International Journal of Clinical Pharmacy

, Volume 37, Issue 6, pp 1258–1266 | Cite as

Exploring autistic-like traits relating to empathic attitude and psychological distress in hospital pharmacists

  • Yuji Higuchi
  • Yosuke Uchitomi
  • Maiko Fujimori
  • Toshihiro Koyama
  • Hitomi Kataoka
  • Yoshihisa Kitamura
  • Toshiaki Sendo
  • Masatoshi InagakiEmail author
Research Article


Background Pharmacists are expected to play a key role in modern cancer care. Research suggests that an empathic approach and attitude in medical staff improves the quality of patient care. An empathic attitude and psychological distress are thought to be associated with autistic-like traits, but little is known about such traits. Objective In this study, we aimed to clarify the associations among autistic-like traits, empathic attitude in a medical context, and psychological health in hospital pharmacists. Setting Eligibility criteria for inclusion were certified pharmacists working at hospitals for patient care who returned their questionnaires. Method Eight hundred and twenty-three hospital pharmacists completed a number of self-administered questionnaires anonymously by mail. Main outcome measures Scores were obtained on the Autism-Spectrum Quotient, the Jefferson Scale of Empathy, the General Health Questionnaire-12, and subscales of the Interpersonal Reactivity Index (Perspective Taking, IRI-Empathic Concern, IRIPersonal Distress). We performed correlation and mediation analyses to confirm that the empathy and general health questionnaires were associated with autism-spectrum quotient scores, and with each IRI subscale. Results Complete responses were obtained from 379 pharmacists comprising 151 males (39.8 %) with a mean age of 37.7 ± 10.8 years (missing data, n = 13) and a median of 11 years after qualification as a pharmacist. Autism-Spectrum Quotient scores were inversely correlated with empathy (r = −0.22, p < 0.001) and positively correlated with general health scores (r = 0.40, p < 0.001). In the models with mediation, the inverse correlation between autism-spectrum quotient and empathy scores was mediated indirectly by IRI-Perspective Taking and IRI-Empathic Concern, and the positive correlation between autism-spectrum quotient and general health was mediated indirectly by IRI-Personal Distress. There were also direct effects, with significant effects of autism-spectrum quotient on empathy and general health scores. Conclusion Our findings suggest that autistic-like traits affect both empathic attitude in a medical context and the psychological health of pharmacists. We recommend that to improve empathy in those with high levels of autistic-like traits, we may need to develop specialized interventions, such as improving communication skills training.


Empathy Hospital pharmacist Japan Pharmaceutical care 



The authors thank the Okayama Society of Hospital Pharmacists for study participation, and all the participants. The authors thank Akio Wakabayashi for permission to use the Japanese AQ. The authors express their gratitude for the enormous help of Shoko Yoshimoto for fund management and Yifei Tang and Kyoko Hageshita for excellent data management.


This study was supported by the Research for Promotion of Cancer Control Programmes (H26-Gan Seisaku-ippan-002 and H25-Seishin-ippan-001) Health and Labour Sciences Research Grants from the Ministry of Health, Labour and Welfare, Japan.

