Psychometric validation of an Arabic-language version of the Pictorial Empathy Test (PET) and the single-item empathy scale (SITES) for adults

Psychometric validation of an Arabic-language version of the Pictorial Empathy Test (PET) and the single-item empathy scale (SITES) for adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric validation of an Arabic-language version of the Pictorial Empathy Test (PET) and the single-item empathy scale (SITES) for adults Feten Fekih-Romdhane, Ghada Amouchi, Amira Mohammed Ali, Majda Cheour, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4660388/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background No instrument could be considered and recommended as the gold standard assessment method for empathy based on desirable validity and reliability indices. Recently, two new measures were developed to address previous gaps in measuring empathy, i.e. the Pictorial Empathy Test (PET) to assess affective empathic reactions and the Single Item Trait Empathy Scale (SITES) to assess general trait empathy. The PET stands out from the existing self-report measures that use text-based items because it proposes a novel approach to conceptualize the empathy construct from an ecological perspective using photographs as emotional stimuli, while the SITES stands out because it consists of a single item. This study aims to examine the psychometric properties of an Arabic translation of the PET and SITES in a sample of Arabic-speaking young adults from the general population of Tunisia. Methods This is a cross-sectional study carried out from March to May 2024 using a snowball spread method. A total of 502 participants (mean age of 21.74 years, 64.9% females) filled an online anonymous survey. The PET and SITES were translated into Arabic using the forward-backward translation method. Results Exploratory Factor Analysis showed that the PET’s unidimensionality was supported with an acceptable goodness-of-fit, and that good congruence of the factor structure of the SITES was supported across sex. Besides, the PET and the SITES exhibited satisfactory reliability coefficients. Positive correlations were observed between PET and SITES scores. The SITES, but not the PET, scores correlated significantly and positively with psychological distress. Both the SITES and the PET showed no significant correlations with self-esteem scores. Comparison of empathy levels between sexes showed no significant differences between males and females, both when using the PET or the SITES. Conclusion While the present validation study leaves further work to be completed, it provides to practitioners and researchers two validated measures of empathy in the Arabic language. The two scales are brief, cost-effective, well-accepted, and can be easily understood by participants. We thus recommend their use in future clinical and research practices, in particular in settings where resources and time can be limited. Empathy Affective empathy Trait empathy Single-item Validation Psychometric properties Arabic INTRODUCTION Empathy is essential at all ages, in everyday life and every part of society. Affective empathy refers to the ability to feel other people’s emotional experiences indirectly, thus enabling to comprehend their intentions and anticipate their behaviors [ 1 ]. During childhood, experiencing empathic feelings for others is crucial to emotional development [ 2 ] and contributes to the development of social morality[ 3 ]. During adulthood, the ability to feel empathy allows effective interactions with people in social contexts. There is certain agreement that empathy includes two different components, cognitive and affective (or emotional) [ 4 , 5 ], which are neurologically dissociable, underpinned by impairments in different areas of the brain [ 6 , 7 ]. Cognitive empathy is being able to take the other’s perspective [ 8 ] or to understand the other’s emotions [ 9 ]. Affective or emotional empathy is the ability to respond with an appropriate emotional reaction to the other’s feelings or situation [ 4 , 8 ]. There are important interindividual differences in emotional reactions arising from contact with other people in the general population [ 10 ]; and such variations in empathic abilities were shown to affect, in turn, one’s social life [ 11 ]. For instance, being able to feel empathy in a given situation, such as a person’s suffering, can be impaired in traumatic brain injury [ 12 ], in schizophrenia [ 13 ], in high risk states of developing criminal behavior [ 14 ], and nonexistent or inappropriate in psychopathy [ 15 ]. Affective empathic reactions have many positive effects on people’s social life and interactions. For example, affective empathy is closely connected to helping behavior and being human in caring (e.g., psychotherapeutic) relationships [ 16 ]. Possessing higher affective empathy is also associated with enhanced prosocial behavior [ 17 ], stronger intrinsic motivation for altruistic behavior [ 18 ], lower likelihood of engaging in traditional bullying [ 19 ] or substance using behavior [ 20 ], lower levels of aggression [ 21 ], and a better quality of sleep [ 22 ]. At the same time, the experience of empathy may lead to a confusion between self and other, and contribute, in turn, to psychological distress [ 23 ]. For all these reasons, a large range of psychotherapeutic approaches highlight the role of empathy as an important component of treatment [ 24 ]. Given that affective empathy was consistently shown to be elementary to social behavior, and because its impairment was linked to a range of psychopathology and behavioral problems, its exploration and measurement in adults’ populations represent a growing need for both clinicians and researchers. The following section expands on the different measurement tools currently available for the assessment of the (general and affective) empathy construct. Measurement instruments of Empathy Empathy can be reflected through many psychological constructs, and measured using self-administered tools [ 25 ]. A wide range of instruments have been developed and utilized to survey individuals’ ability to empathize with others either in general or in specific contexts, such as empathy among physicians [ 26 ], perceived relational empathy among patients in the consultation [ 27 ], teachers’ empathy for students [ 28 ], empathy for the vicarious experience of pain [ 29 ], empathy experienced as anger on behalf of a victimized person, and ethnocultural empathy [ 30 ] (for systematic review and meta-analysis, see [ 31 ]). General empathy instruments available for use in the general population include the 60-item Empathy Quotient [ 4 ], the 28-item Interpersonal Reactivity Index [ 8 ], the Questionnaire of Cognitive and Affective Empathy [ 32 ], the Questionary Measure of Emotional Empathy [ 33 ], the Toronto Empathy Questionnaire [ 34 ], the Empathy Assessment Index [ 35 ], and the Affective and Cognitive Measure of Empathy [ 36 ]. However, most of these measures showed limitations regarding factorial structure and convergent validity [ 31 ], which is likely due to controversies and a lack of theoretical consensus on the multidimensional conceptualization of the empathy construct [ 37 ]. In addition, some of the existing measures were designed to and used in specific subgroups, such as the Basic Empathy Scale intended for assessing empathy in adolescents with antisocial tendencies [ 9 ]. Furthermore, one of the most recurring criticisms of empathy measures is that the construct being assessed is often unclear. For example, it was claimed that the Empathy Quotient measures the ability to function socially rather than empathic tendencies of the individual [ 38 ]; the Interpersonal Reactivity Index contains a “Personal Distress” and a “Fantasy” dimensions that are distinct from the concept of empathy [ 4 ]; the Questionary Measure of Emotional Empathy appears to measure sympathetic reactions and emotional arousal by the environment in general rather than measuring empathy and other people’s distress in particular [ 39 , 40 ]. As such, systematic reviews performed so far on measures of empathic ability both in specific populations [ 41 , 42 ] and in the general population [ 31 ] concluded that no instrument could be considered and recommended as the gold standard assessment method for empathy based on desirable validity and reliability indices. To address these gaps, Lindeman et al. [ 38 ] developed a brief test of affective empathic ability arousal, the Pictorial Empathy Test (PET), and Konrath et al. [ 43 ] developed the Single Item Trait Empathy Scale (SITES). The PET stands out from the existing self-report measures that use text-based items because it proposes a novel approach to conceptualize the empathy construct from an ecological perspective using photographs as emotional stimuli [ 44 ], while the SITES stands out because it consists of a single item [ 31 ]. The PET The PET was designed as a visual measure of affective empathy skills. It consists of 7 sequential photographs of people in vulnerable states (i.e. physical and/or emotional distress) and that are susceptible to elicit empathic emotions. Respondents are asked “How emotionally moving do you find the photograph?”, with answers ranging on a 5-point Likert scale from 1 (not at all) to 5 (very much). Total PET scores can be obtained by calculating mean score of the responses, with higher scores reflecting greater affective empathy. The PET can be applied in different ways, as a web-based questionnaire, as a paper-and-pencil test, or as part of an interview [ 38 ]. As a photo-based instrument, the PET has the potential advantage over other empathy scales of having stronger ecological validity in assessing affective empathy, given that facial expressions of emotions generate an “emotional resonance mechanism” in their watcher, and are thereby central to empathic responses [ 45 ]. The PET can also be appropriate and convenient-to-use when applied in clinical samples who have difficulty to express their answers in questionnaires [ 38 ]. In addition, the PET is different from other measures, that are retrospective in nature, because it enables to immediately capture the respondents’ emotional reactions and empathic feelings. The PET was originally developed and validated in the Finnish language in three different samples of adults from the general population, where it demonstrated good internal reliability and seven-month test-retest reliability, adequate convergent validity, as well as a single-latent-factor structure [ 38 ]. Other cross-cultural adaptation studies have been carried out and reported equivalent