .22]
	Honesty-Humility	.01	.06	.01	[-.10, .13]
	Emotionality	− .58	.06	− .51***	[-.70, − .47]
	Extraversion	.31	.05	.27***	[.21, .41]
	Agreeableness	− .03	.06	− .03	[-.15, .08]
	Conscientiousness	.25	.06	.20***	[.13, .37]
	Openness	− .10	.05	− .08	[-.21, .01]
	Empathy	.01	.00	.10	[.00, .02]	24.49***	.38
Note. B = unstandardized regression coefficient; SE = standard error, CI = confidence interval * p < .05, p < .01, * p < .001.

The results for PTG (Table 4) found that the overall model was significant, F(9, 300) = 8.81, p < .001, with an adjusted R² = .19. The initial model was also significant, F(8, 301) = 6.62, p < .001, with an adjusted R² = .13. In Step 1, extraversion (β = .27, p < .01), agreeableness (β = .12, p = .04) and conscientiousness (β = .15, p < .01), were positively associated with PTG. In Step 2, the model was significantly improved (R² change = .06, p < .01). In addition to extraversion, empathy was significant (β = .32, p < .001), indicating that, after controlling for the personality traits and demographics, higher levels of empathy were associated with higher levels of PTG.

Table 4

*Hierarchical Regression Model Explaining PTG*
Model	Predictors	B	SE	Beta	CI	F	Adjusted R²
1	Age	.00	.02	.01	[-.03, .03]
	Sex	.13	.15	.05	[-.16, .42]
	Honesty-Humility	.01	.10	.01	[-.19, .22]
	Emotionality	.13	.10	.08	[-.06, .32]
	Extraversion	.43	.09	.27***	[.25, .62]
	Agreeableness	.21	.10	.12*	[.01, .42]
	Conscientiousness	.28	.11	.15**	[.07, .49]
	Openness	− .00	.09	− .00	[-.19, .18]	6.62***	.13
2	Age	− .00	.01	− .01	[-.03, .03]
	Sex	.12	.14	.05	[-.16, .40]
	Honesty-Humility	− .07	.10	− .04	[-.27, .13]
	Emotionality	− .07	.10	− .04	[-.27, .13]
	Extraversion	.35	.09	.22***	[.17, .53]
	Agreeableness	.10	.10	.06	[-1.10, .30]
	Conscientiousness	.17	.11	.10	[-.04, .38]
	Openness	− .06	.09	− .03	[-.26, .12]
	Empathy	.04	.01	.32***	[.02, .05]	8.81***	.19
Note. B = unstandardized regression coefficient; SE = standard error, CI = confidence interval * p < .05, p < .01, * p < .001.

Stressful and potentially traumatic life experiences hold the capacity to manifest into a variety of outcomes, including depressive symptoms. Other individuals may be highly resilient and experience very little mental distress that resolves swiftly due to their personal attributes that help to protect them against negative psychological symptomatology. On the other hand, some individuals that experience heightened levels of stress in the wake of adversity may experience psychological growth after their struggle [70, 71], a phenomenon known as PTG. Empathy is, generally speaking, a beneficial and important interpersonal skill that has been associated with various positive outcomes, but it may also increase one’s susceptibility for psychological disorders, such as depression, which has led to the investigation of the relationships it shares with depressive symptoms, resiliency and PTG.

The current study is among the first to assess the associations that empathy has with not just depression and resiliency, but PTG, when considering confounding factors such as age, sex, and personality. As hypothesized, the results indicated that empathy contributed to both depressive symptoms and PTG, but not resiliency. The current study suggests that the more empathetic someone is, the more likely they perceive positive psychological changes in the aftermath of trauma; however, they are also more likely to get depressive. Nevertheless, this may not necessarily be a negative outcome. Since depressive symptoms could coexist with PTG after traumatic life experiences, as it does with empathy, susceptibility to it may not be entirely disadvantageous as it can promote psychological growth through rumination, social support, active- and problem-focused coping [70, 72]. The current findings also revealed that empathy and resiliency are independent from each other, even when considering personality characteristics. This means that perhaps one’s innate personal attributes (i.e., emotionality, extraversion, conscientiousness) are more associated with their perceived ability to bounce back from adversity and remain psychologically healthy after traumatic events than empathic ability.

