Empathy in Adults with Acquired Brain Injury: a Systematic Review and Meta-Analysis

Empathy is the ability to recognise, share and understand others' emotional states. Increasing evidence suggests that empathy may be impacted by acquired brain injury (ABI), with consequences for social and emotional functioning. However, the literature has been characterised by inconsistent findings and small sample sizes. To address these limitations, we provide the first meta-analytic review of empathy in adults with ABI. Specifically, the review aimed to quantify the degree of impairment in adults with ABI across four empathy-related domains: cognitive, affective, empathic concern (e.g. sympathy) and personal distress. We also sought to estimate the prevalence of deficits in each area and explore whether demographic and injury factors moderate impairment. A systematic search yielded 29 studies measuring self-reported empathy in adults with ABI versus healthy, matched peers. A series of random-effects meta-analyses revealed moderate deficits in cognitive empathy (Hedges' g =  - 0.68, 95% CI [- 0.87, - 0.50]) and affective empathy (Hedges' g =  - 0.43, 95% CI [- 0.65, - 0.21]), as well as small-to-moderate deficits in empathic concern (Hedges' g =  - 0.38, 95% CI [- 0.63, - 0.13]). No significant difference was found for personal distress. We estimated the proportion of ABI participants scoring equal to or more than 1 SD below the normative mean to be 15.3-35.0%, depending on the empathy subcomponent. Our results highlight that empathy deficits may play an important role in functional or emotional difficulties post-brain injury. This demonstrates the need for routine clinical assessment of empathy in survivors of brain injury and the need to develop interventions which target both cognitive and affective components.