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 Table of Contents  
ORIGINAL ARTICLES
Year : 2021  |  Volume : 9  |  Issue : 4  |  Page : 136-139

An observational study on empathy and factors associated with individual variations in empathy levels among youth in Central Kerala


Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India

Date of Submission20-Apr-2021
Date of Decision02-May-2021
Date of Acceptance29-May-2021
Date of Web Publication15-Jul-2022

Correspondence Address:
Shaliet Rose Sebastian
Department of Community Medicine, Believers Church Medical College Hospital, Kuttapuzha, Thiruvalla - 689 103, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/dypj.DYPJ_21_21

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  Abstract 

Background: Empathy is a social skill that exerts influence on the quality of social relationships. The importance of being empathetic is not only limited to the health care field. An empathetic person is able to understand the emotions of others, accurately express their feelings, comprehend others’ situations and act appropriately. According to the census data of 2011, one-fifth of India’s population is made up of the youth. Added to the volatile nature of the age, our youth face challenges from social exclusion, gender-based violence, and the lack of access to rights and opportunities. Aim: The aim of the study is to measure empathy levels among young adults aged 19–24 years in Central Kerala and to find out the factors associated with individual variations in empathy levels among them. Materials and Methods: A cross-sectional survey was conducted among 610 young adults of both gender in Pathanamthitta, Kottayam, Alappuzha, Kollam, and Trivandrum districts in South-central Kerala. Results: Good academic performance among study participants was found to be significantly associated with fantasy scale. The personal distress scale among study participants was found to be significantly associated with burnout, medical stream, and involvement in humanitarian acts. Burnout scores of study participants were found to be inversely correlated with fantasy scale, empathic concern, personal distress, and the combined interpersonal reactivity index. Conclusion: The present study sheds light on the prevalence of empathy and humanistic values among the youth in Kerala.

Keywords: Burn out, empathy, Kerala, youth


How to cite this article:
Sebastian SR, Saji JA, Mathew G, Babu BP. An observational study on empathy and factors associated with individual variations in empathy levels among youth in Central Kerala. D Y Patil J Health Sci 2021;9:136-9

How to cite this URL:
Sebastian SR, Saji JA, Mathew G, Babu BP. An observational study on empathy and factors associated with individual variations in empathy levels among youth in Central Kerala. D Y Patil J Health Sci [serial online] 2021 [cited 2022 Aug 8];9:136-9. Available from: http://www.dypatiljhs.com/text.asp?2021/9/4/136/351080




  Introduction Top


Empathy is understood as an ability to place oneself in another’s position.[1] In the field of health care, Empathy is an unavoidable determinant of the quality of physician-patient relationship. Empathy is “a cognitive attribute that involves an understanding of the inner experiences and perspectives of the patient as a separate individual, combined with a capability to communicate this understanding to the patient”[2] and “act on that shared understanding in a helpful and therapeutic way.”[3] This understanding allows the patient to feel respected and validated.[4],[5] The importance of being empathetic is not only limited to the health care field. Empathy is a social skill that exerts influence on the quality of social relationships. Empathy influences the development of behavior and maintenance of healthy relationships. An empathetic person is able to understand the emotions of others, accurately express their feelings, comprehend others’ situations, and act appropriately.[6] Empathy has a large impact on how people act in social situations.[7] According to the existing literature, People who are innately more empathetic get more affected by emotionally charged situations compared to others.[8] Empathy is thus an emotional awareness that affects the professional as well as personal lives.[9]

According to the census data of 2011, one-fifth of India’s population is made up of the youth. Added to the volatile nature of the age, our youth face challenges from social exclusion, gender-based violence, and the lack of access to rights and opportunities and deal with various life-threatening experiences such as depression, suicidal tendencies, and other mental health problems needless to say then, if the world’s largest young population starts focusing on becoming more morally aware and responsible, our country would be in very safe hands.

