Psychological barriers to bystander AED use: Associations of empathy with willingness to perform bystander rescue behaviors.
Resuscitation plus · 2026-06-23 · Observational study
Abstract
BACKGROUND: Despite public access to automated external defibrillators (AEDs), bystander use remains limited. The psychological factors influencing rescue behaviors are not well understood. OBJECTIVE: To examine how three empathy dimensions (empathic concern, perspective-taking, and personal distress) are associated with willingness to intervene in bystander rescue behaviors. METHODS: A cross-sectional survey of laypersons from Japan recruited using a nationwide online research panel operated by a commercial company was conducted using hypothetical train-station cardiac arrest scenarios. Participants rated their willingness to perform three rescue behaviors-running up to the victim or calling for help, retrieving an AED, and using an AED-on a 5-point Likert scale, with high willingness indicated by scores of 4-5. Univariable and multivariable logistic regression analyses were performed to examine associations between empathy dimensions and willingness to intervene. RESULTS: Overall, 1050 participants were included. High willingness was most frequent for running up to the victim or calling for help (72.6%), followed by retrieving an AED (40.6%), and using an AED (25.7%). Higher empathic concern was associated with greater willingness across all three rescue behaviors. Similar patterns were observed in univariable analyses and after multivariable adjustment. Perspective-taking was positively associated mainly with AED-related behaviors, whereas personal distress was inversely associated with willingness to retrieve and use an AED. CONCLUSIONS: Distinct empathy dimensions may play different roles depending on the type of rescue behavior. Empathic concern and perspective-taking may facilitate AED-related actions, whereas personal distress may represent a psychological barrier. Interventions targeting emotion regulation and perspective-taking may help improve bystander AED use.