psychometric characteristics to the original measure in different languages, countries and samples, including English [ 46 ], Turkish [ 47 ] and Spanish [ 48 ]. The SITES In contrast with the PET which assesses an emotional, situationally determined “state”, the SITES assesses empathy as a “trait” that is relatively stable across situations and over time. The SITES was proposed as a shorter and more specific alternative to the Interpersonal Reactivity Index [ 8 ], which is composed of 28 items and theoretically designed to assess the same construct of trait empathy through different dimensions (i.e., Fantasy, Perspective-taking, Empathic concern, and Personal distress). Respondents are asked to rate the extent to which the following statement describes them “I am an empathetic person”; the answer is rated from 1 (“Not very true of me”) to 5 (“Very true of me”) [ 43 ]. In seven studies and a large sample of adults (N = 5,724), the SITES demonstrated good predictive validity, discriminant validity, convergent validity, and test-retest reliability [ 43 ]. Overall, the SITES was shown to be a valid and reliable way to assess empathy when an efficient, rapid, but still accurate, method for data collection is demanded. Rationale This study proposes to translate and validate the PET and the SITES into the Arabic language. This choice was made for several reasons. First, validation studies in different linguistic and cultural contexts are crucial, as they allow to generate and/or reinforce psychological theories that take into account the peculiarities of each cultural background [ 49 ]. Indeed, the vast majority of empathy measures, including the PET and the SITES, were developed and mostly used in Western societies of individualistic cultural orientation and it remains uncertain whether these scales also apply to individuals who grew up in the Arab collectivist cultural contexts. Additionally, there has been scant research on empathy in the Arab world, and no study has yet examined the psychometric properties of the PET and the SITES in the Arabic-speaking population to the best of our knowledge. Furthermore, the PET takes a few minutes and the SITES takes a few seconds to complete. As such, one potential benefit of these two scales over other empathy measures is that they are brief and could be easily completed by the respondent in a short amount of time and be easily interpreted by the evaluator, thus offering minimal respondent and administrative burden. The PET and SITES are therefore appropriate for use in Arab settings which often operate under severe human resources, time and monetary constraints. To add to the literature, this study aims to examine the psychometric properties of an Arabic translation of the PET and SITES in a sample of Arabic-speaking young adults from the general population of Tunisia. It is anticipated that the PET will show a unidimensional factor structure in both sexes, good internal consistency reliability. It is also anticipated that good validity will be evidenced through adequate associations with relevant constructs (i.e., psychological distress and self-esteem). METHODS Participants and procedure This study has a cross-sectional design and was carried out from March to May 2024. Eligible participants were adults from the general population of Tunisia, aged > 18 years. Data was gathered using self-report and web-based questionnaires in the Arabic language. A soft copy of the questionnaire was created using Google Forms and distributed online through social media platforms. The snowball sampling method was adopted to recruit participants. Potential participants were approached by the research team, and were then asked to recruit other family members and friends. This process was continued, regardless of participants’ sex. Before starting the survey, the study’s information and general instructions were thoroughly explained. Participants’ anonymity and confidentiality were preserved. The study protocol was approved by the ethics committee of Razi Hospital. Permission from the original authors, Professor Marjaana Lindeman (for the PET; [ 47 ]) and Professor Sara Konrath (for the SITES; [ 43 ]), was obtained to translate and validate the scales. The forward and backward translation method was applied to the PET and SITES following international guidelines [ 50 ]. The first author supervised the translation and back-translation process. The English version was translated to Arabic by a Tunisian translator who was completely unrelated to the study. Then, the Arabic version was translated back into English by another bilingual expert. The translated (Arabic) and original (English) versions were compared to detect any inconsistencies and eliminate them by a committee composed of the two translators and the research team who are all bilingual [ 51 , 52 ]. A pilot study on 30 persons was performed before the start of the official data collection to ensure that questions are well understood; no changes were deemed necessary afterwards. Minimum sample size Following the recommendations of Comrey and Lee [ 53 ], a minimum sample of 10 participants per scale’s item are needed to conduct an exploratory factor analysis (EFA). Consequently, a minimum sample of 70 people was needed to conduct the EFA. After adding the single item empathy scale, 80 participants were deemed necessary. Measures Sociodemographic information The survey asked respondents to start by providing data regarding their age, sex (male, female), marital status (single, married, divorced, widowed), and socioeconomic status (which was reflected through the household crowding index, i.e. number of persons/number of rooms). The depression, Anxiety and Stress Scales (DASS-8) The DASS-8 is a short scale composed of 8 items which assess respondents’ levels of psychological distress through three subscales: anxiety (3 items), depression (3 items), and stress (2 items). Each item is scored on a 4-point Likert scale ranging from 0 (“does not apply to me”) to 3 (“always applies to me”). Higher scores reflect more severe psychological distress. The scale is validated in the Arabic language [ 54 ]. The Arabic Single-Item Self-Esteem Scale (A-SISE) This is a single item measure (i.e. “I have high self-esteem”) scored on a 5-point Likert scale ranging from 1 (“not at all true of me”) to 5 (“very true of me”) [ 55 ]. The Arabic validated version was used [ 56 ]. Analytic Strategy There were no missing responses in the dataset. To examine the factor structure of the SITES, we used an exploratory factor analysis, using a principal component analysis using the FACTOR software [ 57 ]. We merged both instruments in the EFA to test whether the single item empathy scale loads on the same factor/factors as the PET. In case, they did, it means that at the factor level, both instruments belong together. If the single item loads on another factor than the PET items, this would mean that at the factor level, they do not belong together. We verified all requirements related to item-communality [ 58 ], average item correlations, and item-total correlations [ 59 ]. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy (which should ideally be ≥ .80) and Bartlett’s test of sphericity (which should be significant) ensured the adequacy of our sample [ 60 ]. The procedure followed for determining the number of dimensions was the Parallel Analysis (PA) [ 61 ], using the Pearson correlation matrix. Item retention was based on the recommendation that items with “fair” loadings and above (i.e., ≥ .33) and with low inter-item correlations (suggestive of low item redundancy) as indicated by the anti-image correlation matrix should be retained [ 62 ]. Composite reliability in both subsamples was assessed using McDonald’s ω and Cronbach’s α, with values greater than .70 reflecting adequate composite reliability [ 63 ]. The total PET and the SITES scores followed a normal distribution, with skewness and kurtosis values varying between − 1 and + 1 [ 64 ]. To assess convergent and criterion-related validity, we examined bivariate correlations between total PET and the A-SITES scores and those on the additional measures included in the survey using the Pearson test. Student t test was used to compare two means. Based on Cohen [ 65 ], values ≤ .10 were considered weak, ~ .30 were considered moderate, and ~ .50 were considered strong correlations. Results Five hundred two participants filled the survey, with a mean age of 21.74 years (SD: 2.65) and 64.9% females. Other details can be found in Table 1 . Table 1 Sociodemographic characteristics of the participants (n = 502) Gender Male 176 (35.1%) Female 326 (64.9%) Marital status Single 494 (98.4%) Married 8 (1.6%) Family income (in Tunisian Dinars) 3000 71 (14.3%) Descriptive statistics Table 2 presents the descriptive statistics of the used scales, which were all considered as normally distributed. The SITES had a mean of 4.01 (SD = .93, range: 1–5), a median of 4.00, and the following score distribution: 0 = .2%, 1 = 1.0%, 2 = 2.6%, 3 = 27.1%, 4 = 32.3%, 5 = 36.9%. Table 2 Descriptive statistics of all scores. Mean SD Min Max Skewness Kurtosis PET 26.14 6.47 7 35 − .815 .169 SITES 4.01 .93 0 5 − .657 .208 Psychological distress 10.87 5.63 0 24 .324 − .701 Self-esteem 4.00 .93 1 5 − .763 .419 PET = Pictorial Empathy Test; SITES = Single Item Empathy Scale. Exploratory Factor Analysis Factor analysis on the total sample. Bartlett’s test of sphericity, χ 2 (21) = 1506.5, p < .001, and KMO (.858) indicated that the PET items had adequate common variance for factor analysis. The results of the EFA revealed a one-factor solution, which explained 55.49% of the common variance. None of the items was removed as MSA was above .5 for all items. Results indicated an adequate fit to a unidimensional structure supported by the GFI (= .99) being greater than .95, the explained variance of 55.49%, the UniCo (= .98) index greater than .95, the I-ECV (= .88) greater than .85 and MIREAL (= .24) lower than .30. When adding the SITES, Bartlett’s test of sphericity, χ 2 (28) = 1595.6, p < .001, and KMO (.867) remained adequate. The one-factor solution obtained explained 50.83% of the variance. Results indicated an adequate fit to a unidimensional structure supported by the GFI (= .99), the UniCo (= .98), the I-ECV (= .87) and MIREAL (= .22). Factor analysis on with males. Similar results were seen in males; Bartlett’s test of sphericity, χ 2 (21) = 574.8, p < .001, and KMO (.862) again indicated that the PET items had adequate common variance for factor analysis among men. A one-factor solution was obtained explaining 57.02% of the variance. Results indicated an adequate fit