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Cited by 115Schizophrenia research and treatmentMental Health and PsychiatryEmpathy and Medical Education

Empathy in schizophrenia: A meta-analysis of the Interpersonal Reactivity Index

Open access
Bonfils, Kelsey A., Lysaker, Paul H., Minor, Kyle S., Salyers, Michelle P.·2017·Psychiatry Research
DOI 10.1016/j.psychres.2016.12.033
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Abstract

Empathy is a complex construct, thought to contain multiple components. One popular measurement paradigm, the Interpersonal Reactivity Index (IRI), has been used extensively to measure empathic tendencies in schizophrenia research across four domains: empathic concern, perspective-taking, personal distress, and fantasy. However, no recent meta-analysis has been conducted for all four factors of this scale. The goal of this meta-analysis was to examine self-reported empathic tendencies for each factor of the IRI in people with schizophrenia as compared to healthy controls. A literature search revealed 32 eligible schizophrenia studies. The Hedges' g standardized difference effect size was calculated for each component using a random effects meta-analytic model. Compared to healthy controls, schizophrenia samples reported significantly reduced tendencies for empathic concern, perspective-taking, and fantasy, but significantly greater tendencies for personal distress. Duration of illness significantly moderated the results for perspective-taking such that those with a longer duration exhibited greater deficits; percent female significantly moderated the results for personal distress such that samples with more females exhibited reduced effect sizes. Future work is needed to examine the impact of heightened personal distress on the empathic tendencies and abilities of those with schizophrenia, including the possible role of emotion regulation.

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Crossref · 10.1016/j.psychres.2016.12.033

Cites

70 of 70 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 36 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There was a trend-level moderation by illness duration for empathic concern (p = 0.08), with the group difference strengthening by 0.016 per year.

    “There was also a trend (p = 0.08) in the same direction for empathic concern, such that the standardized mean difference is strengthened by .016with every one year increase in duration.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Duration of illness reported in the included studies validly indexes chronic course and is comparable across studies.
  • Findingown data

    People with schizophrenia scored lower than healthy controls on perspective-taking, with a medium effect size (g = 0.55, 95% CI [0.43, 0.67]).

    “perspective taking (0.55, 95% CI [0.43, 0.67])”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The IRI subscales validly measure the four empathy components in people with schizophrenia as they do in healthy controls.
  • Findingown data

    Illness duration did not significantly moderate personal distress or fantasy.

    “Duration of illness did not significantly moderate personal distress or fantasy (Table 4).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Duration of illness reported in the included studies validly indexes chronic course and is comparable across studies.
  • Findingown data

    People with schizophrenia scored lower than healthy controls on empathic concern, with a medium effect size (Hedges' g = 0.29, 95% CI [0.18, 0.41]).

    “participants with schizophrenia evidenced significant deficits (compared to healthy controls) in empathic concern (0.29, 95% CI [0.18, 0.41])”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The IRI subscales validly measure the four empathy components in people with schizophrenia as they do in healthy controls.
  • Findingown data

    Longer illness duration significantly strengthened the group difference in perspective-taking by 0.022 per year, indicating greater impairment in emotional perspective-taking for those with more chronic illness.

    “duration of illness significantly moderated the relationship between sample (i.e., schizophrenia vs. healthy control) and the perspective-taking component such that for every one year increase in duration of illness, the standardized mean difference effect size is strengthened by 0.022, indicating those with a more chronic course have greater impairments in emotional perspective-taking than those”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Duration of illness reported in the included studies validly indexes chronic course and is comparable across studies.
  • May combine two claims. 16
  • Classified as probably not a substantial claim. 8

  • May combine two claims.

    Findingown data

    People with schizophrenia scored higher than healthy controls on personal distress, with a medium effect size (g = -0.72, 95% CI [-0.86, -0.58]).

    “showing elevated personal distress (-0.72, 95% CI [-0.86, -0.58])”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The IRI subscales validly measure the four empathy components in people with schizophrenia as they do in healthy controls.

  • May combine two claims.

    Findingown data

    The meta-analyses showed moderate to high heterogeneity, with all I2 values above 25%.

    “Across meta-analyses, moderate to high heterogeneity was detected, with all I 2 estimates surpassing the 25% threshold to examine moderating variables (see Table 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The personal distress effect was medium to large and negative, indicating that people with schizophrenia report more personal distress than healthy controls when confronted with others' experiences and emotions.

    “The personal distress component, on the other hand, revealed a medium to large negative effect, indicating that compared to healthy controls, people with schizophrenia report heightened personal distress when confronted with the experiences and emotions of others.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The IRI subscales validly measure the four empathy components in people with schizophrenia as they do in healthy controls.

  • May combine two claims.

    Interpretationown data

    The authors conclude that people with schizophrenia have deficits in empathic concern, emotional perspective-taking, and fantasy, and heightened personal distress.

