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

"I'm always going to be tired": a qualitative exploration of adolescents' experiences of fatigue in depression

Adolescent depression is a prevalent and disabling condition, but current psychological treatments are only moderately effective. One way to enhance outcomes is to further our understanding of adolescent depression and improve our capacity to target the most frequently reported and problematic symptoms. A common but often neglected symptom of depression is fatigue, which is associated with considerable impairment and has the potential to interfere with adolescents' engagement in psychological therapies. Despite this, the experience of fatigue in adolescent depression and how we target it in treatment is currently poorly understood. Therefore, we aimed to explore adolescents' experiences and understandings of fatigue in depression, recruiting from clinical and community settings. Semi-structured interviews were conducted with 19 UK-based adolescents aged 14-18 years old with elevated symptoms of depression. Using reflexive thematic analysis, three themes were generated. Fatigue is a complex concept explored adolescents' understanding of fatigue as a dynamic, multifaceted symptom which had mental and physical components. Trapped in a cycle of fatigue considered the complex and reciprocal relationship between fatigue and other depressive symptoms, and the subsequent impact of limited energy on engagement with everyday activities. Finally, stigma as a barrier to help-seeking highlighted how adolescents were reluctant to seek help due to experienced stigma and the perception that fatigue was not a serious enough symptom. Findings from this study suggest that fatigue should be viewed as a psychological as well as somatic symptom of depression, with implications regarding the identification and treatment of fatigue in depression in routine clinical practice.

Empathy and psychopathology in children and adolescents: the role of parental mental illness and emotion regulation

Objective

Although empathy is known to be a strength, recent studies suggest that empathy can be a risk factor for psychopathology under certain conditions in children. This study examines parental mental illness as such a condition. Further, it aims to investigate whether maladaptive emotion regulation (ER) mediates the relationship between empathy and psychopathological symptoms of children.

Methods

Participants were 100 children of parents with a mental illness (55% female) and 87 children of parents without a mental illness (50% female) aged 6 - 16 years and their parents.

Results

Greater cognitive empathy was related to more psychopathological symptoms in COPMI, but not in COPWMI. In addition, in COPMI maladaptive ER mediated this relationship. In contrast, greater affective empathy was associated with more psychopathological symptoms regardless of whether parents had a mental illness.

Conclusion

Our findings highlight the importance of implementing preventive programs for COPMI that specifically target the reduction of maladaptive ER.

Interpersonal school violence and mother-child communication about violence in relation to empathy in early adolescence

INTRODUCTION

Exposure to interpersonal violence at school has been linked with lower empathy, but less is known about factors that may moderate this relationship. Positive parent-child communication has been associated with higher empathy during adolescence and children of parents that communicate their disapproval of violent behavior respond more peacefully in situations involving violence. Mother-child communication about violence may therefore reduce the risk of desensitization to violent behavior and promote empathy in youth that are frequently exposed to violence. Thus, this study examines whether mother-child communication about violence mitigates the association between exposure to interpersonal school violence and adolescents' empathy.

METHODS

This study addressed this question using a diverse sample of early adolescents from the Southeastern United States in 2003 (N = 642; mean age 11.3 years; 52% male; 76% Black, 22% non-Hispanic White). Adolescents reported on how often they witness or experience interpersonal violence at school and how often they communicate with their mother about violence and how to avoid it. Adolescents also self-reported on their level of empathy.

RESULTS

Results from a hierarchical regression model showed that exposure to interpersonal school violence and lower mother-child communication about violence were uniquely associated with lower empathy, but communication about violence did not moderate the link between interpersonal school violence exposure and empathy. There were no sex differences in these relationships.

CONCLUSIONS

Contrary to the hypothesis, youth who experience and witness interpersonal violence at school show lower empathy independent of whether youth communicate with their mother about violence and responding to violent situations.

Protective Behaviors Against COVID-19 and Related Factors in Korean Adults With Depressive Symptoms: Results From an Analysis of the 2020 Korean Community Health Survey

OBJECTIVE

This study evaluated protective behaviors against coronavirus disease-2019 (COVID-19) and related factors in individuals with depressive symptoms.

METHODS

This cross-sectional study included data from the 2020 Korean Community Health Survey. Depressive symptoms, COVID- 19 protection behaviors, and related factors were investigated in 228,485 people. Chi-square test and logistic regression analysis were used to analyze categorical variables. Statistical analysis was performed using SPSS software (version 27.0).

RESULTS

In the study, 3.9% (n=8,970) had depressive symptoms. The prevalence of depressive symptoms was higher in individuals in their 19-39 years , and ≥60s than in those in their 40-59 years (p<0.001). Lower education level and household income were associated with a higher prevalence of depression (p<0.001). Among the various occupations, service workers had the highest prevalence of depressive symptoms (p<0.001). Individuals with depressive symptoms were less likely to adopt protective behaviors against COVID-19 (p<0.001) or exhibit concerns regarding death and economic damage (p<0.001) compared to individuals without depressive symptoms. Individuals with depressive symptoms were more likely to have unhealthy behaviors than those without depressive symptoms (p<0.001). Individuals with depressive symptoms considered that the COVID-19 response by the government and other organizations was inadequate (p<0.001).

CONCLUSION

During the COVID-19 pandemic, individuals with depressive symptoms faced greater challenges in adopting protective behaviors. Therefore, it is crucial to develop strategies to protect people with depressive symptoms during another pandemic in the future.

Association between screen time and depressive symptoms in a sample of Chinese medical students: Mediator role of empathy

Medical students are at high risk of psychological subhealth under heavy stress with increasing screen time. This study aimed to explore the association between screen time and depressive symptoms and determine empathy as a mediating factor. In this cross-sectional study, a total of 945 medical students were surveyed, and 924 medical students were ultimately included after standard exclusion criteria. They reported their daily screen time and completed the Chinese version of the Jefferson Scale of Empathy-Student Version (JSE-S) and the Self-Rating Depression Scale (SDS). t tests and analysis of variance showed a significant difference in empathy and depressive symptoms by sex, stage, and screen time. The correlation analysis revealed that both affective and cognitive empathy have inverse associations with depressive symptoms. The mediation model confirmed that cognitive empathy played a positive mediating role between screen time and depressive symptoms, reducing the impact of screen time on depressive symptoms. Our study may add empirical evidence to prevent and intervene in depressive symptoms. These findings call for considering controlling screen time and enhancing cognitive empathy as interventions for medical students' depressive symptoms.