to a unidimensional structure supported by the GFI (= .99), the UniCo (= .98), the I-ECV (= .89) and MIREAL (= .20). When adding the SITES, Bartlett’s test of sphericity, χ 2 (28) = 619, p < .001, and KMO (.877) remained adequate. The one-factor solution obtained explained 53.21% of the variance. Results indicated an adequate fit to a unidimensional structure supported by the GFI (= .99), the UniCo (= .99), the I-ECV (= .90) and MIREAL (= .18). Factor analysis with females. For females, Bartlett’s test of sphericity, χ 2 (21) = 1016, p < .001, and KMO (.842) again indicated that the PET items had adequate common variance for factor analysis, with 55.91% of variance explained. Results indicated an adequate fit to a unidimensional structure supported by the GFI (= .99), the UniCo (= .99), the I-ECV (= .90) and MIREAL (MIREAL = .18). When adding the SITES, Bartlett’s test of sphericity, χ 2 (28) = 1075.6, p < .001, and KMO (.851) remained adequate, explaining 51.06% of the variance. Results indicated an adequate fit to a unidimensional structure supported by the GFI (= .99), the UniCo (= .98), the I-ECV (= .85) and MIREAL (= .24). The factor loadings reported in Table 3 for the total sample, females and males separately suggest strong similarity across factor structures. Reliability analyses for the PET and SITES scales were very good in the total sample, males and females respectively. Table 3 Rotated factor loads obtained from the Exploratory Factor Analysis (EFA) EFA 1: conducted on the total sample. Model 1: EFA of PET items alone Model 2: EFA of PET items + A-SITES PET 1 .60 .61 PET 2 .58 .59 PET 3 .70 .71 PET 4 .75 .75 PET 5 .72 .72 PET 6 .80 .79 PET 7 .68 .67 SITES - .41 McDonald’s ω .85 .85 Cronbach’s α .86 .85 EFA 2: conducted on males only. PET 1 .57 .58 PET 2 .59 .59 PET 3 .64 .65 PET 4 .82 .82 PET 5 .77 .76 PET 6 .83 .83 PET 7 .71 .70 SITES - .50 McDonald’s ω .85 .86 Cronbach’s α .86 .86 EFA 3: conducted on females only. PET 1 .63 .64 PET 2 .58 .60 PET 3 .75 .76 PET 4 .73 .72 PET 5 .71 .71 PET 6 .80 .78 PET 7 .67 .66 SITES - .39 McDonald’s ω .85 .85 Cronbach’s α .86 .85 PET = Pictorial Empathy Test; SITES = Single Item Empathy Scale. Construct validity Both PET and A-SITES correlated significantly and positively with each other; PET scores did not correlate with psychological distress and self-esteem, whereas higher SITES scores correlated with higher psychological distress (Table 4 ). Furthermore, no significant difference was found between males and females in terms of PET scores (26.16 ± 6.51 vs 26.13 ± 6.45, t(500) = .06, p = .953) and SITES scores (4.11 ± .90 vs 3.95 ± .94, t(500) = 1.87, p = .062). Table 4 Pearson correlation matrix. 1 2 3 4 5 1. PET scores 1 2. SITES .36*** 1 5. Psychological distress .04 .21*** − .01 .11* 1 6. Self-esteem .02 − .07 − .06 .02 − .19*** PET = Pictorial Empathy Test; A-SIES = Arabic Single Item Empathy Scale. *p < .05; ***p < .001 DISCUSSION This study offers, for the first time, an Arabic validated version of two empathy measures, the PET to assess affective empathic reactions and the SITES to assess general trait empathy among Arabic-speaking populations. The psychometric examination indicated that the Arabic versions of the scales have good validity and reliability. In particular, Exploratory Factor Analysis showed that the PET’s unidimensionality was supported with an acceptable goodness-of-fit, and that good congruence of the factor structure of the SITES was supported across sex. Besides, the PET and the SITES exhibited satisfactory reliability coefficients. The validity of both scales was upheld via comparable and appropriate associations with the other constructs investigated (psychological distress and self-esteem). Exploratory Factor Analysis yielded a single factor structure of the PET explaining 55.49% of the common variance in the total sample, and found that the SITES loaded on the same factor as the PET items. As for the PET, our findings are consistent with both the original [ 38 ] and Spanish language [ 48 ] versions, showing that the loadings for all items exceeded the minimum recommended threshold of 0.30 [ 66 ] and endorsing the earlier observation that the PET has a unidimensional factor structure with seven items. In addition, internal consistency reliability of the set of seven photographs was excellent in our Arabic-speaking sample (McDonald’s ω = .85 and Cronbach’s α = .86), which is consistent with previous validation studies of the PET indicating high reliability in a sample of 91 Finnish-speaking adults aged 42.90 years (α = .90) [ 38 ], in 79 Spanish-speaking undergraduate psychology students (α = .77), in 580 Spanish-speaking community adults aged 34.4 years (α = .86) [ 48 ], and in 374 Turkish-speaking university students (α = 0.78) [ 47 ]. Positive correlations were observed between PET and SITES scores, which supports the convergence between the Arabic versions of the PET and the SITES and suggests that the single-item measure is relevant and informative in assessing the empathy construct. Furthermore, the SITES, but not the PET, scores correlated significantly and positively with psychological distress. Given the well-established fact that people with a great ability to feel empathy tend to be more vulnerable to psychological distress [ 23 ], this discrepancy in correlations with distress between the two scales is difficult to explain. Broadly in line with our results, Bennik et al. [ 67 ] found a positive relation between affective empathy and depressive symptoms when using the Quick Inventory of Depressive Symptomatology (QIDS, [ 68 ]), but not the DASS. Authors explained their findings by the fact that DASS includes less physiological symptoms [ 67 ]. The DASS is therefore less likely to correlate with instantaneous empathic emotional arousal as assessed using the PET, and significantly correlates in contrast with empathy when it is regarded as a stable personal trait. On another note, both the SITES and the PET showed no significant correlations with self-esteem scores. An association between empathy and self-esteem was predicted from a theoretical point of view, but there is currently limited and mixed evidence to support this idea [ 69 ]. Previous research has shown either negative [ 70 ], positive [ 71 , 72 ], or no more than a small association [ 69 ] between empathy and self-esteem. Cultural influences may explain in part the lack of association between self-esteem and empathy in our sample, as both constructs are culturally-dependent [ 73 , 74 ] and can be related to each other differently across cultures and contexts. Comparison of empathy levels between sexes showed no significant differences between males and females, both when using the PET or the SITES. There is a “widespread stereotypical belief” that males and females differ in their ability to be empathic [ 75 ], and that females are characterized by being more empathetic than males [ 76 ]. However, the scientific validity of this assumption is questionable, as empirical evidence showed inconsistent findings. Several studies concur with our result and have reported no significant sex difference [ 25 , 43 , 77 ], some studies found that females tended to score higher in empathy compared to males [ 32 , 78 ], whereas other research has even noted higher male competence [ 79 ]. These controversial findings may be explained by the fact that sex differences in self-reported empathy are largely affected by sex stereotypes [ 75 ], which are themselves driven by the cultural context [ 80 ]. Study limitations Some limitations should be acknowledged. First, data was gathered in one time point, which means that test-retest reliability and predictive validity could not be investigated in the context of the present study, and need to be considered in future studies. In addition, participants consisted of Arabic-speaking individuals from a single country and culture (Tunisia), which may limit the generalizability of our findings to adults from other Arab nationalities and cultural backgrounds. Future studies should therefore explore the applicability of the PET and SITES in other Arabic-speaking countries. The representativeness and generalizability of our study's findings to larger populations can also be hindered by the online and snowball sampling method adopted, which mostly attracted young people with a university level of education. Finally, the scales were validated in a non-clinical adult sample, and their validation in clinical populations (such as patients with schizophrenia) is still warranted. Implications and Future Perspectives The present results suggest that the Arabic-language versions of the PET and the SITES are valid and reliable measures of affective empathy and trait empathy, respectively. Due to their brevity, simplicity and easiness of use for practitioners and researchers, both the PET and the SITES can be adopted in settings where there is financial or time strains, and could be suitable methods for large-scale surveys, longitudinal studies, and pre-screening assessments. The two measures may help reduce administration burden, improve data quality and enable to simultaneously survey wide masses of respondents where necessary. In particular, as a photograph-based test, the PET could be the best and most helpful alternative to assess affective empathy reactions in the moment of administration in patients who may have problems in identifying and verbalizing their empathic feelings with a text-based questionnaire. Moreover, through a single item that can be completed in seconds, the SITES helps measure the specific aspect of how caring and empathic people are in nature. It is therefore recommended for use in different situations or settings where longer scales measuring the same construct are not appropriate (due to their length, cost, amount of time and burden generated) or do not suit the outcome of interest (trait empathy specifically versus dimensions such as “Fantasy” and “Personal Distress” that does not really reflect empathy). CONCLUSION While the present validation study leaves further work to be completed, it provides to practitioners and researchers two validated measures of empathy in the Arabic language. The two scales are brief, cost-effective, well-accepted, and can be easily understood by participants. We thus recommend their use in future clinical and research practices, in particular in settings where resources and time can be limited. Making the PET and SITES available in the Arabic language will hopefully benefit patients and stimulate future research in this area in the Arab region, and further advance knowledge about empathy, its correlates and its cross-cultural variation. Declarations Ethics Approval and Consent to Participate: Each participant provided a voluntary oral informed consent before beginning the survey. The research protocol was approved by the ethics committee of the Razi psychiatric hospital, Manouba, Tunisia. The study was performed following the standards for medical research involving human subjects recommended by the Declaration of Helsinki for human research. Consent for publication: Not applicable. Availability of data and materials: The datasets generated and/or analyzed during the current study are not publicly available due to restrictions from the ethics committee but are available from the corresponding author [SH] on reasonable request. Competing interests: The authors have nothing to disclose. Funding: None. Author contributions: FFR designed the study; GA processed the data; FFR and SH drafted the manuscript; SH carried out the analysis and interpreted the results; AMA and MC reviewed the paper for intellectual content; all authors reviewed the final manuscript and gave their consent. Acknowledgements: The authors would like to thank all participants. References Baron-Cohen S. Questione di cervello: La differenza essenziale tra uomini e donne. Mondadori; 2004. Bryant BK. Mental health, temperament, family, and friends: Perspectives on children's empathy and social perspective taking. 