The relations between empathy, guilt, shame and depression in inpatient adolescents

Depression, anxiety, and loneliness among adolescents and young adults with IBD in the UK: the role of disease severity, age of onset, and embarrassment of the condition

Purpose

Adolescents and young adults (AYA) with Inflammatory Bowel Disease (IBD) report higher depressive symptoms and anxiety compared to healthy controls, with disease severity and abdominal pain being important factors. In the current study, building on what young people had told us in our previous work, we examined whether embarrassment of the condition, social self-efficacy, and friendship quality mediated the relationship between abdominal pain and disease severity, and mental health/well-being. We also included loneliness as a component of well-being.

Methods

Data on depression, anxiety, loneliness, friendship quality, social self-efficacy, and disease embarrassment were collected from 130 AYA with IBD ages 14–25 years; data on disease severity and abdominal pain were taken from their medical records. Structural Equation Modeling (SEM) was used to test the relationships between the variables.

Results

Using SEM, we established that higher IBD disease activity negatively impacted how AYA felt about their friendships and how embarrassed they were about their condition; embarrassment then influenced reports of mental health, including loneliness. Abdominal pain, disease onset, and social self-efficacy directly predicted internalising problems.

Conclusion

In this sample of 14–25-year-old patients with IBD, specifics about the disease (severity and pain) predicted poorer mental health, suggesting discussion of mental health should be part of the clinical dialogue between patient and consultant. In addition, embarrassment about their condition increased depression, anxiety, and loneliness, mediating the relationship between disease severity and well-being. Thus, it is important to consider how perceived stigma affects those with chronic illness, and those issues should be explored in clinic.

The role of empathy in the mechanism linking parental psychological control to emotional reactivities to COVID-19 pandemic: A pilot study among Chinese emerging adults

The outbreak of coronavirus disease 2019 (COVID-19) and its worldwide spread have brought economic, social and personal stress. To better understand human adjustments to this public health emergency and its underlying mechanism, the relationship between perceived parental psychological control in emerging adults and individual's emotional reactivity to COVID-19 as well as the role of empathy was examined. The study was conducted among 445 emerging adults using questionnaires measuring parental psychological control, empathy, and emotional reactivities in the initial stage of COVID-19. Results revealed that parental psychological control conferred risks for individual's increased negative emotional reactivity to this pandemic. Moreover, our findings shedlight on personal distress as a mechanism through which parental psychological control induces negative emotional reactivities. Although no direct effect between parental psychological control and positive emotional reactivity was found, personal distress and perspective taking mediate the association in an opposite way. Findings have implications for predicting and intervening mental health problems in COVID-19 pandemic and future public health emergency.

Alexithymia, empathy, negative affect and physical symptoms in patients with asthma

Although alexithymia has been found to be associated with physical symptoms in psychosomatic disorders such as asthma, mechanisms linking this association are unknown. However, affective alexithymic features may be associated with physical symptoms in the presence of deficits in affective characteristics such as low empathy and high negative affect. This study aimed to assess direct effects of alexithymic traits on physical symptoms and indirect effects of these subscales through empathy and negative affect (e.g. depressive, anxious and stress symptoms) by controlling for asthma severity in patients with asthma. Three hundred patients with asthma completed the Toronto Alexithymia Scale-20 (TAS-20), the Basic Empathy Scale (BES), the Depression Anxiety Stress Scales-21 (DASS-21) and the Physical Symptoms Inventory (PSI). After controlling for asthma severity, the results showed that alexithymia subscales of the TAS-20 had no direct effects on physical symptoms, but the difficulty in identifying feelings (DIF) subscale of the TAS-20 was associated with affective empathy and negative affect. Affective empathy was significantly related to negative affect. Affective empathy and negative affect were associated with physical symptoms. The affective subscale of alexithymia on the TAS-20, that is DIF, indirectly affected physical symptoms through affective empathy and negative affect. Findings suggest that patients with asthma who have high levels of DIF may show high physical symptoms in the presence of low affective empathy and high negative affect.

Using shame resilience to decrease depressive symptoms in an adult intensive outpatient population

PURPOSE

The author explores the results of a 12-session therapy to address shame resilience as a mediator of empathy in the treatment of depression.

DESIGN AND METHODS

Two instruments (the Beck Depression Inventory-II and the Test of Self-Conscious Awareness 3S) were used as pre-, mid-, and posttest measures given to a group (n = 20) in an intensive outpatient program receiving an intervention to increase shame resilience.

FINDINGS

A statistical decline in depressive symptoms at both mid- and posttest was noted.

PRACTICE IMPLICATIONS

Adding shame resilience therapy to traditional psychotherapy may be useful to improve patient adherence and alliance but further evidence is needed.

Depressive symptoms in parents are associated with reduced empathy toward their young children

BACKGROUND

While depression is typically associated with reduced levels of empathy, this association differs depending on how empathy is measured. Given the importance of empathy in the parent-child relationship, we sought to examine whether the associations between depression and dispositional empathy would also extend to empathy towards one's own child.

METHODS

Within a non-clinical sample of 150 parents of young children, we examined the associations between self-reported depressive symptoms, dispositional empathic tendencies, and empathy specifically toward their own children, and how these associations might differ based on parent gender.

