When Being Social Is Costly: Empathy's Role for Risk States, Acute Symptoms, and Cumulative Disease Severity of Depression

OBJECTIVES: Patients with major depressive disorder (MDD) frequently report burdensome interpersonal difficulties and altered empathy and perspective-taking. Previous findings on binary comparisons between patients and healthy controls are limited in their clinical translation as they neglect dissociable risk and disease states. In this preregistered study (https://osf.io/k6mdh/overview?view_only=04b7f39f59a8434292cd472120f661ca), we extend case-control comparisons by additionally investigating empathic distress, empathic concern, and perspective-taking in association with (a) familial MDD risk, (b) acute symptom severity, and (c) cumulative MDD severity. METHOD: We analyzed data from n = 499 MDD patients and n = 670 healthy controls from the Marburg-Münster-Affective-Cohort Study. Robust linear regressions were run to investigate group differences in self-reported empathy and perspective-taking and their associations with acute symptom severity and familial MDD risk. Analyses on cumulative MDD severity were run in a structural equation model. RESULTS: Empathic distress was positively associated with both acute and cumulative MDD severity and was elevated in patients compared to healthy controls. A positive association between empathic distress and familial MDD risk became non-significant after adjustment for age and sex. Patients also reported higher levels of empathic concern-likely influenced by acute symptom severity-and slightly lower levels of perspective-taking. CONCLUSIONS: Our associational findings indicate empathic distress to constitute a correlate of acute MDD and longer-term MDD progression, while its relevance for MDD risk requires further investigation. We provide new indications of a generalized heightened emotional attunement during acute depression, entailing both empathic concern and empathic distress. Longitudinal studies are warranted to probe causal associations to prospectively inform psychotherapeutic interventions addressing maladaptive empathic processes.