    “Results of all four components were significant and appear robust to effects of outliers, suggesting that people with schizophrenia experience deficits in empathic concern, emotional perspective-taking, and the ability to relate to fictional characters, and at the same time experience heightened personal distress.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The IRI subscales validly measure the four empathy components in people with schizophrenia as they do in healthy controls.
    • Rests on an assumption: Duration of illness reported in the included studies validly indexes chronic course and is comparable across studies.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The authors followed PRISMA guidelines to maintain high meta-analytic quality.

    “The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Moher et al., 2009) were followed in order to maintain a high level of meta-analytic quality.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher et al., 2009 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Sensitivity analyses removing one study at a time found no outlier that needed removal, and point estimates changed little when studies were removed.

    “Examination of one-study removed sensitivity analyses and forest plots (available upon request from the authors) indicated, across meta-analyses, that no study needed to be removed as an outlier.Point estimates of effect sizes with studies removed did not greatly differ from overall mean effect sizes, indicating all samples could be retained for main analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Before this study, no recent meta-analysis had combined the four empathy factors.

    “however, no recent metaanalysis has been conducted on the four factors together.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Davis (1983) argued that the fantasy subscale should not be expected to relate to interpersonal functioning because engaging with fictional scenarios is not relevant to social relationships.

    “In fact, Davis (1983) asserted that associations between the fantasy subscale and interpersonal functioning were not expected because one's ability to get involved in fictional scenarios from books or movies was not relevant to social relationships, but rather may reflect aspects of emotionality.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Davis, 1983 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Prior work has consistently found cognitive and affective empathy deficits in schizophrenia.

    “While consistent deficits in cognitive empathy (Savla et al., 2013) and affective empathy (Bonfils et al., 2016) have been found in people with schizophrenia”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Savla et al., 2013 source

      Not checked in the free run.

    • cites Bonfils et al., 2016 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Only one prior meta-analysis of the IRI in schizophrenia existed; it contained six studies and did not examine moderators.

    “Yet, only one meta-analysis to our knowledge attempted to synthesize the literature on the IRI in schizophrenia, and it included only six studies (Achim et al., 2011) and did not address moderators.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Achim et al., 2011 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Trim-and-fill analyses found no evidence of publication bias for empathic concern, perspective-taking, or fantasy.

    “Trim and fill analyses found no evidence of publication bias for empathic concern, perspective-taking, or fantasy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Research on illness duration and social cognition is mixed: some studies find greater empathy deficits with longer illness, others find decline, and others find stable early deficits.

    “This work has been mixed, with some studies indicating a longer course of illness is associated with greater deficits in empathy (Montag et al., 2007) and others indicating social cognitive abilities decline over the course of illness (Kucharska-Pietura et al., 2005); however, others indicate deficits begin early, but remain stable (Green et al., 2011;Pinkham et al., 2007).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Montag et al., 2007 source

      Not checked in the free run.

    • cites Kucharska-Pietura et al., 2005

      Not checked in the free run.

    • cites Green et al., 2011

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some studies link greater fantasy ability to more hallucinations and delusions, and greater fantasy in relatives of people with schizophrenia to psychosis risk.

    “some literature shows a significant association between greater fantasy abilities and increased hallucinations and delusions (Sparks et al., 2010), and heightened fantasy abilities in relatives of people with schizophrenia have been associated with measures of psychosis risk (Montag et al., 2012b).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Sparks et al., 2010 source

      Not checked in the free run.

    • cites Montag et al., 2012b

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The perspective-taking subscale mainly measures emotional perspective-taking, while many theory-of-mind tasks assess thoughts and intentions instead.

    “The smaller effect may be related to the content of the perspective-taking subscale, which primarily assesses emotional perspective-taking, whereas many theory of mind assessments focus only on the ability to discern thoughts and intentions, neglecting the emotional aspect of knowing the other (see Shamay-Tsoory et al., 2005 for a discussion of this issue).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Shamay-Tsoory et al., 2005

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    For personal distress, trim-and-fill imputed two values, but the revised effect size was nearly identical to the uncorrected one, so publication bias was judged minimal.

    “As the imputed and non-corrected effect sizes are nearly the same, publication bias can be considered minimal for the personal distress meta-analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Emotional perspective-taking may be more directly affected by duration of illness than other forms of perspective-taking usually assessed in theory of mind measurement.

    “Alternatively, emotional perspective-taking may be more directly impacted by duration of illness, as opposed to other forms of perspective-taking usually assessed in theory of mind measurement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The meta-analytic results were limited by small samples using convenience sampling and by frequently incomplete moderator data.

    “our results were limited by small samples that employed convenience sampling methods and often reported incomplete moderator datathese issues should be considered when interpreting our meta-analytic results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Meta-analyses are always subject to the threat of the file drawer problem.