RESULTS

Depressive symptoms were related to lower levels of cognitive and affective empathy, and higher levels of empathic distress. Over and above the association with dispositional empathy, depressive symptoms were associated with reduced levels of parents' affective empathy toward their own child. The associations between depressive symptoms and both dispositional and own-child specific empathy varied by parent gender. For fathers, depressive symptoms predicted own-child specific affective empathy, over and above dispositional affective empathy, while for mothers, depressive symptoms predicted own-child specific empathic distress, over and above dispositional empathic distress.

CONCLUSIONS

The current findings provide further indication that caregivers with elevated depression may engage in patterns of thoughts and behaviors that have implications for their interactions with their children. Parents' experienced empathy toward their own child may be one mechanism by which depression impacts the early caregiving environment, and thus may be an important target for intervention in improving the early caregiving experiences for children at elevated risk due to parental depression. Differences in cognitive and affective empathy found among those with depression may be even more pronounced in the thoughts and feelings towards one's own child, making this an important clinical target.

Longitudinal Effects of Cognitive and Affective Empathy on Adolescent Substance Use

Background: A deficit in either socio-cognitive or socio-affective components of empathy is associated with the severity of substance use by late adolescence. What remains unknown is how longitudinal changes in these components of empathy predict adolescent substance using behavior. Methods: This secondary data analysis used data that followed adolescents in outpatient treatment for substance use (n = 826) during treatment and at 6 months post-treatment. To examine cross-lagged effects of empathy on substance use over time, we used a latent basis growth curve model. Results: Increases in affective empathy predicted reduced substance use over time. However, cognitive empathy did not predict substance use after controlling for other covariates. Conclusions: Lower levels of affective empathy may indicate a developmental vulnerability for substance using behavior. Modifying affective empathy may be a viable treatment target for reducing adolescent substance use.

Social Cognition and Interpersonal Problems in Persistent Depressive Disorder vs. Episodic Depression: The Role of Childhood Maltreatment

Objective: Little is known about the specific psychological features that differentiate persistent depressive disorder (PDD) and episodic depression (ED). Thus, the present study aimed to investigate differences in social cognition and interpersonal problems between these two forms of depression and healthy controls. In addition, we aimed to examine childhood maltreatment (CM) as a possible origin of these alterations. Methods: In a cross-sectional study, adult patients with a current PDD (n = 34) or in a current episode of ED (n = 38), and healthy controls (n = 39) completed questionnaires about depression severity, empathy, interpersonal problems, and CM, as well as tests of affective theory of mind and facial emotion recognition. Results: Patients with PDD reported higher empathic distress than patients with ED and healthy controls. Both depressive groups recognized angry faces with higher accuracy and reported more interpersonal problems, with no differences between PDD and ED. Empathic distress and interpersonal problems mediated the link between CM and depression in the combined sample. Limitations: Patient groups were not drug-naïve and antidepressant intake might have influenced social-cognitive functions. Self-report measures of empathy and interpersonal problems are vulnerable to bias. The cross-sectional design does not allow causal conclusions. Conclusion: Depressed patients may not show deficits in decoding the affective states of others and in feeling with others. However, depressed individuals-in particular patients with PDD-may feel easily overwhelmed by emotionally tense situations, resulting in empathic distress and avoidant/submissive interpersonal behavior. Exposure to CM might be an origin of alterations in social cognition and interpersonal problems.

A Systematic Review of Instruments to Assess Guilt in Children and Adolescents

Background: Guilt feelings have received considerable attention in past psychological theory and research. Several studies have been conducted that represent a range of views and propose various implications of guilt in children and adolescents. Variations in theoretical definitions of guilt, emphasizing a lack of measurement convergence, make it difficult to derive a comprehensive definition of the construct in childhood and adolescence. Research shows substantial variability in instruments used to measure guilt in children and adolescents. Purpose: The aim is to discuss existing contributions, illustrating the empirical validity of the available instruments used to measure guilt and identifying the nature of their theoretical backgrounds among children and adolescents. Methods: A systematic search was conducted using the following databases: PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, and PubMed (all years up to February 19, 2020). Search terms were compiled into three concepts for all databases: "measure," "guilt," and "childhood/adolescence." In addition, a search was conducted to detect the gray literature. Results: After removing the duplicates, a total of 1,408 records were screened, resulting in the identification of 166 full-text articles to be further scrutinized. Upon closer examination, there was consensus that 148 of those studies met the study inclusion criteria or were not retrieved. Twenty-five studies were included in the quality assessment. The data were organized on three main categories: (1) interpersonal or prosocial guilt; (2) intrapunitive guilt or that referring to an excessive sense of responsibility; (3) not specifying a theoretical construct. A great heterogeneity in psychometric evaluations and substantial variability in guilt construct emerged. The construct most represented and supported by valid instruments was interpersonal or prosocial guilt. Analysis of the gray literature showed that some instruments were not immediately available to the clinical and scientific communities. Conclusions: The studies analyzed and selected for qualitative review employed various instruments to measure guilt. Results confirmed what is widely documented in the literature about substantial variability in instruments used to measure guilt. We argue the need to develop measures that assess currently overlooked dimensions of guilt and to provide further additional information about the psychometric proprieties of the available developed instruments.