The relationship between empathy and mental health: A mediation model via rumination and interpersonal competence.

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, 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.