    “there is always the threat of the “file drawer” problem”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Card, 2012

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Only one other study has examined all four IRI components measured here, and that study had a much reduced sample size.

    “only one other study has examined all four components measured here (Achim et al., 2011), and that was with a much reduced sample size.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Achim et al., 2011 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Some research indicates that reading fiction is linked to greater empathy and prosocial behavior.

    “However, some research indicates that reading fiction is associated with increased empathy and prosocial behavior (Johnson, 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Johnson, 2012 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The results may not generalize to other conceptualizations of empathy and may not represent the complete picture of empathy deficits.

    “Results may not generalize to other empathic conceptualizations and may not represent the complete picture regarding empathy deficits.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Duration of illness may have a greater impact on self-reported perspective-taking abilities than on performance-based theory of mind assessments.

    “It may be that duration of illness has a greater impact on self-reported perspective-taking abilities (perhaps decreasing self-perception due to depleted confidence after years of illness) than on performance-based theory of mind assessments.”
    Quote in the paperNot a substantial claim
22 of 22

  • The paper relies on this without support.

    The IRI subscales validly measure the four empathy components in people with schizophrenia as they do in healthy controls.

    “The four-factor model has been used predominantly in the form of the Interpersonal Reactivity Index (IRI; Davis, 1983), a self-report instrument designed to assess empathic tendencies in each of the four components.”

  • The paper relies on this without support.

    Duration of illness reported in the included studies validly indexes chronic course and is comparable across studies.

    “Variables coded only in the schizophrenia samples included diagnosis (percent schizophrenia, percent schizoaffective disorder, and percent other psychotic disorder) and duration of illness, when available.”
    “Duration of illness was tested as a continuous moderator.”

  • The paper relies on this without support.

    Empathic concern and perspective-taking map most closely onto affective and cognitive empathy, respectively.

    “As the empathic concern and perspective-taking components map most closely onto affective and cognitive empathy”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Self-reported personal distress is atypically high in eating disorders, schizophrenia, Tourette syndrome, OCD, and depression.

    “Self-reported personal distress has been found to be atypically high, for example, in those with eating disorders (Beadle et al., 2013; Duchesne et al., 2012; Guttman and Laporte, 2002), schizophrenia (Bonfils et al., 2017), Tourette syndrome (Eddy et al., 2015), OCD (Kang et al., 2012), and depression (Banzhaf et al., 2018).”

    From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as Bonfils et al., 2017

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. Andrews, 2013, Mirror systems and social cognition in schizophrenia, Schizophr. Bull., 39, S218
  2. Baumeister, 1998, Ego depletion: is the active self a limited resource?, J. Pers. Soc. Psychol., 74, 1252, 10.1037/0022-3514.74.5.1252 · DOI · Paper page
  3. Contardi, 2016, The association among difficulties in emotion regulation, hostility, and empathy in a sample of young Italian adults, Front. Psychol., 7
  4. Corbera, 2014, The relationship between functional deficits and empathy for emotional pain in schizophrenia, Biol. Psychiatry, 75, 200S
  5. Kucharska-Pietura, 2013, Can antipsychotics improve social cognition in patients with schizophrenia? CNS, Drugs, 27, 335
  6. Lam, 2014, The relationship between neurocognition and symptomatology in people with schizophrenia: social cognition as the mediator, BMC Psychiatry, 14, 1
  7. Sprong, 2007, Theory of mind in schizophrenia: meta-analysis, Br. J. Psychiatry, 191, 5, 10.1192/bjp.bp.107.035899 · DOI · Paper page

Cited by

Sorted by citations

Authors
Bonfils, K. A., Lysaker, P. H., Minor, K. S., & Salyers, M. P.
Affiliations
  • Indiana University – Purdue University Indianapolis (US)
  • Richard L. Roudebush VA Medical Center (US)
Corresponding author
Bonfils, Kelsey A.
ORCID
Venue
Psychiatry Research
Publisher
Elsevier BV
Published
2017-03
Volume
249
Pages
293-303
ISSN
0165-1781 (ISSN-L)
DOI
10.1016/j.psychres.2016.12.033
OpenAlex
W2565774283
Cited by
115
References
70
Citations by year
2026: 5 · 2025: 16 · 2024: 14 · 2023: 14 · 2022: 13 · 2021: 12 · 2020: 14 · 2019: 15 · 2018: 8 · 2017: 4
FWCI
1.28
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Psychiatry Research (publishedVersion)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
Keywords
empathy, schizophrenia, Interpersonal Reactivity Index, empathic concern, perspective taking, personal distress, fantasy, disease duration, sex differences, emotion regulation
MeSH terms
Adult, Empathy, Female, Humans, Male, Schizophrenia, Schizophrenic Psychology, Self Report, Social Skills

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