1987. Agosta L. Empathy and sympathy in ethics. 2011. Baron-Cohen S, Wheelwright S. The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. J Autism Dev Disord. 2004;34:163–75. Blair RJR. 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Gerdes KE, Lietz CA, Segal EA. Measuring empathy in the 21st century: Development of an empathy index rooted in social cognitive neuroscience and social justice. Social Work Res. 2011;35(2):83–93. Vachon DD, Lynam DR. Fixing the problem with empathy: Development and validation of the affective and cognitive measure of empathy. Assessment. 2016;23(2):135–49. Murphy BA, Costello TH, Watts AL, Cheong YF, Berg JM, Lilienfeld SO. Strengths and weaknesses of two empathy measures: A comparison of the measurement precision, construct validity, and incremental validity of two multidimensional indices. Assessment. 2020;27(2):246–60. Lindeman M, Koirikivi I, Lipsanen J. Pictorial Empathy Test (PET). Eur J Psychol Assess 2016. Jolliffe D, Farrington DP. Empathy and offending: A systematic review and meta-analysis. Aggress Violent Beh. 2004;9(5):441–76. Mehrabian A, Young AL, Sato S. Emotional empathy and associated individual differences. Curr Psychol. 1988;7:221–40. Yu J, Kirk M. Evaluation of empathy measurement tools in nursing: systematic review. J Adv Nurs. 2009;65(9):1790–806. Hong H, Han A. A systematic review on empathy measurement tools for care professionals. Educ Gerontol. 2020;46(2):72–83. Konrath S, Meier BP, Bushman BJ. Development and validation of the Single Item Trait Empathy Scale (SITES). J Res Pers. 2018;73:111–22. Moya-Albiol L, Herrero N, Bernal MC. The neural bases of empathy. Rev Neurol. 2010;50(2):89–100. Balconi M, Bortolotti A, Gonzaga L. Emotional face recognition, EMG response, and medial prefrontal activity in empathic behaviour. Neurosci Res. 2011;71(3):251–9. Monzel M, Keidel K, Reuter M. Is it really empathy? The potentially confounding role of mental imagery in self-reports of empathy. J Res Pers. 2023;103:104354. Şandor S. Mediator Effects of Cognitive and Affective Empathy on the Relationship Between Schizotypal Symptoms and Social Anxiety/Avoidance Levels. Neuropsychiatric Invest 2022, 60(3). Baliyan S, Cimadevilla JM, Bustillos A, Escamilla JC, Leiman M, Sandi C, Venero C. Cultural adaptation, validation, and psychometric description of the Pictorial Empathy Test (PET) in the Spanish Population. Eur J Psychol Assess 2022. Gomes LB, Bossardi CN, Bolze SDA, Bigras M, Paquette D, Crepaldi MA, Vieira ML. Cross-cultural research in developmental psychology: theoretical and methodological considerations. Arquivos Brasileiros de Psicologia. 2018;70(1):260–75. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186–91. Fekih-Romdhane F, Fawaz M, Hallit R, Sawma T, Obeid S, Hallit S. Psychometric Properties of an Arabic Translation of the Multidimensional Social Support Scale (MSPSS) in a community sample of Lebanese Adults. 2022. Hallit S, Bitar Z, Rogoza R, Obeid S. Validation of the Arabic Version of the Freiburg Mindfulness Inventory (FMI-Ar) Among a Sample of Lebanese University Students. 2022. Comrey AL, Lee HB. A first course in factor analysis. Psychology; 2013. Ali AM, Alkhamees AA, Hori H, Kim Y, Kunugi H. The depression anxiety stress scale 21: development and validation of the depression anxiety stress scale 8-item in psychiatric patients and the general public for easier mental health measurement in a post COVID-19 world. Int J Environ Res Public Health. 2021;18(19):10142. Brailovskaia J, Margraf J. How to measure self-esteem with one item? Validation of the German Single-Item Self-Esteem Scale (G-SISE). Curr Psychology: J Diverse Perspect Diverse Psychol Issues. 2020;39:2192–202. Fekih-Romdhane F, Bitar Z, Rogoza R, Sarray El Dine A, Malaeb D, Rashid T, Obeid S, Hallit S. Validity and reliability of the arabic version of the self-report single-item self-esteem scale (A-SISE). BMC Psychiatry. 2023;23(1):351. Lorenzo-Seva U, Ferrando PJ. FACTOR: a computer program to fit the exploratory factor analysis model. Behav Res Methods. 2006;38(1):88–91. Worthington RL, Whittaker TA. Scale development research: A content analysis and recommendations for best practices. Couns Psychol. 2006;34(6):806–38. Clark L, Watson D. Construct validity: basic issues in objective scale development. Psychol Meas. 1995;28:61–75. Hair JF. Multivariate data analysis. 2009. Timmerman ME, Lorenzo-Seva U. Dimensionality assessment of ordered polytomous items with parallel analysis. Psychol Methods. 2011;16(2):209. Tabachnick B, Fidell L. Using Multivariate Statistics. 7th ed. New York: Pearson; 2019. Dunn TJ, Baguley T, Brunsden V. From alpha to omega: A practical solution to the pervasive problem of internal consistency estimation. Br J Psychol. 2014;105(3):399–412. Hair JF Jr, Sarstedt M, Ringle CM, Gudergan SP. Advanced issues in partial least squares structural equation modeling. saGe; 2017. Cohen J. Quantitative methods in psychology: A power primer. In: Psychological bulletin: 1992 . Citeseer; 1992. Brown TA. Confirmatory factor analysis for applied research. Guilford; 2015. Bennik EC, Jeronimus BF, aan het Rot M. The relation between empathy and depressive symptoms in a Dutch population sample. J Affect Disord. 2019;242:48–51. Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, Markowitz JC, Ninan PT, Kornstein S, Manber R. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54(5):573–83. Sa B, Ojeh N, Majumder MAA, Nunes P, Williams S, Rao SR, Youssef FF. The relationship between self-esteem, emotional intelligence, and empathy among students from six health professional programs. Teach Learn Med. 2019;31(5):536–43. Hanlong L. The characteristics of medical students’ empathy and relevant factors. Tianjin: Tianjin Med Univ 2012. Hongrui Z, Hui Z, Xiaofan L, Fenghua L, Shuyao J. The current status and correlation of empathy ability and self-esteem level among nursing students. Nurs J Chin People’s Liberat Army. 2016;33:1–4. Huang L, Thai J, Zhong Y, Peng H, Koran J, Zhao X-D. The positive association between empathy and self-esteem in Chinese medical students: a multi-institutional study. Frontiers in psychology 2019, 10:1921. Hamamura T. Cultural Differences in Self-Esteem. In: Encyclopedia of Personality and Individual Differences. edn. Edited by Zeigler-Hill V, Shackelford TK. Cham: Springer International Publishing; 2017: 1–3. Hollan D. Empathy across cultures. The Routledge handbook of philosophy of empathy. edn.: Routledge; 2017. pp. 341–52. Löffler CS, Greitemeyer T. Are women the more empathetic gender? The effects of gender role expectations. Curr Psychol. 2023;42(1):220–31. Christov-Moore L, Simpson EA, Coudé G, Grigaityte K, Iacoboni M, Ferrari PF. Empathy: Gender effects in brain and behavior. Neurosci biobehavioral reviews. 2014;46:604–27. Lamm C, Decety J, Singer T. Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain. NeuroImage. 2011;54(3):2492–502. Derntl B, Finkelmeyer A, Eickhoff S, Kellermann T, Falkenberg DI, Schneider F, Habel U. Multidimensional assessment of empathic abilities: neural correlates and gender differences. Psychoneuroendocrinology. 2010;35(1):67–82. Lennon R, Eisenberg N, Carroll J. The relation between nonverbal indices of empathy and preschoolers' prosocial behavior. J Appl Dev Psychol. 1986;7(3):219–24. Aimaganbetova O, Faizullina A, Adilova E, Turgumbayeva A. The impact of culture on gender stereotypes. J Psychol Sociol 2016, 58(3). Additional Declarations No competing interests reported. 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Affective empathy refers to the ability to feel other people\u0026rsquo;s emotional experiences indirectly, thus enabling to comprehend their intentions and anticipate their behaviors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. During childhood, experiencing empathic feelings for others is crucial to emotional development [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and contributes to the development of social morality[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. During adulthood, the ability to feel empathy allows effective interactions with people in social contexts. There is certain agreement that empathy includes two different components, cognitive and affective (or emotional) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], which are neurologically dissociable, underpinned by impairments in different areas of the brain [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Cognitive empathy is being able to take the other\u0026rsquo;s perspective [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] or to understand the other\u0026rsquo;s emotions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Affective or emotional empathy is the ability to respond with an appropriate emotional reaction to the other\u0026rsquo;s feelings or situation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. There are important interindividual differences in emotional reactions arising from contact with other people in the general population [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; and such variations in empathic abilities were shown to affect, in turn, one\u0026rsquo;s social life [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor instance, being able to feel empathy in a given situation, such as a