Interestingly, the current study showed that empathy was positively correlated with all six dimensions of personality traits (Table 1), even though they are not all “positive” characteristics (e.g., emotionality and extraversion were negatively associated with each other). Positive correlations that empathy had with all six dimensions may reveal the double-edged sword effect of empathy. Results also provided evidence for this double-edged sword effect of empathy, because empathy was positively associated with both depressive symptoms and PTG. As mentioned above, one explanation for this result is that people who experience PTG are more likely to experience psychological struggle that accompanies with negative symptoms including depression [60]. According to the PTG theoretical model [61], PTG is less likely to happen when the event is not seismic or influential enough to challenge one’s schema and this challenge is often severe, which leads to negative reactions such as depressive symptoms. Another explanation could be that empathy is associated with sensory processing sensitivity [73, 74]. Highly sensitive individuals are more prone to emotional contagion and likely to recognize their own inner experiences as well as others’ feelings, making them more empathic, which could be a reason why empathy was associated with both depression [75] and PTG. The double-edged sword effect was also suggested for highly sensitive individuals as it can be an attribute that comes with benefits and disadvantages. Thus, future studies should explore ways to assist sensitive people in equipping them with the tools necessary to better manage their own emotions. If researchers focus on prevention methods or ways to alleviate negative symptoms, the take home message may be to not become too empathic toward others (i.e., mild levels of empathy are beneficial, but high levels are not); however, studies revealing or even emphasizing the beneficial impact of empathy have indicated that the more empathy, the better for society. In order to address this dilemma, it is crucial to investigate the conditions, contexts, and populations that may take advantage of a person’s empathic disposition. If empathy is a desirable trait that everyone must have, then more studies should investigate the curvilinear relationship that empathy may share with mental health factors (i.e., finding a “happy medium” level of empathy). Given that most studies thus far focus on linear relationship, we must find more nuanced ways to understand the roles that empathy has with self, our relationships with others, and society, without falling into the trap of binary approaches (e.g., whether or not we should be more empathic). Perhaps, even when humans know empathy could hurt us, we may not be able to fully control our empathic reactions and responses, which has been revealed in studies investigating the neurobiological, or motor, nature of empathy [23, 76].

The current results also revealed the independent nature between resiliency and empathy, which was different from previous studies [55, 77, 78, 79]. Perhaps this is due to the current study measuring empathy using the Toronto Empathy Questionnaire and measuring resilience using the Brief Resilience Scale, whereas previous studies assessed empathy using interpersonal reactivity scales and/or assessed resilience using the Connor-Davidson Resilience Scale [80]. One potential reason why resilience and empathy were independent from each other could be that some highly resilient individuals are also highly flexible and are able to be empathic toward others (i.e., easy for me, but I can understand others are not like me) but some highly resilient individuals may have a hard time being empathic toward others if they are highly competent (i.e., easy for me, why can’t you). Another reason could be their respective relationships with other variables. For example, based on the current results (Table 1), empathy was higher in females, but resiliency was higher in males; thus, these two concepts may be associated with biological components such as hormones or psychosocial components such as gender role. Future research could make profiles among five groups, namely, highly empathic and resilient individuals, lack of empathy and resilient individuals, highly empathic but not resilient individuals, highly resilient but not empathic individuals, and those who are equipped with moderate levels of both qualities.

Finally, although we chose a hierarchical regression analysis to understand the impact empathy had on posttraumatic outcomes, it is important to note that due to the cross-sectional nature of this study, our results may be interpreted in the opposite direction. Therefore, it could be interpreted as the more PTG someone experiences, the more likely they are to be more empathetic. Additionally, it could also be true that individuals exhibiting depression symptomatology may be more likely to understand and relate to the emotional experiences of others. Nonetheless, our findings suggest that empathy is positively related to both depression and PTG, but not to resilience.