Interpersonal Factors, Peer Relationship Stressors, and Gender Differences in Adolescent Depression

PURPOSE OF REVIEW

Compared to boys, girls value close relationships more. Thus, heightened affiliative proclivities may serve as a particularly salient psychosocial risk factor for depression in adolescent girls. The purpose of this review is to examine whether the preponderance of depression in girls is because of gender differences in interpersonal vulnerabilities and peer relationship stressors and/or in the associations between these factors and depression.

RECENT FINDINGS

Girls (vs. boys) exhibit higher levels of co-rumination and affective empathy, but not excessive reassurance-seeking. The prevalence of different forms of peer relationship stressors (e.g., peer victimization) varies by gender depending on the specific type. Evidence is mixed regarding gender differences in the association between peer victimization and depression. Gender differences in the association between peer victimization and depression not only depend on peer victimization subtype but also on the country. Most studies were conducted in non-clinical samples, highlighting the need for future research to assess major depressive disorder (not just depressive symptoms). Future research should also assess interpersonal factors (e.g., co-rumination) and peer relationship stressors together.

Relationship of depression with empathy, emotional intelligence, and symptoms of a weakened immune system

Introduction

Previous studies have used different individual scales to examine the relationship of depression with emotional intelligence, empathy, and immune-based diseases. In this study, we used a combination of psychometric scales to examine the relationships of depression with emotional intelligence (intrapersonal and interpersonal), empathy (affective and cognitive), and symptoms of weakened immune system.

Methods

This cross-sectional prospective study examined 158 volunteers (39 males and 119 females). A score of 10 or more on the Beck Depression Inventory-II (BDI-II) was used to define depression. The Cognitive and Affective Empathy Test (TECA) was used to assess empathy, and the Profile of Emotional Competence (PEC) was used to assess the self-perception of intrapersonal and interpersonal competence. The symptoms of a weakened immune system (WIS) were assessed by measurements of permanent tiredness, frequent infections and colds, slow wound healing, persistent and recurrent diarrhea, recurring herpes, insomnia and difficulty sleeping, and dry eyes.

Results

The total PEC score and intrapersonal PEC score had negative correlations with depression, and the WIS score had a positive correlation with depression. The TECA score had no significant correlation with depression or the WIS score, but had positive correlations with the total PEC score, intrapersonal PEC score, and interpersonal PEC score.

Conclusion

The total PEC score, intrapersonal PEC score, and WIS score were significantly associated with depression. The TECA score was not significantly associated with depression or the WIS score. Our findings suggest that improving intrapersonal emotional skills may improve function of the immune system and reduce the symptoms of depression. We suggest that further studies examine the effect of targeted improvement of interpersonal skills (empathy) on depression.

Relationship Between Empathy and Interpersonal Distress of Chinese Left-Behind Children: The Role of Emotion Regulation and Gender

Introduction

Interpersonal relationship serve as crucial of social support and a sense of security for left-behind children, playing a compensatory role in mitigating the absence of familial affection. Interpersonal distress can significantly impact their mental well-being. Although previous research has established a connection between empathy and interpersonal distress, the mechanisms by which empathy triggers interpersonal distress, as well as potential gender-based variations in this relationship, remain elusive. To bridge this gap in knowledge, this study investigates the mediating influence of emotion regulation and the moderating impact of gender in the relationship between empathy and interpersonal distress.

Methods

A total of 713 rural left-behind children completed the Interpersonal Reactivity Index scale, Emotion Regulation Competence Scale, and Interpersonal Relationship Assessment Scale.

Results

Pearson correlation analyses suggested strong significant correlations among empathy, emotion regulation ability, and interpersonal distress. Path analyses indicated that emotion regulation ability mediated the relationship between empathy and interpersonal distress. Furthermore, hierarchical regression analyses suggest a moderating effect of gender in the relationship between empathy and emotion regulation ability.

Discussion

The present study reveals the role of emotion regulation ability and gender in the relationship between empathy and interpersonal distress, which has important theoretical and practical implications for the prevention and intervention of interpersonal distress in left-behind children. Moreover, it may strengthen the relationship between peer and teacher at school, and improve the quality of parent-child communication at home.

Bridge connection between depression and anxiety symptoms and lifestyles in Chinese residents from a network perspective

Background

Lifestyle habits are vital components of the culture of mental health treatment settings. We examined the bridge connection between depressive and anxiety symptoms and lifestyles from a network perspective using a population-based study.

Methods

Face-to-face interviews were conducted with a provincially representative sample of 13,768 inhabitants from the Guangdong Sleep and Psychosomatic Health Survey based on standardized evaluation techniques. We identified the central symptoms by expected influence. The interconnection between depression and anxiety symptoms, as well as the bridge connectivity linking depression-anxiety symptoms and lifestyle factors, were assessed using the bridge centrality index. Network stability and sensibility analyses were performed using a case-dropping bootstrap procedure.

Results

The core symptom that exhibited the highest expected influence was fatigue or little energy, followed by uncontrollable worry, trouble relaxing, and sad mood in the depression-anxiety symptoms network, while guilt was the most interconnected symptom and had the highest bridge strength. Surrounding nodes of each node explained an average variance of 57.63%. Additionally, suicidal thoughts were recognized as collective bridging symptoms connecting lifestyle variables in the network integrating depression-anxiety symptoms with lifestyle factors. Current tobacco and alcohol consumption were positively associated with suicidal thoughts and irritability. Habitual diet rhythm and physical exercise frequency were linked to suicidal thoughts, guilt, and poor appetite or overeating. Suicidal thoughts, irritability, and guilt indicated the greatest connectivity with lifestyle factors. All networks had high stability and accuracy.

Conclusion

These highlighted core and bridge symptoms could serve as latent targets for the prevention and intervention of comorbid depression and anxiety. It might be crucial for clinical practitioners to design effective and targeted treatment and prevention strategies aiming at specific lifestyles and behaviors.