Conflicts of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Liekweg A, Westfeld M, Jaehde U. From oncology pharmacy to pharmaceutical care: new contributions to multidisciplinary cancer care. Support Care Cancer. 2004;12:73–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Pollak KI, Arnold RM, Jeffreys AS, Alexander SC, Olsen MK, Abernethy AP, et al. Oncologist communication about emotion during visits with patients with advanced cancer. J Clin Oncol. 2007;25:5748–52.CrossRefPubMedGoogle Scholar
  3. 3.
    Larson EB, Yao X. Clinical empathy as emotional labor in the patient-physician relationship. JAMA, J Am Med Assoc. 2005;293:1100–6.CrossRefGoogle Scholar
  4. 4.
    Fujimori M, Shirai Y, Asai M, Kubota K, Katsumata N, Uchitomi Y. Effect of communication skills training program for oncologists based on patient preferences for communication when receiving bad news: a randomized controlled trial. J Clin Oncol. 2014;32:2166–72.CrossRefPubMedGoogle Scholar
  5. 5.
    Fujimori M, Uchitomi Y. Preferences of cancer patients regarding communication of bad news: a systematic literature review. Jpn J Clin Oncol. 2009;39:201–16.CrossRefPubMedGoogle Scholar
  6. 6.
    Fujimori M, Oba A, Koike M, Okamura M, Akizuki N, Kamiya M, et al. Communication skills training for Japanese oncologists on how to break bad news. J Cancer Educ. 2003;18:194–201.CrossRefPubMedGoogle Scholar
  7. 7.
    World-Health-Organization. The role of the pharmacist in the Health Care System. 1994 Accessed 21 Jun 2015.
  8. 8.
    American-Society-of-Health-System-Pharmacists. ASHP statement on pharmaceutical care. Am J Hosp Pharm. 1993;50:1720–3.Google Scholar
  9. 9.
    Wallman A, Vaudan C, Sporrong SK. Communications training in pharmacy education, 1995-2010. Am J Pharm Educ. 2013;77:36.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Berger BA. Building an effective therapeutic alliance: competence, trustworthiness, and caring. Am J Hosp Pharm. 1993;50:2399–403.PubMedGoogle Scholar
  11. 11.
    Fjortoft N, Zgarrick D. An assessment of pharmacists’ caring ability. J Am Pharm Assoc JAPhA. 2003;43:483–7.CrossRefGoogle Scholar
  12. 12.
    Lonie JM. From counting and pouring to caring: the empathic developmental process of community pharmacists. Res Social Adm Pharm RSAP. 2006;2:439–57.CrossRefPubMedGoogle Scholar
  13. 13.
    Lor KB, Truong JT, Ip EJ, Barnett MJ. A randomized prospective study on outcomes of an empathy intervention among second-year student pharmacists. Am J Pharm Educ. 2015;79:18.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Lundstrom S, Chang Z, Kerekes N, Gumpert CH, Rastam M, Gillberg C, et al. Autistic-like traits and their association with mental health problems in two nationwide twin cohorts of children and adults. Psychol Med. 2011;41:2423–33.CrossRefPubMedGoogle Scholar
  15. 15.
    Lundstrom S, Chang Z, Rastam M, Gillberg C, Larsson H, Anckarsater H, et al. Autism spectrum disorders and autistic like traits similar etiology in the extreme end and the normal variation. Arch Gen Psychiatry. 2012;69:46–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Zaki J, Ochsner K. The neuroscience of empathy: progress, pitfalls and promise. Nat Neurosci. 2012;15:675–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Mazza M, Pino MC, Mariano M, Tempesta D, Ferrara M, De Berardis D, et al. Affective and cognitive empathy in adolescents with autism spectrum disorder. Front Hum Neurosci. 2014;8:791.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Baron-Cohen S. Zero degrees of empathy: a new theory of human cruelty. Delhi: Penguin Books Limited; 2011.Google Scholar
  19. 19.
    Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E. The Autism-Spectrum Quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001;31:5–17.CrossRefPubMedGoogle Scholar
  20. 20.
    Wakabayashi A, Baron-Cohen S, Wheelwright S, Tojo Y. The Autism-Spectrum Quotient (AQ) in Japan: a cross-cultural comparison. J Autism Dev Disord. 2006;36:263–70.CrossRefPubMedGoogle Scholar
  21. 21.
    Hojat M, Mangione S, Nasca TJ, Cohen MJM, Gonnella JS, Erdmann JB, et al. The Jefferson Scale of Physician Empathy: development and preliminary psychometric data. Educ Psychol Meas. 2001;61:349–65.CrossRefGoogle Scholar
  22. 22.
    Hojat M, Gonnella JS, Mangione S, Nasca TJ, Veloski JJ, Erdmann JB, et al. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002;36:522–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Hojat M. Empathy in patient care: antecedents, development, measurement, and outcomes. Heidelberg: Springer; 2007.Google Scholar
  24. 24.