person\u0026rsquo;s suffering, can be impaired in traumatic brain injury [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], in schizophrenia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], in high risk states of developing criminal behavior [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and nonexistent or inappropriate in psychopathy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Affective empathic reactions have many positive effects on people\u0026rsquo;s social life and interactions. For example, affective empathy is closely connected to helping behavior and being human in caring (e.g., psychotherapeutic) relationships [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Possessing higher affective empathy is also associated with enhanced prosocial behavior [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], stronger intrinsic motivation for altruistic behavior [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], lower likelihood of engaging in traditional bullying [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] or substance using behavior [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], lower levels of aggression [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and a better quality of sleep [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. At the same time, the experience of empathy may lead to a confusion between self and other, and contribute, in turn, to psychological distress [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. For all these reasons, a large range of psychotherapeutic approaches highlight the role of empathy as an important component of treatment [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Given that affective empathy was consistently shown to be elementary to social behavior, and because its impairment was linked to a range of psychopathology and behavioral problems, its exploration and measurement in adults\u0026rsquo; populations represent a growing need for both clinicians and researchers. The following section expands on the different measurement tools currently available for the assessment of the (general and affective) empathy construct.\u003c/p\u003e\n\u003ch3\u003eMeasurement instruments of Empathy\u003c/h3\u003e\n\u003cp\u003eEmpathy can be reflected through many psychological constructs, and measured using self-administered tools [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. A wide range of instruments have been developed and utilized to survey individuals\u0026rsquo; ability to empathize with others either in general or in specific contexts, such as empathy among physicians [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], perceived relational empathy among patients in the consultation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], teachers\u0026rsquo; empathy for students [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], empathy for the vicarious experience of pain [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], empathy experienced as anger on behalf of a victimized person, and ethnocultural empathy [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] (for systematic review and meta-analysis, see [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]). General empathy instruments available for use in the general population include the 60-item Empathy Quotient [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], the 28-item Interpersonal Reactivity Index [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], the Questionnaire of Cognitive and Affective Empathy [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], the Questionary Measure of Emotional Empathy [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], the Toronto Empathy Questionnaire [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], the Empathy Assessment Index [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and the Affective and Cognitive Measure of Empathy [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. However, most of these measures showed limitations regarding factorial structure and convergent validity [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], which is likely due to controversies and a lack of theoretical consensus on the multidimensional conceptualization of the empathy construct [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In addition, some of the existing measures were designed to and used in specific subgroups, such as the Basic Empathy Scale intended for assessing empathy in adolescents with antisocial tendencies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Furthermore, one of the most recurring criticisms of empathy measures is that the construct being assessed is often unclear. For example, it was claimed that the Empathy Quotient measures the ability to function socially rather than empathic tendencies of the individual [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]; the Interpersonal Reactivity Index contains a \u0026ldquo;Personal Distress\u0026rdquo; and a \u0026ldquo;Fantasy\u0026rdquo; dimensions that are distinct from the concept of empathy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]; the Questionary Measure of Emotional Empathy appears to measure sympathetic reactions and emotional arousal by the environment in general rather than measuring empathy and other people\u0026rsquo;s distress in particular [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. As such, systematic reviews performed so far on measures of empathic ability both in specific populations [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] and in the general population [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] concluded that no instrument could be considered and recommended as the gold standard assessment method for empathy based on desirable validity and reliability indices. To address these gaps, Lindeman et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] developed a brief test of affective empathic ability arousal, the Pictorial Empathy Test (PET), and Konrath et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] developed the Single Item Trait Empathy Scale (SITES). The PET stands out from the existing self-report measures that use text-based items because it proposes a novel approach to conceptualize the empathy construct from an ecological perspective using photographs as emotional stimuli [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], while the SITES stands out because it consists of a single item [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eThe PET\u003c/h3\u003e\n\u003cp\u003eThe PET was designed as a visual measure of affective empathy skills. It consists of 7 sequential photographs of people in vulnerable states (i.e. physical and/or emotional distress) and that are susceptible to elicit empathic emotions. Respondents are asked \u0026ldquo;How emotionally moving do you find the photograph?\u0026rdquo;, with answers ranging on a 5-point Likert scale from 1 (not at all) to 5 (very much). Total PET scores can be obtained by calculating mean score of the responses, with higher scores reflecting greater affective empathy. The PET can be applied in different ways, as a web-based questionnaire, as a paper-and-pencil test, or as part of an interview [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. As a photo-based instrument, the PET has the potential advantage over other empathy scales of having stronger ecological validity in assessing affective empathy, given that facial expressions of emotions generate an \u0026ldquo;emotional resonance mechanism\u0026rdquo; in their watcher, and are thereby central to empathic responses [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The PET can also be appropriate and convenient-to-use when applied in clinical samples who have difficulty to express their answers in questionnaires [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In addition, the PET is different from other measures, that are retrospective in nature, because it enables to immediately capture the respondents\u0026rsquo; emotional reactions and empathic feelings. The PET was originally developed and validated in the Finnish language in three different samples of adults from the general population, where it demonstrated good internal reliability and seven-month test-retest reliability, adequate convergent validity, as well as a single-latent-factor structure [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Other cross-cultural adaptation studies have been carried out and reported equivalent psychometric characteristics to the original measure in different languages, countries and samples, including English [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], Turkish [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] and Spanish [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eThe SITES\u003c/h3\u003e\n\u003cp\u003eIn contrast with the PET which assesses an emotional, situationally determined \u0026ldquo;state\u0026rdquo;, the SITES assesses empathy as a \u0026ldquo;trait\u0026rdquo; that is relatively stable across situations and over time. The SITES was proposed as a shorter and more specific alternative to the Interpersonal Reactivity Index [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], which is composed of 28 items and theoretically designed to assess the same construct of trait empathy through different dimensions (i.e., Fantasy, Perspective-taking, Empathic concern, and Personal distress). Respondents are asked to rate the extent to which the following statement describes them \u0026ldquo;I am an empathetic person\u0026rdquo;; the answer is rated from 1 (\u0026ldquo;Not very true of me\u0026rdquo;) to 5 (\u0026ldquo;Very true of me\u0026rdquo;) [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In seven studies and a large sample of adults (N\u0026thinsp;=\u0026thinsp;5,724), the SITES demonstrated good predictive validity, discriminant validity, convergent validity, and test-retest reliability [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Overall, the SITES was shown to be a valid and reliable way to assess empathy when an efficient, rapid, but still accurate, method for data collection is demanded.