A Case Study of Depression in High Achieving Students Associated With Moral Incongruence, Spiritual Distress, and Feelings of Guilt

Psychosocial and cultural factors play an important, but often neglected, role in depression in young individuals. In this article, we present two cases of young, educated males with major depressive disorder and prominent themes of guilt and spiritual distress. We explore the relationship between moral incongruence, spiritual distress, and feelings of guilt with major depressive episodes by presenting two cases of depression in young individuals who were high-achieving students. Both cases presented with low mood, psychomotor slowing, and selective mutism. Upon detailed history, spiritual distress and feelings of guilt due to internet pornographic use (IPU) and the resulting self-perceived addiction and moral incongruence were linked to the initiation and progression of major depressive episodes. The severity of the depressive episode was measured using the Hamilton Depression Scale (HAM-D). Themes of guilt and shame were measured using the State of Guilt and Shame Scale (SSGS). High expectations from the family were also a source of stress. Hence, it is important to keep these factors in mind while managing mental health problems in young individuals. Late adolescence and early adulthood are periods of high stress and vulnerabe to mental illness. Psychosocial determinants of depression in this age group generally go unexplored and unaddressed leading to suboptimal treatment, particularly in developing countries. Further research is needed to assess the importance of these factors and to determine ways to mitigate them.

Indirect aggression, anxiety, and empathy: Disaggregating between and within person longitudinal associations during childhood and adolescence

Although indirectly aggressive behavior and anxiety symptoms can co-occur, it is unclear whether anxiety is an antecedent or outcome of indirect aggression at the individual level and whether other personality traits can contribute to these longitudinal associations. Therefore, the between- and within-person associations among indirect aggression, anxiety symptoms, and empathic concern were examined across adolescence from ages 11 to 16 in a cohort of individuals followed annually (N = 700; 52.9% girls; 76.0% White) controlling for direct aggression and demographic variables. Results of autoregressive latent trajectory models with structured residuals supported an acting out model at the within-person level. Specifically, anxiety symptoms positively predicted indirect aggression and indirect aggression negatively predicted empathic concern at each adjacent time point. These findings suggest that methods of reducing worries about the self and increasing healthy self-confidence could prevent indirect aggression and help build concern and compassion toward others.

Cognitive flexibility as a protective factor for empathy

Although cognitive flexibility has always been considered essential to empathy, the relevant findings have been inconsistent. Inconsistent results may be because cognitive flexibility is a multi-level structure, while empathy is also a multilayer structure, and there are differences in how researchers define and measure cognitive flexibility. Therefore, the study explores the relationship between cognitive flexibility and empathy from a multi-dimensional perspective. This study involved 105 China students aged between 18 and 22 (M age = 20.26, SD = 2.00) who completed the Cognitive Flexibility Scale (cognitive flexibility trait, cognitive flexibility at the individual level), perspective-switching flexibility task (perspective-switching flexibility, cognitive flexibility at the cognitive level), the Interpersonal Reactivity Index scale (IRI, traits empathy), Multi-dimensional Empathy Test (state empathy), 2-back task (inhibitory control), and Stroop task (working memory). After controlling for additional variables, the results showed that: (1) Cognitive flexibility traits negatively predicted trait cognitive (IRI-PT) and affective empathy (IRI-EC). (2) The Other/Self perspective-switching flexibility negatively predicted the affective component of state empathy. (3) Cognitive flexibility traits and Other/Self perspective-switching flexibility negatively predicted empathy even after controlling for one of these. The study's results suggested that cognitive flexibility negatively predicts empathy and is a protective factor for reducing the cost of empathy and promoting emotion regulation.

Depression and quality of life among Macau residents in the 2022 COVID-19 pandemic wave from the perspective of network analysis

Background

In the summer of 2022, Macau experienced a surge of COVID-19 infections (the 618 COVID-19 wave), which had serious effects on mental health and quality of life (QoL). However, there is scant research on mental health problems and QoL among Macau residents during the 618 COVID-19 wave. This study examined the network structure of depressive symptoms (hereafter depression), and the interconnection between different depressive symptoms and QoL among Macau residents during this period.

Method

A cross-sectional study was conducted between 26th July and 9th September 2022. Depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9), while the global QoL was measured with the two items of the World Health Organization Quality of Life-brief version (WHOQOL-BREF). Correlates of depression were explored using univariate and multivariate analyses. The association between depression and QoL was investigated using analysis of covariance (ANCOVA). Network analysis was used to evaluate the structure of depression. The centrality index "Expected Influence" (EI) was used to identify the most central symptoms and the flow function was used to identify depressive symptoms that had a direct bearing on QoL.

Results

A total 1,008 participants were included in this study. The overall prevalence of depression was 62.5% (n = 630; 95% CI = 60.00-65.00%). Having depression was significantly associated with younger age (OR = 0.970; p < 0.001), anxiety (OR = 1.515; p < 0.001), fatigue (OR = 1.338; p < 0.001), and economic loss (OR = 1.933; p = 0.026). Participants with depression had lower QoL F (1, 1,008) =5.538, p = 0.019). The most central symptoms included PHQ2 ("Sad Mood") (EI: 1.044), PHQ4 ("Fatigue") (EI: 1.016), and PHQ6 ("Guilt") (EI: 0.975) in the depression network model, while PHQ4 ("Fatigue"), PHQ9 ("Suicide"), and PHQ6 ("Guilt") had strong negative associations with QoL.

Conclusion

Depression was common among Macao residents during the 618 COVID-19 wave. Given the negative impact of depression on QoL, interventions targeting central symptoms identified in the network model (e.g., cognitive behavioral therapy) should be developed and implemented for Macau residents with depression.

The relationship between dimensions of empathy and symptoms of depression among university students during the COVID-19 pandemic: A network analysis

Background

The relationship between different dimensions of empathy and individual symptoms of depression during the COVID-19 pandemic remains unclear, despite the established link between empathy and depression. The network analysis offers a novel framework for visualizing the association between empathy and depression as a complex system consisting of interacting nodes. In this study, we investigated the nuanced associations between different dimensions of empathy and individual symptoms of depression using a network model during the pandemic.

