Meta‐analysis of associations between empathy and alcohol use and problems in clinical and non‐clinical samples

Abstract

Aims: To (1) measure the aggregated effect size of empathy deficits in individuals with alcohol use disorder (AUD) compared with healthy controls, (2) measure the aggregated effect sizes for associations between lower empathy and heavier alcohol consumption and more alcohol problems in non-clinical samples and (3) identify potential moderators on the variability of effect sizes across studies in these meta-analyses.Method: PsycINFO, PubMed and Google Scholar were searched following a preregistered International Prospective Register of Systematic Reviews (PROSPERO) protocol (CRD42021225392) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We meta-analyzed (using random-effects models) mean differences in empathy between individuals with AUD compared with healthy controls and associations between empathy and alcohol consumption and alcohol problems in non-clinical samples. A total of 714 participants were included in the meta-analysis on clinical samples; 3955 were included in the meta-analyses on non-clinical samples.Results: Individuals with AUD reported significantly lower empathy than healthy controls [Hedges' g = −0.53, 95% confidence interval (CI) = −0.91, -0.16, k = 9, P < 0.01, Q = 40.09, I 2 = 80.04]. Study quality [Q = 1.88, degrees of freedom (d.f.) = 1, P = 0.17] and gender (β = −0.006, Z = −0.60, P = 0.55) were not moderators. Increases in age corresponded to an increase in effect size (β = 0.095, Z = 3.34, P < 0.001). Individuals with AUD (versus healthy controls) had significantly lower cognitive (Hedges' g = −0.44, CI = −0.79, -0.10, P < 0.05), but not affective empathy (Hedges' g = −0.19, CI = −0.51, 0.14, P = 0.27), and the difference between these was significant (Z = 2.34, k = 6, P < 0.01). In non-clinical samples, individuals with lower (versus higher) empathy reported heavier alcohol consumption (r = −0.12, CI = −0.15, -0.09, k = 11, P < 0.001, Q = 9.68, I 2 = 0.00) and more alcohol problems (r = −0.08, CI = −0.14, -0.01, k = 7, P = 0.021, Q = 6.55, I 2 = 8.34). There was no significant heterogeneity across studies. Conclusion:Individuals with alcohol use disorder appear to show deficits in empathy compared with healthy controls. Deficits are particularly pronounced for older individuals and for cognitive (versus affective) empathy. In non-clinical samples, lower empathy appears to be associated with heavier alcohol consumption and more alcohol problems.

Systematic review and meta‐analysis on the association between theory of mind and alcohol problems in non‐clinical samples

“…Longterm heavy alcohol use is often thought to explain deficits in ToM in individuals with AUD (Bora & Zorlu, 2016;Onuoha et al, 2016), but this meta-analysis demonstrates that links between ToM and alcohol problems also exist in non-clinical samples (i.e., individuals without a similar history of long-term and heavy alcohol consumption as those with AUD). Studies included in this meta-analysis were all cross-sectional, but the results align with the notion suggested by some researchers that deficits in ToM and related socio-cognitive constructs (e.g., empathy) may also precede the development of AUD and serve as a risk factor for problematic alcohol use (Kumar et al, 2022;Massey et al, 2018;Winters et al, 2021). Indeed, we recently reported a reliable association between lower empathy and heavier alcohol use and more alcohol problems in non-clinical samples, with comparable effect sizes to what was found here (Kumar et al, 2022).…”

“…Studies included in this meta-analysis were all cross-sectional, but the results align with the notion suggested by some researchers that deficits in ToM and related socio-cognitive constructs (e.g., empathy) may also precede the development of AUD and serve as a risk factor for problematic alcohol use (Kumar et al, 2022;Massey et al, 2018;Winters et al, 2021). Indeed, we recently reported a reliable association between lower empathy and heavier alcohol use and more alcohol problems in non-clinical samples, with comparable effect sizes to what was found here (Kumar et al, 2022).…”

“…Multiple mechanisms have been proposed to explain the link between ToM deficits and greater alcohol use and problems in non-clinical samples, including alcohol consumption for peer acceptance, misperceiving peers' attitudes about drinking, using alcohol as a coping mechanism in social situations, or because alcohol use is preferred over making social connections (Kuntsche et al, 2005;Laghi et al, 2019;Lyvers et al, 2019;Winters et al, 2021). Another proposed mechanism is that individuals with impaired social cognition (e.g., ToM, empathy) may especially benefit from alcohol's prosocial effects (Kumar et al, 2022). For TA B L E 2 Meta-analysis of studies assessing the association between ToM and alcohol problems in nonclinical samples instance, a recent study showed that a low dose (0.24-0.29 g/kg) of alcohol, compared to a placebo, increased affective empathy in adult social drinkers (N = 60), and this effect was stronger for individuals with lower baseline trait empathy (Dolder et al, 2017).…”

Indirect effects of theory of mind on alcohol use and problems in underage drinkers: The role of peer pressure to drink

“…Additionally, this is the first study to test for and find indirect effects of ToM on alcohol consumption and drinking problems through conformity motives in an underaged sample. Our findings add to a growing literature indicating the risks of lower socio-cognitive abilities on alcohol consumption and problems among young people ( Kumar et al, 2022a , Laghi et al, 2019 , Lannoy et al, 2020 ) by suggesting a potential underlying mechanism in the link between lower ToM and alcohol misuse.…”

“…Recent work highlights the importance of socio-cognitive abilities, such as theory of mind (ToM) and empathy ( Bulgarelli & Molina, 2016 ), in predicting alcohol use and problems among young people ( Kumar et al, 2022a , Kumar et al, 2022b , Lannoy et al, 2020 , Winters et al, 2021 ). Theory of mind (ToM) is typically defined as the ability to recognize and attribute mental states (e.g., intentions, desires, beliefs, emotions) to oneself and others ( Frith & Frith, 2005 ), and is often measured using the Reading the Mind in the Eyes Task (RMET; Baron-Cohen et al, 2001 ), which assesses the ability to infer the mental states of others based on eye region cues.…”