It is this social awareness and responsibility rooted in empathy that makes a young person feel more socially inclusive. The enthusiastic participation of youth in humanitarian acts in the present era becomes a pivotal milestone in the way they look at giving back to the community, be it in big ways or small. The overwhelming response of youth as volunteers during the flood in 2018 in Kerala is a proof of the feelings of empathy in their hearts. However, no published literature could be found on the prevalence of empathy among the youth population of the state of Kerala. There are very little published data related to empathy and its correlates among the youth of India. This study has attempted to measure empathy levels among young adults aged 19–24 years in Central Kerala and to find out the factors associated with individual variations in Empathy levels among them.


  Materials and Methods Top


This cross-sectional survey was conducted among 610 young adults of both genders in Pathanamthitta, Kottayam, Alappuzha, Kollam, and Trivandrum districts in South-central Kerala over a period of 2 months. Sample size for the study was estimated using the formula N = (1.96)2 pq/L2 using the prevalence from a similar study.[10] Ethical clearance was obtained from the institutional ethics committee.

After asking consent to participate in the survey, the questionnaire was shared as Google docs link. Data were collected using the following instruments:

  • (1) A short demographic questionnaire about age, gender, academic performance, occupation of parents, and year of study.


  • (2) Interpersonal reactivity index (IRI): The IRI is a measure of empathy on three subscales:[11]

    • (a) Empathic concern, which “inquires about respondents’ feelings of warmth, compassion and concern for others” (emotional empathy domain)


    • (b) Perspective taking, which “contains items assessing spontaneous attempts to adopt the perspectives of other people and see things from their point of view” (cognitive empathy domain) and (c) personal distress, which “measures the personal feelings of anxiety and discomfort that result from observing another’s negative experience.” Each subscale comprises seven items and answers are provided on a five-point Likert-like scale (0 = does not describe me well; 4 = describes me very well), with scores ranging from 0 to 28. Higher scores in each subscale indicate higher dispositions for empathic concern, perspective taking, and personal distress.




  • (3) The Malach-pines (2005) burnout measure (BM): Short version.[12] The BM--short version is a 10-item version of the BM by pines and Aronson (1988). The original scale includes 21 items, evaluated on 7-point frequency scales, assessing the level of an individual’s physical, emotional, and mental exhaustion. The shorter, 10-item version of the BM (Battery management system) was developed in response to researchers’ and practitioners’ need for an easy-to-use instrument requiring less questionnaire space and less time for administration and scoring.



Statistical analysis

Categorical variables were analyzed with Chi-square tests. Correlation between variables was analyzed using Pearson’s correlation coefficients for continuous variables. Binary logistic regression analysis was used to evaluate the association of independent variables with empathy.


  Results Top


The mean age of the study participants was 21 ± 1.6 years. Out of the 610 study participants, 304 were graduating in the medical stream and 306 were doing graduation in various nonmedical streams such as B Tech, BSc, BA, Architecture, Agriculture, Fishing, and Forestry The study population consisted of 342 (56.1%) males and 268 (43.9%) females. 439 (71.8%) study participants reported to have been involved humanitarian acts while 172 (28.2%) participants had never done any humanitarian acts yet. Of the 610 study participants, 386 (63.3%) were performing well academically.

The dispositional empathy was calculated using the values from four component subscales of empathy namely fantasy scale, perspective-taking scale, empathic concern scale, and personal distress scale. The mean values of fantasy scale, perspective-taking, empathic concern, and personal distress, were 12.6 ± 3.9, 19.2 ± 5.9,15 ± 3.6 and 15.6 ± 3.9 respectively. The mean burnout score of study participants was 41.03 ± 12.3.

The Chi-square analysis of the study data revealed good academic performance to be significantly associated with fantasy scale.(χ2 = 9.23, P = 0.026) The empathic concern among the study participants was found to be significantly associated with burn out score (χ2 = 4.86, P = 0.028) The personal distress scale among study participants was found to be significantly associated with burn out (χ2 = 4.54, P = 0.033), medical stream (χ2 = 5.13, P = 0.026) and involvement in humanitarian acts (χ2 = 4.54, P = 0.033).