Methods

1,177 students completed the Chinese version of the Interpersonal Reactivity Index (IRI), measuring dimensions of empathy, and the Chinese version of the Patient Health Questionnaire-9 (PHQ-9), measuring symptoms of depression. First, we investigated the nuanced associations between different dimensions of empathy and individual depressive symptoms. Then, we calculated the bridge expected influence to examine how different dimensions of empathy may activate or deactivate the symptoms of depression cluster. Finally, we conducted a network comparison test to explore whether network characteristics such as empathy-depression edges and bridge nodes differed between genders.

Results

First, our findings showed that personal distress was positively linked to symptoms of depression. These symptoms involved psychomotor agitation or retardation (edge weight = 0.18), sad mood (edge weight = 0.12), trouble with concentrating (edge weight = 0.11), and guilt (edge weight = 0.10). Perspective-taking was found to be negatively correlated with trouble with concentrating (edge weight = -0.11). Empathic concern was negatively associated with suicidal thoughts (edge weight = -0.10) and psychomotor agitation or retardation (edge weight = -0.08). Fantasy was not connected with any symptoms of depression. Second, personal distress and empathic concern were the most positive and negative influential nodes that bridged empathy and depression (values of bridge expected influence were 0.51 and -0.19 and values of predictability were 0.24 and 0.24, respectively). The estimates of the bridge expected influence on the nodes were adequately stable (correlation stability coefficient = 0.75). Finally, no sex differences in the studied network characteristics were observed.

Conclusions

This study applied network analysis to reveal potential pathways between different dimensions of empathy and individual symptoms of depression. The findings supported the existing theoretical system and contribute to the theoretical mechanism. We have also made efforts to suggest interventions and preventions based on personal distress and empathic concern, the two most important dimensions of empathy for depressive symptoms. These efforts may help Chinese university students to adopt better practical methods to overcome symptoms of depression during the COVID-19 pandemic.

Shame, Guilt, and Self-Consciousness in Anorexia Nervosa

BACKGROUND

the role of self-conscious emotions (SCE) such as shame and guilt in eating disorders (ED) has been systematically studied only in recent years, but it is still debated. This study aims to investigate the role of SCE in anorexia nervosa (AN), evaluating the role of self-consciousness.

METHODS

fifty-five individuals with AN and seventy-four healthy controls (HC) were enrolled and completed a battery of tests evaluating the proneness to feel shame and guilt, as well as comparing self-consciousness, eating, and general psychopathology.

RESULTS

individuals with AN showed a higher proneness to shame. Shame was correlated with body dissatisfaction and drive for thinness, which are core symptoms in AN, after controlling for scores of depression and anxiety. Proneness to guilt seemed to be less correlated with eating and body symptomatology, but it appeared to have a negative correlation with binge-purging symptoms. Furthermore, proneness to shame was independent of guilt or self-consciousness and the two groups did not differ regarding public and private self-consciousness.

CONCLUSIONS

shame is an important and independent factor in AN. Future research may offer progress in the development of shame-focused therapies.

The psychological effects of imprisonment: The role of cognitive, psychopathic and affective traits

The present cross-sectional correlational study aimed to investigate a set of cognitive, affective, and personality traits impacting the psychological effects of imprisonment. Ninety-three male inmates filled out a battery including measures of intelligence, working memory, psychopathy, aggressiveness, anxious trait, emotionality, rumination styles, and empathy proneness. Inmates' psychological outcomes were conceptualized in terms of mood, anxiety, depression, and general health. Results showed that inmates with high cognitive abilities, psychopathic impulsivity, proactive aggression, personal distress and fantasy, anxious and negative emotionality are mainly prone to ill-being psychological outcomes. Contrariwise, the fearless dominance trait, positive emotionality and empathic concern ability seem to expose inmates to positive psychological outcomes. Reactive aggression and perspective taking seem to impact both positive and negative moods. Ruminative style was unrelated to psychological outcomes. These preliminary results provide an insight into which factors intervention programs should be based upon in order to enhance well-being and reduce distress among inmates.

Disenfranchised Guilt—Pet Owners’ Burden

Simple Summary

Guilt is the unpleasant emotion associated with one’s behaviors, thoughts, or intentions, and it is based on the possibility that one may be in the wrong or others may have this perception. Parental guilt is one common type of guilt and is often associated with work–family conflict (WFC). WFC and related guilt have been found to be related to depression and anxiety. The current study was designed to explore dog owners’ guilt surrounding their dogs through an online anonymous survey. Results suggest that dog owners’ guilt and WFC associated with their dog are at similar levels to those reported in human family studies. Additionally, the relationship between dog owners’ guilt and discrepancy between their actual and ideal self, in regard to the role of a dog owner, also mirrored human-only family research. Because pet-related guilt is unrecognized, acknowledged, or supported, we suggest it is disenfranchised. In this period of post-COVID-19 pandemic time, as people return to work, it is important that companies and communities acknowledge pet owner guilt and pet-related WFC and help owners find practical, effective solutions.

Abstract

Guilt refers to an unpleasant emotional state associated with one’s behaviors, thoughts, or intentions, and it is based on the possibility that one may be in the wrong or that others may have this perception. Parental guilt is one common subtype and is often associated with work–family conflict (WFC). WFC and related guilt have been found to be associated with depression and anxiety. Through an online anonymous survey, the current study was designed to explore dog owners’ guilt surrounding their dogs. Results suggest that dog owners’ guilt and WFC associated with their dog are at levels similar to those reported in human family studies. Additionally, the relationship between dog owners’ guilt and discrepancy between participants’ actual and ideal self, in regard to the role of a dog owner, also mirrored human-only family research. Because pet-related guilt is unrecognized, acknowledged, or supported, we suggest it is disenfranchised. As people return to work, in this period of post-COVID-19 pandemic time, it is paramount that companies and communities acknowledge pet owner guilt and WFC and help owners find practical, effective solutions.

Parental care and depressive symptoms among Chinese medical students: roles of empathy and gender

BACKGROUND

Medical students in China who face the dual pressure of study and employment tend to experience subclinical depressive symptoms. Parental care plays an important direct and indirect role in the psychological development of medical students, and the extent and mechanism of this role urgently need to be studied and discussed.

