{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:07:49Z","timestamp":1791378469035,"version":"4.3.2"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As a critical capacity in medical education, the trajectory of empathy development and its relationship with medical students\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2019 interpersonal competence, rumination, and psychological distress were measured. Linear regression assessed the empathy\u2013distress association, and parallel mediation modeling tested rumination and interpersonal competence as simultaneous mediators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 \u00b1 9.84 vs. 82.68 \u00b1 8.58,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.016); and higher-grade students performed higher empathy (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Empathy was positively associated with psychological distress, more rumination thinking, and better interpersonal competence. Interpersonal competence (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = -0.01,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.018) and rumination (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = 0.02,\n                      <jats:italic>p<\/jats:italic>\n                      = 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1725496","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T09:00:11Z","timestamp":1766134811000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The relationship between empathy and mental health: A mediation model via rumination and interpersonal 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