ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Public Mental Health
This article is part of the Research TopicPromoting Mental Health among Healthcare ProfessionalsView all 7 articles
The relationship between empathy and mental health: A mediation model via rumination and social competence
Provisionally accepted
Fan Zhang
Chenqi JiangTszching WongYachang LinChing-yi HoYen-wen ChenMeiyan Poon
Siuhin Li
Xueting WangYuting FangXinhua Li*Pengjun Li*Yuying Ma*- Jinan University, Guangzhou, China
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Background: 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. Methods: 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. Results: 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. Conclusion: 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.
Keywords: Empathy, Medical students, psychological distress, rumination, Interpersonalcompetence
Received: 15 Oct 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Zhang, Jiang, Wong, Lin, Ho, Chen, Poon, Li, Wang, Fang, Li, Li and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xinhua Li, tlixinhua@jnu.edu.cn
Pengjun Li, pengjunsd@163.com
Yuying Ma, mayuying@jnu.edu.cn
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