METHODS

After simple random sampling and screening of valid questionnaires, data from a total of 924 people were used. The participants completed the parental bonding instrument, self-rating depression scale, Chinese version of the Jefferson empathy scale-medical student edition and self-rating anxiety scale to evaluate parental care, empathy, depressive symptoms and anxiety. The data were statistically processed using a descriptive analysis, correlation analysis and test of moderated mediation.

RESULTS

Maternal care had a significant negative predictive effect on depressive symptoms among medical students. Strong maternal care can reduce the occurrence of depressive symptoms in medical students. Empathy played a positive mediating role such that both types of empathy could alleviate the effect of weak maternal care on the depressive symptoms of medical students. However, neither cognitive empathy nor affective empathy played a mediating role in the relationship between paternal care and depressive symptoms. Nevertheless, the relationship between maternal care and empathy was moderated by the medical students' gender.

CONCLUSIONS

The effect of this relationship on female medical students deserves special attention. The results of this study provide a reference and basis for the adjustment of medical education. This study could also help in the design of effective psychological intervention measures to reduce the degree of depressive symptoms and enhance personal empathy.

The Mediating Role of Affective Empathy in the Relationship Between Insecure Attachment and Depressive Symptoms Among Emerging Adult

Insecure attachment is regarded as a risk factor for depressive symptoms. However, insecure attachment can be divided into attachment avoidance and anxiety, so a better understanding of the relationship between attachment avoidance, attachment anxiety, and depressive symptoms is needed. The current study applied a structural equation model to verify our hypothesis that different facets of affective empathy mediate the relationship between attachment avoidance, attachment anxiety, and depressive symptoms. The participants of this study included four hundred and sixty-four undergraduate students who completed the Experiences in Close Relationships-Relationship Structures Questionnaire, Interpersonal Reactivity Index, and Center for Epidemiologic Studies Depression Scale. The results indicated that the correlation between attachment avoidance and depressive symptoms was mediated by empathic concern, while the correlation between attachment anxiety and depressive symptoms was mediated by personal distress. These results implied that attachment avoidance and attachment anxiety work on depressive symptoms through different pathways.

Predictors of Embarrassment in Daily Social Interactions in Social Phobia, Major Depression and Healthy Controls

Introduction: Embarrassment is a social affect. Once experienced in social interactions (SIs), it can be a precursor of clinical symptoms like depersonalization and ruminative thinking. This experience sampling study investigated predictors of embarrassment in social phobia (SP), major depressive disorder (MDD), and controls. Methods: For seven days, a total of n = 165 patients (n = 47 SP, n = 118 MDD) and n = 119 controls completed five surveys per day on their smartphones. The effect of social anxiety and depression facets on embarrassment was examined in contemporaneous and time-lagged models. Results: Individuals with SP or MDD experienced more embarrassing SIs than controls. Among facets of depression, feelings of guilt, and low self-worth significantly predicted embarrassment in contemporaneous, but not in time-lagged models. Among facets of social anxiety, worries about other people's opinion and worries of saying or doing something wrong during a social interaction significantly predicted embarrassment (contemporaneous and time-lagged; all p < .05). Discussion: The study reveals important cognitive factors that accompany embarrassment in SIs and that connect social experience and clinical symptoms. Targeting these putative dysfunctions could be an important strategy in therapy. The differential patterns in SP and MDD are discussed.

Psychometric Evaluation of the Personal Feelings Questionnaire-2 (PFQ-2) Shame Subscale Among Spanish-Speaking Female Sex Workers in Mexico

Shame may increase HIV risk among stigmatized populations. The Personal Feelings Questionnaire-2 (PFQ-2) measures shame, but has not been validated in Spanish-speaking or nonclinical stigmatized populations disproportionately affected by HIV in resource-limited settings. We examined the psychometric properties of the Spanish-translated PFQ-2 shame subscale among female sex workers in two Mexico-U.S. border cities. From 2016 to 2017, 602 HIV-negative female sex workers in Tijuana and Ciudad Juarez participated in an efficacy trial evaluating a behavior change maintenance intervention. Interviewer-administered surveys collected information on shame (10-item PFQ-2 subscale), psychosocial factors, and sociodemographics. Item performance, confirmatory factor analysis, internal consistency, differential item functioning by city, and concurrent validity were assessed. Response options were collapsed to 3-point responses to improve item performance, and one misfit item was removed. The revised 9-item shame subscale supported a single construct and had good internal consistency (Cronbach's α = .86). Notable differential item functioning was found but resulted in a negligible effect on overall scores. Correlations between the revised shame subscale and guilt (r = .79, p < .01), depression (r = .69, p < .01), and emotional support (r = -.28, p < .01) supported concurrent validity. The revised PFQ-2 shame subscale showed good reliability and concurrent validity in our sample, and should be explored in other stigmatized populations.

Mothers' parenting stress, depression, marital conflict, and marital satisfaction: The moderating effect of fathers' empathy tendency

BACKGROUND

The decreased marriage satisfaction has become one of the main reasons for the rising divorce rate. However, few studies have focused on the relationship between mother's parenting stress, mental health, and marriage satisfaction. This study addressed this research gap by examining the direct influence of mothers' parental stress on their marital satisfaction, and the indirect influence of depression and marital conflict. Additionally, we explored the moderating effect of fathers' empathy tendency.

METHODS

Using a sample of parenting couples in Southwest China (n = 2,979) to conduct a questionnaire survey, a moderated mediation analysis was performed to simultaneously analyze the chain mediation of depression and marital conflict, and the moderating role of fathers'' empathy.

RESULTS

The mother's childcare pressure was negatively correlated with marital satisfaction (β = -0.478, p < 0.001). Depression and marital conflict have a chain mediating effect in explaining the relationship between mothers'' parenting stress and marital satisfaction (b = -0.064, 95% CI [-0.075, -0.053]). It is important to note that fathers with cognitive empathy can alleviate depression and marital conflict caused by the mothers' parental stress and a decrease in marital satisfaction, while fathers with high empathy can exacerbate these negative effects.

CONCLUSION

The study's findings identify the serious impact of contemporary female parenting pressure on marital satisfaction and confirm the important role of husbands' empathy.