    Hojat M, Mangione S, Kane GC, Gonnella JS. Relationships between scores of the Jefferson scale of physician empathy (JSPE) and the interpersonal reactivity index (IRI). Med Teach. 2005;27:625–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002;159:1563–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86:359–64.CrossRefPubMedGoogle Scholar
  27. 27.
    Del Canale S, Louis DZ, Maio V, Wang XH, Rossi G, Hojat M, et al. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Acad Med. 2012;87:1243–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Kataoka HU, Koide N, Ochi K, Hojat M, Gonnella JS. Measurement of empathy among japanese medical students: psychometrics and score differences by gender and level of medical education. Acad Med. 2009;84:1192–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med. 1979;9:139–45.CrossRefPubMedGoogle Scholar
  30. 30.
    Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, et al. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med. 1997;27:191–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Davis MH. Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol. 1983;44:113–26.CrossRefGoogle Scholar
  32. 32.
    Aketa Y. Structure and measurement of empathy: Japanese version of Davis’s Interpersonal Reactivity Index (IRI-J). The Psychological report of Sophia University. 1999, vol 23, pp 19–31.Google Scholar
  33. 33.
    Doherty RW. The emotional contagion scale: a measure of individual differences. J Nonverbal Behav. 1997;21:131–54.CrossRefGoogle Scholar
  34. 34.
    Kimura M, Yogo M, Daibo I. Development of a Japanese version of the Emotional Contagion Scale. Jpn J Interpers Soc Psychol. 2007;7:31–9.Google Scholar
  35. 35.
    O’Brien E, Konrath SH, Gruhn D, Hagen AL. Empathic concern and perspective taking: linear and quadratic effects of age across the adult life span. J Gerontol B Psychol. 2013;68:168–75.CrossRefGoogle Scholar
  36. 36.
    Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40:879–91.CrossRefPubMedGoogle Scholar
  37. 37.
    Hadjikhani N, Zurcher NR, Rogier O, Hippolyte L, Lemonnier E, Ruest T, et al. Emotional contagion for pain is intact in autism spectrum disorders. Transl Psychiatry. 2014;4:e343.PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Mazefsky CA, Herrington J, Siegel M, Scarpa A, Maddox BB, Scahill L, et al. The role of emotion regulation in autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2013;52:679–88.PubMedCentralCrossRefPubMedGoogle Scholar
  39. 39.
    Epner DE, Baile WF. Difficult conversations: teaching medical oncology trainees communication skills one hour at a time. Acad Med. 2014;89:578–84.CrossRefPubMedGoogle Scholar
  40. 40.
    Buruck G, Wendsche J, Melzer M, Strobel A, Dorfel D. Acute psychosocial stress and emotion regulation skills modulate empathic reactions to pain in others. Front Psychol. 2014;5:517.PubMedCentralCrossRefPubMedGoogle Scholar
  41. 41.
    Kidd DC, Castano E. Reading literary fiction improves theory of mind. Science. 2013;342:377–80.CrossRefPubMedGoogle Scholar
  42. 42.
    McLellan MF, Jones AH. Why literature and medicine? Lancet. 1996;348:109–11.CrossRefPubMedGoogle Scholar
  43. 43.
    Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA, J Am Med Assoc. 2009;302:1284–93.CrossRefGoogle Scholar
  44. 44.
    Spek AA, van Ham NC, Nyklicek I. Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial. Res Dev Disabil. 2013;34:246–53.CrossRefPubMedGoogle Scholar
  45. 45.
    White SW, Albano AM, Johnson CR, Kasari C, Ollendick T, Klin A, et al. Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clin Child Fam Psychol Rev. 2010;13:77–90.PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Curtis JR, Back AL, Ford DW, Downey L, Shannon SE, Doorenbos AZ, et al. Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. JAMA. 2013;310:2271–81.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Yuji Higuchi
    • 1
  • Yosuke Uchitomi
    • 2
  • Maiko Fujimori
    • 3
  • Toshihiro Koyama
    • 4
  • Hitomi Kataoka
    • 5
  • Yoshihisa Kitamura
    • 4
  • Toshiaki Sendo
    • 4
  • Masatoshi Inagaki
    • 6
    Email author
  1. 1.Department of NeuropsychiatryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  2. 2.Innovation Center for Supportive, Palliative and Psychosocial CareNational Cancer Center TokyoJapan
  3. 3.Center for Suicide Prevention, National Institute of Mental HealthNational Center for Neurology and PsychiatryKodaira, TokyoJapan
  4. 4.Department of Clinical PharmacyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  5. 5.Department of Primary Care and Medical EducationOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  6. 6.Department of NeuropsychiatryOkayama University HospitalKita-ku, OkayamaJapan

Personalised recommendations