A Meta-Analysis Taxonomizing Empathy in Schizophrenia

Background: Trait empathy is integral to relationship development and maintenance. Therefore, impairment in this ability can have an adverse effect on many domains of life including social, sexual, and marital. Previous reviews show in schizophrenia, this ability to be impaired but with a high amount of heterogeneity that is yet to be explored more thoroughly.Aim and method: Considering this, we aim to synthesise the extent literature using a meta-analytic approach and examine the source of the heterogeneity observed in previous reviews and develop taxonomy of empathy deficits in schizophrenia. Hedges’ g was calculated for cognitive and affective empathy using random effects models. Meta-regression models of key cognitive, clinical and demographic risk and protective factors were run. These included: Impact year of publication, age, gender, ethnicity, education, general IQ, verbal/pre-morbid IQ, global neuro-cognition, positive, negative and general symptoms of schizophrenia, age at schizophrenia diagnosis, duration of illness and medication has on cognitive and affective empathy.Results: A literature search revealed 39 independent studies examining empathy in schizophrenia. Healthy controls scored higher than people with a diagnosis of schizophrenia, with a small effect size for affective empathy (Hedges’ g = 0.29) and a medium effect size for cognitive empathy (Hedges’ g = 0.53). Both components were heterogeneous. Analyses using meta-regression models found age at diagnosis and the duration of illness moderated the difference in effect size for cognitive empathy, such that those with an earlier diagnosis or a more chronic course exhibit greater difficulty in cognitive empathy compared to healthy controls.Conclusion: We find a longer duration of illness and younger age at clinical diagnosis enhances impairments in cognitive empathy in severe and enduring schizophrenia. For affective empathy, we conclude, compared to healthy controls, some patients report having a deficit [i.e. experience lower affective empathy], others report comparable levels, and the remaining report to be experiencing higher emotional arousal. As an earlier diagnosis, prolonged illness course and dysfunctional emotional reactions are significant risk factors of poorer empathic interactions, it will be important to address the underlying mechanisms of this deficit in future work