LIMITATIONS

The scope of the survey is single, the parenting period is not staged, and there may be limitations such as overlapping stressors, which can be corrected in future research.

COVID-19-related stressful experiences and posttraumatic stress disorder symptoms among college students in China: A moderated mediation model of perceived control over the future and empathy

The current study aims to investigate the mediating effect of perceived control over the future and the moderating effect of empathy on the association between stressful experiences and PTSD symptoms among college students in China in response to COVID-19. A sample of 1,225 college students (70.69% were female, M age = 20.22 years, SD = 2.02) were recruited using web-based surveys at wave 1 (W1) and wave 2 (W2) longitudinally. Results showed that COVID-19-related stressful experiences were significantly associated with PTSD symptoms. Perceived control over the future partially mediated the relationship between these two variables ( indirect effect size = 0.09, p < 0.01). Empathy significantly moderated the path from perceived control over the future to PTSD symptoms, suggesting that the association was stronger for individuals with higher levels of empathy. Findings suggest a protective effect of perceived control over the future on college students’ PTSD symptoms during the COVID-19 pandemic. Such a protective effect was intensified by empathy. Future intervention to manage PTSD symptoms should be tailored to positive future expectations and empathy.

Emotional Reactivity, Emotion Regulation, and Social Emotions in Affective Disorders

Abstract. Affective disorders, specifically Major Depressive Disorder and Bipolar Disorders, show high prevalence, relapse rates, and a high likelihood to develop a chronic course. For the past two decades, research has investigated the neural correlates of emotion processing and emotion regulation in patients with affective disorders. Putative underlying causal mechanisms of dysregulated affect have been informed by knowledge from the intersection of neuroimaging and clinical psychology. More recent investigations also consider processing the role of mostly negative, self-blaming social emotions, which have been linked to treatment resistance and, hence, provide a prolific target for intervention. Several psychotherapeutic treatment approaches already focus on emotion, and here specific knowledge about the mechanisms underlying persistent changes in affect bears the potential to improve the treatment of affective disorders. In this narrative review, we delineate why and how our insights into the neural correlates of emotion processing and regulation can be applied to the treatment of patients with affective disorders.

Basic Empathy Scale: A Systematic Review and Reliability Generalization Meta-Analysis

The Basic Empathy Scale (BES) has been internationally used to measure empathy. A systematic review including 74 articles that implement the instrument since its development in 2006 was carried out. Moreover, an evidence validity analysis and a reliability generalization meta-analysis were performed to examine if the scale presented the appropriate values to justify its application. Results from the systematic review showed that the use of the BES is increasing, although the research areas in which it is being implemented are currently being broadened. The validity analyses indicated that both the type of factor analysis and reliability are reported in validation studies much more than the consequences of testing are. Regarding the meta-analysis results, the mean of Cronbach's α for cognitive empathy was 0.81 (95% CI: 0.77-0.85), with high levels of heterogeneity (I2 = 98.81%). Regarding affective empathy, the mean of Cronbach's α was 0.81 (95% CI: 0.76-0.84), with high levels of heterogeneity. It was concluded that BES is appropriate to be used in general population groups, although not recommended for clinical diagnosis; and there is a moderate to high heterogeneity in the mean of Cronbach's α. The practical implications of the results in mean estimation and heterogeneity are discussed.

The association between sleep and empathy in young preschoolers: A population study

Sleep is vital for children's early socio-emotional development, particularly empathy. This study aimed to explore the associations between sleep and empathy in young preschoolers. A sample of 23,259 preschoolers (4.3 ± 0.3 years) at the entry year of preschool was recruited as part of the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) study. Caregivers reported on child sleep, affective empathy, and cognitive empathy through the Children's Sleep Habits Questionnaire and the Griffith Empathy Measure. Ordinary least-square regression and quantile regression were performed for the associations between sleep and empathy. Sex differences were also investigated. Night sleep duration was negatively associated with affective empathy (β = -0.35, p < 0.001), and positively associated with cognitive empathy (β = 0.41, p < 0.001). Longer nap duration was associated with higher affective empathy (β = 0.28, p < 0.001). Sleep disturbances were positively associated with affective empathy (β = 0.04, p < 0.001) and negatively associated with cognitive empathy (β = -0.09, p < 0.001). These associations were generally stronger in children at higher empathy quantiles and also those at the 10^th cognitive empathy quantile. The associations between sleep and affective empathy were mainly contributed by girls, and were more common in boys in terms of cognitive empathy, particularly at the 10^th and the 30^th quantiles. In conclusion, longer night sleep duration and fewer sleep disturbances are associated with a more mature empathy pattern in young preschoolers. The associations are more prominent in children at the higher end of the empathy spectrum, and vary by sex. These findings highlight the importance to promote sleep health in young children for optimal socio-emotional development.

Postpartum Depression Is Associated With Altered Neural Connectivity Between Affective and Mentalizing Regions During Mother-Infant Interactions

Although there has been growing interest in mood-related neural alterations in women in the initial weeks postpartum, recent work has demonstrated that postpartum depression often lingers for months or years following birth. However, research evaluating the impact of depression on maternal brain function during mother-infant interactions in the late postpartum period is lacking. The current study tested the hypothesis that depressive symptoms at 12-months postpartum are associated with neural alterations in affective and social neural regions, using near-infrared spectroscopy during in vivo mother-infant interactions. Participants were 23 birth mothers of 12-month-old infants (60% boys). While undergoing near-infrared spectroscopy, mothers engaged in an ecologically valid interactive task in which they looked at an age-appropriate book with their infants. Mothers also reported on their depressive symptoms in the past week and were rated on their observed levels of maternal sensitivity during mother-infant play. Greater depressive severity at 12-months postpartum was related to lower connectivity between the right temporoparietal junction and the lateral prefrontal cortex, but greater connectivity between the right temporoparietal junction and anterior medial prefrontal cortex during mother-infant interaction. Given the putative functions of these neural regions within the maternal brain network, our findings suggest that in the context of depression, postpartum mothers' mentalizing about her infants' thoughts and feelings may be related to lower ability to express and regulate her own emotions, but greater ability to engage in emotional bonding with her infant. Future work should explore how connectivity among these regions is associated with longitudinal changes in maternal behavior, especially in the context of changes in mothers' depressive symptoms (e.g., with treatment) over time.