\u003c/p\u003e\n\u003ch3\u003eRationale\u003c/h3\u003e\n\u003cp\u003eThis study proposes to translate and validate the PET and the SITES into the Arabic language. This choice was made for several reasons. First, validation studies in different linguistic and cultural contexts are crucial, as they allow to generate and/or reinforce psychological theories that take into account the peculiarities of each cultural background [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Indeed, the vast majority of empathy measures, including the PET and the SITES, were developed and mostly used in Western societies of individualistic cultural orientation and it remains uncertain whether these scales also apply to individuals who grew up in the Arab collectivist cultural contexts. Additionally, there has been scant research on empathy in the Arab world, and no study has yet examined the psychometric properties of the PET and the SITES in the Arabic-speaking population to the best of our knowledge. Furthermore, the PET takes a few minutes and the SITES takes a few seconds to complete. As such, one potential benefit of these two scales over other empathy measures is that they are brief and could be easily completed by the respondent in a short amount of time and be easily interpreted by the evaluator, thus offering minimal respondent and administrative burden. The PET and SITES are therefore appropriate for use in Arab settings which often operate under severe human resources, time and monetary constraints. To add to the literature, this study aims to examine the psychometric properties of an Arabic translation of the PET and SITES in a sample of Arabic-speaking young adults from the general population of Tunisia. It is anticipated that the PET will show a unidimensional factor structure in both sexes, good internal consistency reliability. It is also anticipated that good validity will be evidenced through adequate associations with relevant constructs (i.e., psychological distress and self-esteem).\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and procedure\u003c/h2\u003e \u003cp\u003eThis study has a cross-sectional design and was carried out from March to May 2024. Eligible participants were adults from the general population of Tunisia, aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years. Data was gathered using self-report and web-based questionnaires in the Arabic language. A soft copy of the questionnaire was created using Google Forms and distributed online through social media platforms. The snowball sampling method was adopted to recruit participants. Potential participants were approached by the research team, and were then asked to recruit other family members and friends. This process was continued, regardless of participants\u0026rsquo; sex. Before starting the survey, the study\u0026rsquo;s information and general instructions were thoroughly explained. Participants\u0026rsquo; anonymity and confidentiality were preserved. The study protocol was approved by the ethics committee of Razi Hospital.\u003c/p\u003e \u003cp\u003ePermission from the original authors, Professor Marjaana Lindeman (for the PET; [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]) and Professor Sara Konrath (for the SITES; [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]), was obtained to translate and validate the scales. The forward and backward translation method was applied to the PET and SITES following international guidelines [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. The first author supervised the translation and back-translation process. The English version was translated to Arabic by a Tunisian translator who was completely unrelated to the study. Then, the Arabic version was translated back into English by another bilingual expert. The translated (Arabic) and original (English) versions were compared to detect any inconsistencies and eliminate them by a committee composed of the two translators and the research team who are all bilingual [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. A pilot study on 30 persons was performed before the start of the official data collection to ensure that questions are well understood; no changes were deemed necessary afterwards.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMinimum sample size\u003c/h2\u003e \u003cp\u003eFollowing the recommendations of Comrey and Lee [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e], a minimum sample of 10 participants per scale\u0026rsquo;s item are needed to conduct an exploratory factor analysis (EFA). Consequently, a minimum sample of 70 people was needed to conduct the EFA. After adding the single item empathy scale, 80 participants were deemed necessary.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eSociodemographic information\u003c/h2\u003e \u003cp\u003eThe survey asked respondents to start by providing data regarding their age, sex (male, female), marital status (single, married, divorced, widowed), and socioeconomic status (which was reflected through the household crowding index, i.e. number of persons/number of rooms).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eThe depression, Anxiety and Stress Scales (DASS-8)\u003c/h2\u003e \u003cp\u003eThe DASS-8 is a short scale composed of 8 items which assess respondents\u0026rsquo; levels of psychological distress through three subscales: anxiety (3 items), depression (3 items), and stress (2 items). Each item is scored on a 4-point Likert scale ranging from 0 (\u0026ldquo;does not apply to me\u0026rdquo;) to 3 (\u0026ldquo;always applies to me\u0026rdquo;). Higher scores reflect more severe psychological distress. The scale is validated in the Arabic language [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe Arabic Single-Item Self-Esteem Scale (A-SISE)\u003c/h2\u003e \u003cp\u003eThis is a single item measure (i.e. \u0026ldquo;I have high self-esteem\u0026rdquo;) scored on a 5-point Likert scale ranging from 1 (\u0026ldquo;not at all true of me\u0026rdquo;) to 5 (\u0026ldquo;very true of me\u0026rdquo;) [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. The Arabic validated version was used [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAnalytic Strategy\u003c/h2\u003e \u003cp\u003eThere were no missing responses in the dataset. To examine the factor structure of the SITES, we used an exploratory factor analysis, using a principal component analysis using the FACTOR software [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. We merged both instruments in the EFA to test whether the single item empathy scale loads on the same factor/factors as the PET. In case, they did, it means that at the factor level, both instruments belong together. If the single item loads on another factor than the PET items, this would mean that at the factor level, they do not belong together. We verified all requirements related to item-communality [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], average item correlations, and item-total correlations [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy (which should ideally be \u0026ge;\u0026thinsp;.80) and Bartlett\u0026rsquo;s test of sphericity (which should be significant) ensured the adequacy of our sample [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. The procedure followed for determining the number of dimensions was the Parallel Analysis (PA) [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e], using the Pearson correlation matrix. Item retention was based on the recommendation that items with \u0026ldquo;fair\u0026rdquo; loadings and above (i.e., \u0026ge; .33) and with low inter-item correlations (suggestive of low item redundancy) as indicated by the anti-image correlation matrix should be retained [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComposite reliability in both subsamples was assessed using McDonald\u0026rsquo;s ω and Cronbach\u0026rsquo;s α, with values greater than .70 reflecting adequate composite reliability [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. The total PET and the SITES scores followed a normal distribution, with skewness and kurtosis values varying between \u0026minus;\u0026thinsp;1 and +\u0026thinsp;1 [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. To assess convergent and criterion-related validity, we examined bivariate correlations between total PET and the A-SITES scores and those on the additional measures included in the survey using the Pearson test. Student t test was used to compare two means. Based on Cohen [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e], values\u0026thinsp;\u0026le;\u0026thinsp;.10 were considered weak, ~ .30 were considered moderate, and ~\u0026thinsp;.50 were considered strong correlations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFive hundred two participants filled the survey, with a mean age of 21.74 years (SD: 2.65) and 64.9% females. Other details can be found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of the participants (n\u0026thinsp;=\u0026thinsp;502)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e176 (35.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e326 (64.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e494 (98.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily income (in Tunisian Dinars)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e500\u0026ndash;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116 (23.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1000\u0026ndash;2000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e191 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2000\u0026ndash;3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive statistics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the descriptive statistics of the used scales, which were all considered as normally distributed. The SITES had a mean of 4.01 (SD\u0026thinsp;=\u0026thinsp;.93, range: 1\u0026ndash;5), a median of 4.00, and the following score distribution: 0\u0026thinsp;=\u0026thinsp;.2%, 1\u0026thinsp;=\u0026thinsp;1.0%, 2\u0026thinsp;=\u0026thinsp;2.6%, 3\u0026thinsp;=\u0026thinsp;27.1%, 4\u0026thinsp;=\u0026thinsp;32.3%, 5\u0026thinsp;=\u0026thinsp;36.9%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics of all scores.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSkewness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eKurtosis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSITES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-esteem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.419\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePET\u0026thinsp;=\u0026thinsp;Pictorial Empathy Test; SITES\u0026thinsp;=\u0026thinsp;Single Item Empathy Scale.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eExploratory Factor Analysis\u003c/h2\u003e \u003cp\u003e \u003cb\u003eFactor analysis on the total sample.