# The relationship between empathy and mental health: A mediation model via rumination and interpersonal competence

## TL;DR

The study finds that higher empathy in medical students is linked to more psychological distress through increased rumination and interpersonal challenges.

## Contribution

This study identifies rumination and interpersonal competence as dual mediators linking empathy to psychological distress in medical students.

## Key findings

- Empathy is positively associated with psychological distress in medical students.
- Rumination and interpersonal competence fully mediate the relationship between empathy and distress.
- Male students and higher-grade students report higher empathy levels.

## Abstract

As a critical capacity in medical education, the trajectory of empathy development and its relationship with medical students’ mental health has remained inconclusive. To address this purpose, the current study was conducted, with addressing the mediation role of rumination and interpersonal competence in this relationship.

A total of 640 medical students from Guangdong Province, China, were recruited. The levels of empathy across grades and genders were assessed. In addition, participants’ interpersonal competence, rumination, and psychological distress were measured. Linear regression assessed the empathy–distress association, and parallel mediation modeling tested rumination and interpersonal competence as simultaneous mediators.

In total, 523 participants were included in the final analysis (with 44% were male). Group comparisons showed that male students reported higher empathy than females (84.69 ± 9.84 vs. 82.68 ± 8.58, p = 0.016); and higher-grade students performed higher empathy (p < 0.001). Empathy was positively associated with psychological distress, more rumination thinking, and better interpersonal competence. Interpersonal competence (β = -0.01, p = 0.018) and rumination (β = 0.02, p = 0.016) significantly fully mediated the relationship between empathy and distress. Empathy was associated with increased rumination and better interpersonal competence; however, the first linked to higher distress and the latter was associated with reduced distress.

Empathy in medical students associates with greater psychological distress through dual pathways: heightened rumination (intrapersonal) and impaired interpersonal competence (interpersonal). The findings have highlighted the need for tailor-made empathy training programs, differentiated by gender and grade, that integrate coping strategies and interpersonal skills development.