The dark side of empathy: Meta-analysis evidence of the relationship between empathy and depression

Regardless of a large amount of literature, whether empathy closely relates to depression is far from conclusive. The present study collected previous evidence and performed a meta-analysis to investigate the correlation between empathy and depression. By searching databases, 21 studies and 48 effect sizes were collected. Results showed that empathy was not correlated to depression (r = .006, p = .87). However, subgroup analyses showed that while the relationship between affective empathy and depression was significantly positively correlated (r = .108, p < .01), cognitive empathy was not (r = -.03, p = .26). Additionally, the relationship between empathy and depression varied during development, with a positive correlation in adolescence (r = .084, p < .01) and negative correlation in older adults (r = -.191, p < .001). Results implied that affective empathy might be one of the risk factors for depression, and higher affective empathy might mean more vulnerability to depression. Further studies would help by examining when and how this relationship builds, as well as the contributing factors of its development.

Network analysis of depressive symptoms in Hong Kong residents during the COVID-19 pandemic

In network theory depression is conceptualized as a complex network of individual symptoms that influence each other, and central symptoms in the network have the greatest impact on other symptoms. Clinical features of depression are largely determined by sociocultural context. No previous study examined the network structure of depressive symptoms in Hong Kong residents. The aim of this study was to characterize the depressive symptom network structure in a community adult sample in Hong Kong during the COVID-19 pandemic. A total of 11,072 participants were recruited between 24 March and 20 April 2020. Depressive symptoms were measured using the Patient Health Questionnaire-9. The network structure of depressive symptoms was characterized, and indices of "strength", "betweenness", and "closeness" were used to identify symptoms central to the network. Network stability was examined using a case-dropping bootstrap procedure. Guilt, Sad Mood, and Energy symptoms had the highest centrality values. In contrast, Concentration, Suicide, and Sleep had lower centrality values. There were no significant differences in network global strength (p = 0.259), distribution of edge weights (p = 0.73) and individual edge weights (all p values > 0.05 after Holm-Bonferroni corrections) between males and females. Guilt, Sad Mood, and Energy symptoms were central in the depressive symptom network. These central symptoms may be targets for focused treatments and future psychological and neurobiological research to gain novel insight into depression.

Associations of affective and cognitive empathy with depressive symptoms among a sample of Chinese college freshmen

BACKGROUND

College freshmen are at high risk for mental and socioemotional problems after entering a new environment. However, few investigators have evaluated the associations between empathy and depressive symptoms among college freshmen. The present study examined the presence and associations of affective and cognitive empathy with depressive symptoms among college freshmen in China.

METHODS

In total, 4297 college freshmen completed the Interpersonal Reactivity Index as an assessment of empathy and the University Personality Inventory to evaluate the prevalence of depressive symptoms.

RESULTS

The empathy scores of females were higher than that of males, and approximately 18.4% of freshmen had high-depressive symptoms (HDS). Freshmen with a higher positive component of affective empathy (empathic concern (EC)) experienced fewer HDS. In contrast, freshmen with a higher negative component of affective empathy (personal distress (PD)) and lower cognitive empathy (perspective taking (PT)) experienced more HDS. EC was negatively associated with depressive symptoms, PD was positively related to depressive symptoms, and PT was negatively associated with depressive symptoms. Males with a higher degree of PT experienced fewer HDS, while females with a higher degree of PT experienced more HDS.

CONCLUSION

Affective empathy was positively associated with depressive symptoms, while cognitive empathy was negatively related to depressive symptoms. The association between affective and cognitive empathy with depressive symptoms may add some support to the detection of clinical depressive symptoms. These findings call for the necessity of considering the characteristics of affective and cognitive empathy as a crucial concern in the prevention of depressive symptoms.

Shame and guilt in youth at ultra-high risk for psychosis

OBJECTIVE

Feelings of shame and guilt have rarely been investigated in people at ultra-high risk (UHR) for psychosis. We aimed to outline differences in shame and guilt in relation to empathy and theory of mind (ToM) in young people, particularly those at UHR for psychosis.

METHODS

First, 166 young healthy controls were assessed for their proneness to shame and guilt using the Test of Self-Conscious Affect, empathy and its four subdomains (perspective taking, fantasy, empathic concern, and personal distress) using the Interpersonal Reactivity Index (IRI), ToM using the ToM picture stories task, and neurocognitive performance using the Raven's Standard Progressive Matrices (SPM). Next, we evaluated shame and guilt in 24 UHR individuals comparing them to 24 age- and sex-matched healthy controls. Finally, we explored relationships for shame and guilt in relation to empathy and ToM in the UHR individuals.

RESULTS

In the healthy youth, a regression analysis showed fantasy and personal distress in IRI to be significant determinants of shame, while perspective taking and empathic concern in IRI, ToM, and SPM were independent predictors of guilt. Meanwhile, compared to the healthy controls, individuals with UHR exhibited higher levels of shame, which was associated with increased personal distress.

DISCUSSION

Our findings showed that four subdomains of empathy, ToM, and neurocognition were differentially associated with shame and guilt in healthy young people. Given the correlation between excessive feelings of shame and high levels of the personal distress dimension of empathy in UHR for psychosis, redressing the tendency to focus on self-oriented negative emotions upon witnessing distress of others could possibly reduce self-blame or self-stigma of help-seeking individuals.

Association between parental control and subclinical depressive symptoms in a sample of college freshmen: Roles of empathy and gender

BACKGROUND

College freshmen are at high-risk for depressive symptoms after experiencing drastic transitions in a new environment. Perceived parental control has proved as a prominent role in an adolescent's mental health. However, the further understandings of the mechanisms underlying the relation between perceived parental control and freshmen's depressive symptoms are urgent.

METHODS

A total of 4,297 Chinese freshmen (57% female) were recruited. They completed the self-report Parental Bonding Instrument (PBI), Interpersonal Reactivity Index (IRI), and University Personality Inventory (UPI), which assess parental control, empathy and depressive symptoms, respectively. The data were analysed using correlation analysis and a test of moderated mediation.