Student’s t-test was done to compare the outcome variables across study participants based on their burnout score. The study participants with a moderate burnout score had higher scores on the perspective-taking scale (P < 0.05) and personal distress scale (P < 0.05) compared to the study participants with no burnout [Table 1].
Table 1: Dispositional Empathy according to burnout score

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Age of study participants was positively correlated with fantasy scale score (P < 0.01) and IRI (P < 0.05). Burnout scores of study participants were positively correlated with perspective-taking scale. Burn out scores of study participants were found to be inversely correlated with fantasy scale, empathic concern, personal distress, and the combined IRI [Table 2].
Table 2: Pearson’s correlation coefficient among study participants

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Binary logistic regression was performed to ascertain the effect of independent variables on dispositional empathy among the study participants. Medical stream of study was found to have lower personal distress scores among study participants (adjusted odds ratio [OR] =1.51, 95% confidence interval [CI] =1.07–2.14, P = 0.020). History of being involved in humanitarian deeds was found to have lower personal distress scores among the study participants (adjusted OR = 0.688, 95% CI = 0.48–0.99, P = 0.046). Study participants with burn out were found to have lower empathetic concern scores (adjusted OR = 0.62, 95% CI = 0.42–0.92, P = 0.019).


  Discussion Top


The present study has attempted to measure the empathy levels among youth and assess the factors associated with empathy. The present study showed an inverse relationship between burnout and empathy level among the study participants. A similar study conducted by Paro et al. about empathy among medical students showed that empathy scores were moderately correlated with burnout.[13] In the present study, female students were found to have higher empathy scores. It was similar to the findings of Santos et al.,[14] Raof and Yassin[15] Quince et al.,[16] Youssef et al.,[17] and Dehning et al.[18] The present study observed an inverse relationship with the level of burnout and empathy among the study participants. The negative association of empathy with burnout among medical professionals is recorded in a large number of studies[19],[20] Empathy is an important virtue that enables the health professionals to offer their services after assessing their needs. The development of empathetic skills thus becomes necessary in medical profession.[21] In concordance with these facts, the present study observed a significant positive association between being in medical profession and dispositional empathy. The existing literature shows that empathic concern positively affects the donation decision. People with high levels of empathic concern donate in various contexts, and they are compassionate toward others and seem to be oriented toward alleviating the suffering of others in need.[22] The current study revealed a significant positive association between involvement in humanitarian acts and Empathy. A similar study conducted among medical students also points to an important role for cognitive empathy in generosity, and suggests that long-term changes in empathy influence individual differences in pro social behaviour.[23] The Chi-square analysis of the study data revealed good academic performance to be significantly associated with fantasy scale. We feel that it could be the confidence that the students feel about themselves after performing well academically that has reflected as their high scores on the fantasy scale.


  Conclusion Top


The present study revealed the prevalence of empathy and humanistic values among the youth in Kerala. However certain factors like burn out and academic performance that can affect total individual empathy scores need to be addressed better. Promotion of empathy and human values must be included in the curriculum of all graduate courses instead of only health professions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bellet PS, Maloney MJ The importance of empathy as an interviewing skill in medicine. JAMA 1991;266:1831-2.  Back to cited text no. 1
    
2.
Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M Physician empathy: Definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry 2002;159:1563-9.  Back to cited text no. 2
    
3.
Mercer SW, Reynolds WJ Empathy and quality of care. Br J Gen Pract 2002;52:S9-12.  Back to cited text no. 3
    
4.
Beckman HB, Markakis KM, Suchman AL, Frankel RM The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med 1994;154:1365-70.  Back to cited text no. 4
    
5.
Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997;277:553-9.  Back to cited text no. 5
    