\u003c/b\u003e Bartlett\u0026rsquo;s test of sphericity, χ\u003csup\u003e2\u003c/sup\u003e(21)\u0026thinsp;=\u0026thinsp;1506.5, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, and KMO (.858) indicated that the PET items had adequate common variance for factor analysis. The results of the EFA revealed a one-factor solution, which explained 55.49% of the common variance. None of the items was removed as MSA was above .5 for all items. Results indicated an adequate fit to a unidimensional structure supported by the GFI (=\u0026thinsp;.99) being greater than .95, the explained variance of 55.49%, the UniCo (=\u0026thinsp;.98) index greater than .95, the I-ECV (=\u0026thinsp;.88) greater than .85 and MIREAL (=\u0026thinsp;.24) lower than .30.\u003c/p\u003e \u003cp\u003eWhen adding the SITES, Bartlett\u0026rsquo;s test of sphericity, χ\u003csup\u003e2\u003c/sup\u003e(28)\u0026thinsp;=\u0026thinsp;1595.6, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, and KMO (.867) remained adequate. The one-factor solution obtained explained 50.83% of the variance. Results indicated an adequate fit to a unidimensional structure supported by the GFI (=\u0026thinsp;.99), the UniCo (=\u0026thinsp;.98), the I-ECV (=\u0026thinsp;.87) and MIREAL (=\u0026thinsp;.22).\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactor analysis on with males.\u003c/b\u003e Similar results were seen in males; Bartlett\u0026rsquo;s test of sphericity, χ\u003csup\u003e2\u003c/sup\u003e(21)\u0026thinsp;=\u0026thinsp;574.8, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, and KMO (.862) again indicated that the PET items had adequate common variance for factor analysis among men. A one-factor solution was obtained explaining 57.02% of the variance. Results indicated an adequate fit to a unidimensional structure supported by the GFI (=\u0026thinsp;.99), the UniCo (=\u0026thinsp;.98), the I-ECV (=\u0026thinsp;.89) and MIREAL (=\u0026thinsp;.20).\u003c/p\u003e \u003cp\u003eWhen adding the SITES, Bartlett\u0026rsquo;s test of sphericity, χ\u003csup\u003e2\u003c/sup\u003e(28)\u0026thinsp;=\u0026thinsp;619, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, and KMO (.877) remained adequate. The one-factor solution obtained explained 53.21% of the variance. Results indicated an adequate fit to a unidimensional structure supported by the GFI (=\u0026thinsp;.99), the UniCo (=\u0026thinsp;.99), the I-ECV (=\u0026thinsp;.90) and MIREAL (=\u0026thinsp;.18).\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactor analysis with females.\u003c/b\u003e For females, Bartlett\u0026rsquo;s test of sphericity, χ\u003csup\u003e2\u003c/sup\u003e(21)\u0026thinsp;=\u0026thinsp;1016, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, and KMO (.842) again indicated that the PET items had adequate common variance for factor analysis, with 55.91% of variance explained. Results indicated an adequate fit to a unidimensional structure supported by the GFI (=\u0026thinsp;.99), the UniCo (=\u0026thinsp;.99), the I-ECV (=\u0026thinsp;.90) and MIREAL (MIREAL\u0026thinsp;=\u0026thinsp;.18).\u003c/p\u003e \u003cp\u003eWhen adding the SITES, Bartlett\u0026rsquo;s test of sphericity, χ\u003csup\u003e2\u003c/sup\u003e(28)\u0026thinsp;=\u0026thinsp;1075.6, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, and KMO (.851) remained adequate, explaining 51.06% of the variance. Results indicated an adequate fit to a unidimensional structure supported by the GFI (=\u0026thinsp;.99), the UniCo (=\u0026thinsp;.98), the I-ECV (=\u0026thinsp;.85) and MIREAL (=\u0026thinsp;.24).\u003c/p\u003e \u003cp\u003eThe factor loadings reported in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for the total sample, females and males separately suggest strong similarity across factor structures. Reliability analyses for the PET and SITES scales were very good in the total sample, males and females respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRotated factor loads obtained from the Exploratory Factor Analysis (EFA)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eEFA 1: conducted on the total sample.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1: EFA of PET items alone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModel 2: EFA of PET items\u0026thinsp;+\u0026thinsp;A-SITES\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSITES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMcDonald\u0026rsquo;s ω\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCronbach\u0026rsquo;s α\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEFA 2: conducted on males only.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSITES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMcDonald\u0026rsquo;s ω\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCronbach\u0026rsquo;s α\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEFA 3: conducted on females only.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePET 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSITES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMcDonald\u0026rsquo;s ω\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCronbach\u0026rsquo;s α\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePET\u0026thinsp;=\u0026thinsp;Pictorial Empathy Test; SITES\u0026thinsp;=\u0026thinsp;Single Item Empathy Scale.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eConstruct validity\u003c/h2\u003e \u003cp\u003eBoth PET and A-SITES correlated significantly and positively with each other; PET scores did not correlate with psychological distress and self-esteem, whereas higher SITES scores correlated with higher psychological distress (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Furthermore, no significant difference was found between males and females in terms of PET scores (26.16\u0026thinsp;\u0026plusmn;\u0026thinsp;6.51 vs 26.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.45, t(500)\u0026thinsp;=\u0026thinsp;.06, p\u0026thinsp;=\u0026thinsp;.953) and SITES scores (4.11\u0026thinsp;\u0026plusmn;\u0026thinsp;.90 vs 3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;.94, t(500)\u0026thinsp;=\u0026thinsp;1.87, p\u0026thinsp;=\u0026thinsp;.062).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlation matrix.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. PET scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. SITES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.36***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Psychological distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.21***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.11*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Self-esteem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.19***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ePET\u0026thinsp;=\u0026thinsp;Pictorial Empathy Test; A-SIES\u0026thinsp;=\u0026thinsp;Arabic Single Item Empathy Scale. *p\u0026thinsp;\u0026lt;\u0026thinsp;.05; ***p\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study offers, for the first time, an Arabic validated version of two empathy measures, the PET to assess affective empathic reactions and the SITES to assess general trait empathy among Arabic-speaking populations. The psychometric examination indicated that the Arabic versions of the scales have good validity and reliability. In particular, Exploratory Factor Analysis showed that the PET\u0026rsquo;s unidimensionality was supported with an acceptable goodness-of-fit, and that good congruence of the factor structure of the SITES was supported across sex. Besides, the PET and the SITES exhibited satisfactory reliability coefficients. The validity of both scales was upheld via comparable and appropriate associations with the other constructs investigated (psychological distress and self-esteem).\u003c/p\u003e \u003cp\u003eExploratory Factor Analysis yielded a single factor structure of the PET explaining 55.49% of the common variance in the total sample, and found that the SITES loaded on the same factor as the PET items. As for the PET, our findings are consistent with both the original [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] and Spanish language [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] versions, showing that the loadings for all items exceeded the minimum recommended threshold of 0.30 [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e] and endorsing the earlier observation that the PET has a unidimensional factor structure with seven items. In addition, internal consistency reliability of the set of seven photographs was excellent in our Arabic-speaking sample (McDonald\u0026rsquo;s ω\u0026thinsp;=\u0026thinsp;.85 and Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;.86), which is consistent with previous validation studies of the PET indicating high reliability in a sample of 91 Finnish-speaking adults aged 42.90 years (α\u0026thinsp;=\u0026thinsp;.90) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], in 79 Spanish-speaking undergraduate psychology students (α\u0026thinsp;=\u0026thinsp;.77), in 580 Spanish-speaking community adults aged 34.4 years (α\u0026thinsp;=\u0026thinsp;.86) [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], and in 374 Turkish-speaking university students (α\u0026thinsp;=\u0026thinsp;0.78) [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePositive correlations were observed between PET and SITES scores, which supports the convergence between the Arabic versions of the PET and the SITES and suggests that the single-item measure is relevant and informative in assessing the empathy construct. Furthermore, the SITES, but not the PET, scores correlated significantly and positively with psychological distress. Given the well-established fact that people with a great ability to feel empathy tend to be more vulnerable to psychological distress [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], this discrepancy in correlations with distress between the two scales is difficult to explain. Broadly in line with our results, Bennik et al. [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e] found a positive relation between affective empathy and depressive symptoms when using the Quick Inventory of Depressive Symptomatology (QIDS, [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]), but not the DASS. Authors explained their findings by the fact that DASS includes less physiological symptoms [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. The DASS is therefore less likely to correlate with instantaneous empathic emotional arousal as assessed using the PET, and significantly correlates in contrast with empathy when it is regarded as a stable personal trait. On another note, both the SITES and the PET showed no significant correlations with self-esteem scores. An association between empathy and self-esteem was predicted from a theoretical point of view, but there is currently limited and mixed evidence to support this idea [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Previous research has shown either negative [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e], positive [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e], or no more than a small association [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e] between empathy and self-esteem. Cultural influences may explain in part the lack of association between self-esteem and empathy in our sample, as both constructs are culturally-dependent [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e] and can be related to each other differently across cultures and contexts.