The relationship between dispositional empathy, psychological distress, and posttraumatic stress responses among Japanese uniformed disaster workers: a cross-sectional study

Nagamine et al. BMC Psychiatry (2018) 18:328 https://doi.org/10.1186/s12888-018-1915-4 RESEARCH ARTICLE Open Access The relationship between dispositional empathy, psychological distress, and posttraumatic stress responses among Japanese uniformed disaster workers: a cross-sectional study Masanori Nagamine1* , Jun Shigemura2, Toshimichi Fujiwara3, Fumiko Waki3, Masaaki Tanichi2, Taku Saito2, Hiroyuki Toda2, Aihide Yoshino2 and Kunio Shimizu1 Abstract Background: Disaster workers suffer from psychological distress not only through the direct experience of traumatic situations but also through the indirect process of aiding disaster victims. This distress, called secondary traumatic stress, is linked to dispositional empathy, which is the tendency for individuals to imagine and experience the feelings and experiences of others. However, the association between secondary traumatic stress and dispositional empathy remains understudied. Methods: To examine the relationship between dispositional empathy and mental health among disaster workers, we collected data from 227 Japan Ground Self-Defense Force personnel who engaged in international disaster relief activities in the Philippines following Typhoon Yolanda in 2013. The Impact of Event Scale-Revised and the Kessler Psychological Distress Scale were used to evaluate posttraumatic stress responses (PTSR) and general psychological distress (GPD), respectively. Dispositional empathy was evaluated through the Interpersonal Reactivity Index, which consists of four subscales: Perspective Taking, Fantasy, Empathic Concern, and Personal Distress. Hierarchial linear regression analyses were performed to identify the variables related to PTSR and GPD. Results: High PTSR was significantly associated with high Fantasy (identification tendency, β = 0.21, p < .01), high Personal Distress (the self-oriented emotional disposition of empathy, β = 0.18, p < .05), and no experience of disaster relief activities (β = 0.15, p < .05). High GPD was associated with high Personal Distress (β = 0.28, p < .001), marital status (married, β = 0.22, p < .01), being female (β = 0.18, p < .01), medical unit (β = 0.18, p < .05), and no experience of disaster relief activities (β = 0.13, p < .05). Conclusions: Among Japanese uniformed disaster workers, high PTSR was associated with two subtypes of dispositional empathy: the self-oriented emotional disposition of empathy and high identification tendency, whereas high GPD was associated with high identification tendency. Educational interventions that aim to mitigate these tendencies might be able to relieve the psychological distress of disaster workers. Keywords: Disaster workers, Empathy, Interpersonal reactivity index, Identification, Secondary traumatic stress, Posttraumatic stress response, Psychological distress * Correspondence: 1 Division of Behavioral Science, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Nagamine et al. BMC Psychiatry (2018) 18:328 Background On November 8, 2013, Typhoon Yolanda struck the Philippines and caused large-scale damage: 6300 individuals were killed, 28,688 were injured, and 1062 were missing [1]. The Japanese government responded to a humanitarian assistance request from the Filipino government and sent Japan Self-Defense Forces’ personnel to the affected area. Disaster relief activities consisted of medical assistance, epidemic prevention, and transport of relief supplies [2], which continued until December 18, 2013. Disasters result in mental health distress not only among survivors but also among disaster workers [3, 4]. These individuals have the burden of rescuing lives in disaster-stricken sites fraught with life-threatening danger. In addition to such direct traumatic stresses, disaster workers can also experience indirect psychological effects of aiding disaster victims, which is defined as secondary traumatic stress [5]. These psychological effects can result in various reactions, including depression and anxiety disorder, in addition to stress-related disorders, such as acute and post-traumatic stress disorder [6]. According to a recent meta-analysis, the pooled prevalence of posttraumatic stress disorder among rescue workers was 10% [7], indicating the magnitude of their work-related traumatic experience on worker’s mental health. Countermeasures for work-related traumatic stress are crucial for disaster workers to prevent adverse mental health outcomes. Coping strategies to mitigate such impacts include sufficient training prior to missions [8–10], awareness of and pride in one’s duties [11, 12], and humor [8, 13, 14]. Minimization of excessive empathy and identification with victims is also recommended to prevent traumatic stress [8, 15–17], which is supported by two empirical studies [15, 17]. Empathy is a multi-dimensional concept with emotional and cognitive components [18]. Davis defined empathy as the “reactions of one individual to the observed experiences of another” and developed the Interpersonal Reactivity Index (IRI), which is a multi-dimensional scale of empathic traits [19]. The IRI consists of four subscales: Perspective Taking (PT; the tendency to spontaneously adopt the psychological point of view of others), Fantasy (FS; the respondents’ tendencies to transpose themselves imaginatively into the feelings and actions of fictitious characters in books, movies, and plays), Empathic Concern (EC; “other-oriented” feelings of sympathy and concern for unfortunate others), and Personal Distress (PD; “self-oriented” feelings of personal anxiety and unease in tense interpersonal settings). Although the construct of self-oriented negative feeling (e.g., PD) is not included in the narrowly defined empathy [20], IRI provides multifaceted information on aspects of dispositional empathy and thus, is one of the most widely used measures to evaluate empathy [21]. Page 2 of 7 As to the relationships between empathy and secondary traumatic stress, Figley reported that individuals who have a great capacity to feel and express empathy tend to be more vulnerable to the traumatic stress in his studies of healthcare workers [22]. Klimecki and Singer suggest that the consequence of empathy take on two paths; one is an “other-orient (...truncated)