6.
Killen M, Smetana JG, ediors. Handbook of Moral Development. London: Lawrence Erlbaum Associates Inc; 2006.  Back to cited text no. 6
    
7.
Batson CD, Fultz J, Schoenrade PA Distress and empathy: Two qualitatively distinct vicarious emotions with different motivational consequences. J Pers 1987;55:19-39.  Back to cited text no. 7
    
8.
Jolliffe D, Farrington DP Examining the relationship between low empathy in bullying. Aggress Behav 2006;32:540-50.  Back to cited text no. 8
    
9.
Carlo G, Edwards CP Moral Motivation through the Life Span. Vol. 51. London: University of Nebraska Press; 2005.  Back to cited text no. 9
    
10.
Sanjai S, Gopichandran V Selfless giving in medicine: A study of altruistic attitudes among medical students. Indian J Med Ethics 2018;3:28-34.  Back to cited text no. 10
    
11.
Davis MH A multidimensional approach to individual differences in empathy. In: Catalog of Selected Documents in Psychology. Florida, US: JSAS; 1980. p. 10.  Back to cited text no. 11
    
12.
Malach-Pines A The burnout measure, short version. Int J Stress Manage 2005;12:78-88.  Back to cited text no. 12
    
13.
Paro HB, Silveira PS, Perotta B, Gannam S, Enns SC, Giaxa RR, et al. Empathy among medical students: Is there a relation with quality of life and burnout? PLoS One 2014;9:e94133.  Back to cited text no. 13
    
14.
Santos MA, Grosseman S, Morelli TC, Giuliano IC, Erdmann TR Empathy differences by gender and specialty preference in medical students: A study in Brazil. Int J Med Educ 2016;7:149-53.  Back to cited text no. 14
    
15.
Raof AM, Yassin BA Measuring empathy levels among kurdish medical students in Erbil City, Iraq: Cross-sectional study. Sultan Qaboos Univ Med J 2016;16:e62-7.  Back to cited text no. 15
    
16.
Quince TA, Kinnersley P, Hales J, da Silva A, Moriarty H, Thiemann P, et al. Empathy among undergraduate medical students: A multi-centre cross-sectional comparison of students beginning and approaching the end of their course. BMC Med Educ 2016;16:92.  Back to cited text no. 16
    
17.
Youssef FF, Nunes P, Sa B, Williams S An exploration of changes in cognitive and emotional empathy among medical students in the Caribbean. Int J Med Educ 2014;5:185-92.  Back to cited text no. 17
    
18.
Dehning S, Girma E, Gasperi S, Meyer S, Tesfaye M, Siebeck M Comparative cross-sectional study of empathy among first year and final year medical students in Jimma University, Ethiopia: Steady state of the heart and opening of the eyes. BMC Med Educ 2012;12:34.  Back to cited text no. 18
    
19.
Wilkinson H, Whittington R, Perry L, Eames C Examining the relationship between burnout and empathy in healthcare professionals: A systematic review. Burn Res 2017;6:18-29.  Back to cited text no. 19
    
20.
Lee PT, Loh J, Sng G, Tung J, Yeo KK Empathy and burnout: A study on residents from a Singapore institution. Singapore Med J 2018;59:50-4.  Back to cited text no. 20
    
21.
Kahriman I, Nural N, Arslan U, Topbas M, Can G, Kasim S The effect of empathy training on the empathic skills of nurses. Iran Red Crescent Med J 2016;18:e24847.  Back to cited text no. 21
    
22.
Verhaert GA, Van den Poel D Empathy as added value in predicting donation behavior. J Bus Res 2011;64:1288-95.  Back to cited text no. 22
    
23.
Smith KE, Norman GJ, Decety J Medical students’ empathy positively predicts charitable donation behavior. J Posit Psychol 2020;15:734-42.  Back to cited text no. 23
    



 
 
    Tables

  [Table 1], [Table 2]



 

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