\u003c/p\u003e \u003cp\u003eComparison of empathy levels between sexes showed no significant differences between males and females, both when using the PET or the SITES. There is a \u0026ldquo;widespread stereotypical belief\u0026rdquo; that males and females differ in their ability to be empathic [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e], and that females are characterized by being more empathetic than males [\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. However, the scientific validity of this assumption is questionable, as empirical evidence showed inconsistent findings. Several studies concur with our result and have reported no significant sex difference [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e], some studies found that females tended to score higher in empathy compared to males [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e], whereas other research has even noted higher male competence [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e]. These controversial findings may be explained by the fact that sex differences in self-reported empathy are largely affected by sex stereotypes [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e], which are themselves driven by the cultural context [\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eSome limitations should be acknowledged. First, data was gathered in one time point, which means that test-retest reliability and predictive validity could not be investigated in the context of the present study, and need to be considered in future studies. In addition, participants consisted of Arabic-speaking individuals from a single country and culture (Tunisia), which may limit the generalizability of our findings to adults from other Arab nationalities and cultural backgrounds. Future studies should therefore explore the applicability of the PET and SITES in other Arabic-speaking countries. The representativeness and generalizability of our study's findings to larger populations can also be hindered by the online and snowball sampling method adopted, which mostly attracted young people with a university level of education. Finally, the scales were validated in a non-clinical adult sample, and their validation in clinical populations (such as patients with schizophrenia) is still warranted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eImplications and Future Perspectives\u003c/h2\u003e \u003cp\u003eThe present results suggest that the Arabic-language versions of the PET and the SITES are valid and reliable measures of affective empathy and trait empathy, respectively. Due to their brevity, simplicity and easiness of use for practitioners and researchers, both the PET and the SITES can be adopted in settings where there is financial or time strains, and could be suitable methods for large-scale surveys, longitudinal studies, and pre-screening assessments. The two measures may help reduce administration burden, improve data quality and enable to simultaneously survey wide masses of respondents where necessary. In particular, as a photograph-based test, the PET could be the best and most helpful alternative to assess affective empathy reactions in the moment of administration in patients who may have problems in identifying and verbalizing their empathic feelings with a text-based questionnaire. Moreover, through a single item that can be completed in seconds, the SITES helps measure the specific aspect of how caring and empathic people are in nature. It is therefore recommended for use in different situations or settings where longer scales measuring the same construct are not appropriate (due to their length, cost, amount of time and burden generated) or do not suit the outcome of interest (trait empathy specifically versus dimensions such as \u0026ldquo;Fantasy\u0026rdquo; and \u0026ldquo;Personal Distress\u0026rdquo; that does not really reflect empathy).\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eWhile the present validation study leaves further work to be completed, it provides to practitioners and researchers two validated measures of empathy in the Arabic language. The two scales are brief, cost-effective, well-accepted, and can be easily understood by participants. We thus recommend their use in future clinical and research practices, in particular in settings where resources and time can be limited. Making the PET and SITES available in the Arabic language will hopefully benefit patients and stimulate future research in this area in the Arab region, and further advance knowledge about empathy, its correlates and its cross-cultural variation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eParticipate:\u0026nbsp;\u003c/strong\u003eEach participant provided a voluntary oral informed consent before beginning the survey. The research protocol was approved by the ethics committee of the Razi psychiatric hospital, Manouba, Tunisia. The study was performed following the standards for medical research involving human subjects recommended by the Declaration of Helsinki for human research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to restrictions from the ethics committee but are available from the corresponding author [SH] on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors have nothing to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003eFFR designed the study; GA processed the data; FFR and SH drafted the manuscript; SH carried out the analysis and interpreted the results; AMA and MC reviewed the paper for intellectual content; all authors reviewed the final manuscript and gave their consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003eThe authors would like to thank all participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBaron-Cohen S. 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NeuroImage. 2011;54(3):2492\u0026ndash;502.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDerntl B, Finkelmeyer A, Eickhoff S, Kellermann T, Falkenberg DI, Schneider F, Habel U. Multidimensional assessment of empathic abilities: neural correlates and gender differences. Psychoneuroendocrinology. 2010;35(1):67\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLennon R, Eisenberg N, Carroll J. The relation between nonverbal indices of empathy and preschoolers' prosocial behavior. J Appl Dev Psychol. 1986;7(3):219\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAimaganbetova O, Faizullina A, Adilova E, Turgumbayeva A. The impact of culture on gender stereotypes. J Psychol Sociol 2016, 58(3).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Empathy, Affective empathy, Trait empathy, Single-item, Validation, Psychometric properties, Arabic","lastPublishedDoi":"10.21203/rs.3.rs-4660388/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4660388/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNo instrument could be considered and recommended as the gold standard assessment method for empathy based on desirable validity and reliability indices. Recently, two new measures were developed to address previous gaps in measuring empathy, i.e. the Pictorial Empathy Test (PET) to assess affective empathic reactions and the Single Item Trait Empathy Scale (SITES) to assess general trait empathy. The PET stands out from the existing self-report measures that use text-based items because it proposes a novel approach to conceptualize the empathy construct from an ecological perspective using photographs as emotional stimuli, while the SITES stands out because it consists of a single item. This study aims to examine the psychometric properties of an Arabic translation of the PET and SITES in a sample of Arabic-speaking young adults from the general population of Tunisia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a cross-sectional study carried out from March to May 2024 using a snowball spread method. A total of 502 participants (mean age of 21.74 years, 64.9% females) filled an online anonymous survey. The PET and SITES were translated into Arabic using the forward-backward translation method.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eExploratory Factor Analysis showed that the PET\u0026rsquo;s unidimensionality was supported with an acceptable goodness-of-fit, and that good congruence of the factor structure of the SITES was supported across sex. Besides, the PET and the SITES exhibited satisfactory reliability coefficients. Positive correlations were observed between PET and SITES scores. The SITES, but not the PET, scores correlated significantly and positively with psychological distress. Both the SITES and the PET showed no significant correlations with self-esteem scores. Comparison of empathy levels between sexes showed no significant differences between males and females, both when using the PET or the SITES.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWhile the present validation study leaves further work to be completed, it provides to practitioners and researchers two validated measures of empathy in the Arabic language. The two scales are brief, cost-effective, well-accepted, and can be easily understood by participants. We thus recommend their use in future clinical and research practices, in particular in settings where resources and time can be limited.\u003c/p\u003e","manuscriptTitle":"Psychometric validation of an Arabic-language version of the Pictorial Empathy Test (PET) and the single-item empathy scale (SITES) for adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-29 18:03:12","doi":"10.21203/rs.3.rs-4660388/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e006af4a-4651-48be-92b3-f1f6e1660d47","owner":[],"postedDate":"July 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-07T08:39:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-29 18:03:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4660388","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4660388","identity":"rs-4660388","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}