RESULTS

The results showed positive association between parental control and depressive symptoms, partially mediated by empathy. The relation between parental control and affective empathy, was moderated by gender. Specifically, maternal control had a more significant positive effect on males' personal distress. Moreover, the influence of paternal control was also greater for males, with a negative effect on empathic concern and positive on personal distress.

CONCLUSIONS

Parental control significantly positively predicted college freshmen's depressive symptoms, and empathy played a partially mediating role. In addition, the relations between parental control and affective empathy were moderated by freshmen's gender. The findings of this study provide a better understanding of how parental control is related to freshmen's depressive symptoms, offering a theoretical basis for promoting the development of adolescents' mental health and supporting the design of effective psychological interventions to relieve their depressive symptoms.

Moralische Emotionsattributionen im Jugendalter

Zusammenfassung. Theoretischer Hintergrund: Moralische Emotionen bieten einen vielversprechenden Ansatz für Prävention und Intervention, da sie mit moralischer Motivation und Handlungsregulation assoziiert sind. Fragestellung: Insgesamt N = 163 Jugendliche ( MAlter = 15.27, SD = 1.03, n = 87 weiblich) nahmen an einer Studie teil, in der Zusammenhänge zwischen moralischen Emotionen und einem delinquenten sozialen Umfeld sowie Empathie untersucht wurden. Methode: Moralische Emotionen wurden als Intensität moralischer Emotionsattributionen (MEA) operationalisiert. Ergebnisse: Jugendliche mit einem delinquenten sozialen Umfeld weisen sowohl bei einer selbstlosen (kleine Effekte) als auch einer selbstsüchtigen Entscheidung (mittlere bis starke Effekte) eine signifikant niedrigere Intensität von MEA auf als Jugendliche ohne ein delinquentes soziales Umfeld. MEA bei einer selbstsüchtigen Entscheidung werden zu 33 % durch ein delinquentes soziales Umfeld und affektive Empathie erklärt. Diskussion und Schlussfolgerung: Die Ergebnisse werden im Hinblick auf wissenschaftliche und praktische Relevanz diskutiert.

Network functional connectivity underlying dissociable cognitive and affective components of empathy in adolescence

Empathy, the capacity to understand and share others' emotions, can occur through cognitive and affective components. These components are different conceptually, behaviorally, and in the brain. Neuroimaging task-based research in adolescents and adults document that cognitive empathy associates with the default mode and frontoparietal networks, whereas regions of the salience network underlie affective empathy. However, cognitive empathy is slower to mature than affective empathy and the extant literature reveals considerable developmental differences between adolescent and adult brains within and between these three networks. We extend previous work by examining empathy's association with functional connectivity within and between these networks in adolescents. Participants (n = 84, aged 13-17; 46.4% female) underwent resting state fMRI and completed self-report measures (Interpersonal Reactivity Index) for empathy as part of a larger Nathan-Kline Institute study. Regression analyses revealed adolescents reporting higher cognitive empathy had higher within DMN connectivity. Post hoc analysis revealed cognitive empathy's association within DMN connectivity is independent of affective empathy or empathy in general; and this association is driven by positive pairwise connections between the bilateral angular gyri and medial prefrontal cortex. These results suggest introspective cognitive processes related to the DMN are specifically important for cognitive empathy in adolescence.

A Psychometric Evaluation of the Guilt and Shame Experience Scale (GSES) on a Representative Adolescent Sample: A Low Differentiation between Guilt and Shame

The Guilt and Shame Experience Scale (GSES) is a new, brief self-report instrument for assessing experiences of guilt and shame. It includes two distinct scales: feelings of shame and feelings of guilt. The present report focuses on results from a final validation study using a nationally representative sample of 7899 adolescents (M age = 14.5 ± 1.1 years, 50.7% boys) who participated in the 2014 Health Behavior in School-aged Children study. For factor analysis, the dataset was divided into two groups. One group (n = 3950) was used for the Exploratory Factor Analysis (EFA) and the second (n = 3949) for the Confirmatory Factor Analysis (CFA). The EFA results in a one-factor model of the GSES scale, while the CFA suggests a two-factor solution mirroring two scales, feelings of shame and feelings of guilt. Both models have a good fit to the data, and the scale also showed high internal consistency (Cronbach's alpha = 0.89). A nonparametric comparison of different sociodemographic groups showed a higher disposition for experiencing guilt and shame among girls, students of the ninth grade, and religious respondents. A comparison of the results to previously published results obtained from adults indicates that adolescence is a developmental period involving low differentiation between moral emotions like guilt and shame compared with adulthood. Moreover, positive association with religious attendance shows a need of addressing these issues in a pastoral care setting.

The relations between childhood maltreatment, shame, guilt, depression and suicidal ideation in inpatient adolescents

BACKGROUND

Previous studies demonstrated positive relations between various forms of maltreatment and suicidal ideation in youth; however, mechanisms underlying these relationships are not well understood. We propose that the experience of maltreatment in childhood may lead to high levels of generalized guilt and shame, resulting in an increase of depressive symptoms and suicidal thoughts in adolescents. The aim of the current study was to test our model of relations between these constructs using path analysis.

METHODS

112 inpatient adolescents aged 12-17 years completed the Childhood Trauma Questionnaire to measure various types of maltreatment, the Personal Feelings Questionnaire to evaluate generalized guilt and shame, the Beck Depression Inventory-II to assess depressive symptoms, and the Columbia-Suicide Severity Rating Scale to assess suicidal ideation.

RESULTS

Findings partly confirmed the theoretical model. Indirect positive effects of sexual and emotional abuse, as well as emotional and physical neglect on suicidal ideation via generalized self-conscious emotion and/or depression were demonstrated. In contrast to our predictions, indirect negative effects of physical abuse on suicidal thoughts via generalized guilt and shame and depression were found.

LIMITATIONS

Sample characterized by predominately Caucasian inpatient adolescents from financially stable and well-educated environments, over-reliance on self-report measures and the lack of a longitudinal design were main limitations of the study.

CONCLUSIONS

The study provides novel information on the potential mechanisms underlying the association between childhood maltreatment and suicidal ideation in adolescents. Generalized guilt and/or shame could be possible targets for interventions for victims of some forms of maltreatment to reduce depressive symptoms and suicidal ideation.

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.