A focus on empathy and its relationship with depression and PTG may have direct and paramount influence on the clinical realm of psychology. The current research lent insight into the factors influencing depression, and our sample of college students aids in further understanding these results, as they typically report experiencing moderate to high levels of stress and depressive symptoms [81, 82, 83]. Empathy should have the capacity to be a beneficial process that may help individuals who undergo trauma to experience PTG. However, while working with clients in clinical care who have a history of depression or with populations who are at a higher risk for experiencing depressive symptoms, clinicians should address and foster empathy cautiously for those who have experienced trauma, helping clients to understand the complexities of altruistic tendencies. For example, in situations of interpersonal trauma, one may expect great benefit in “putting themselves in another’s shoes” and working to emotionally understand how another may feel. Recently, the negative impact of social media on depressive symptoms has received attention [84], which might be explained by empathy perhaps due to the overwhelming influence of taking in vast amounts of interpersonal information. Through social media, one might see other human’s negative posts (e.g., complaining, sadness, frustration), which may elicit empathy, that could in turn lead to depressive symptoms. More studies are needed to elucidate the relationships between empathy, depression, resiliency, and PTG. However, although empathy and PTG revealed a positive relationship, these positive processes can often be complex and contextual, supporting the idea of finding balance in encouraging these seemingly beneficial concepts.

Although the current study offers novel insight to the understanding of empathy and its relationship with depression, resiliency, and PTG; it is not without limitations. A cross-sectional design was used which prevents the results from supporting causal inferences. Since the Toronto Empathy Questionnaire is a measure of global empathy, it could not assess the cognitive and affective components of the participants’ empathic ability and disposition, separately, which restricts our view into which component may contribute more to depression and PTG. Additionally, data were collected from an American college sample so the present results may not be generalized to or representative of other populations. Also, data were collected via self-report and online which may elicit socially desirable responses. Finally, other potentially confounding variables, such as gender role, interpersonal sensitivity, competence, dark personality traits (e.g., narcissism, Machiavellianism, and psychopathy) were not considered in this study.

Future research should aim to replicate these findings using another measure of empathy that may better encompass the cognitive and affective components of empathic ability and disposition. Doing so may offer greater understanding into the contributions of cognitive and affective empathy in posttraumatic outcomes like depression, resiliency, and PTG. Moreover, future research may aim to look at a wider variety of intra and interpersonal posttraumatic outcomes, such as, but not limited to, posttraumatic stress disorder, coping abilities, and relationships with others. Considering various posttraumatic outcomes, while also investigating this research in a more generalized population, can aid in holistic understanding of empathy’s role in stressful or traumatic life events. From this, clinical interventions for highly empathetic people or lack thereof, who have experienced trauma and/or experience negative psychological symptoms can begin to be further researched. Additionally, due to the potential negative effects that extremely low or high levels of empathy can have on one’s psychological adjustment (e.g., depression), it is imperative for researchers to consider the cognitive and affective empathy levels of their participants before implementing empathy training practices to ensure those on the lower end of the empathic ability spectrum are partaking in them, and not those already exhibiting high levels. Individuals that exhibit high levels of affective empathy may be at a greater risk for experiencing empathic distress and/or depression so it is important for researchers to further explore the ways in which cognitive empathy may be fostered without also enhancing affective empathy. Finally, empathy depends on the context and characteristics of the target as well. Being inspired by studies demonstrating decreases in stigma, empathy research can also contribute to the understanding of how people change (e.g., sudden or gradual increases or decreases) in empathy when they encounter people who are marginalized, vulnerable, or simply different from them (e.g., out-group).

All experimental protocols involved in this study were approved by Oakland University’s Institutional Review Board (IRB-FY2023-215). Informed consent was obtained from all participants.

Competing Interests

Statement: The authors declare no competing or conflicts of interests.

Author Contribution

Conception and design of the study: T.E., A.E., and K.T. Acquisition of the data: T.E., A.E., and K.T. Analysis of the data: T.E. and K.T. Drafting the manuscript and tables: T.E., A.E., and K.T. All authors have reviewed and edited the manuscript.

Data Availability

The authors confirm that the data supporting the findings of this study are available within the article and tables.

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The Association Empathy has with Depressive Symptoms, Resilience, and Posttraumatic Growth

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