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. Author manuscript; available in PMC: 2025 May 1.
Published in final edited form as: Brain Behav Immun. 2024 Feb 24;118:128–135. doi: 10.1016/j.bbi.2024.02.022

Children’s Empathy Moderates the Association Between Perceived Interparental Conflict and Child Health

Hannah M C Schreier 1,2, Mark E Feinberg 3, Damon E Jones 3, Aishwarya Ganguli 1, Caitlin Givens 1, Jennifer Graham-Engeland 1
PMCID: PMC11008563  NIHMSID: NIHMS1971935  PMID: 38408496

Abstract

Interparental conflict is known to negatively impact child well-being, including behavioral and physiological well-being. Children’s empathy – that is, vicariously experiencing others’ emotions – may increase children’s sensitivity to and the biological repercussions of interparental conflict. Although empathy represents a valued trait and is an important part of socioemotional development, its influence on children’s physical health is unknown. This study examined whether empathy moderates the association between perceived interparental conflict and both child systemic inflammation and parent-rated overall child health in a sample of children between the ages of seven to nine. Children and their parents participating in the long-term evaluation of the Family Foundations program, a randomized trial of a perinatal preventative intervention, provided data approximately eight years following enrollment into the program. We collected peripheral blood samples via dried blood spots, anthropometric measurements, and child and parent psychosocial questionnaires. Results indicated significant positive main effects of child empathy on both C-reactive protein (CRP; B = .26, SE = .11, p = .026) and Interleukin-6 (IL-6; B = .20, SE = .10, p = .045) levels. Further, child affective empathy moderated the associations between perceived interparental conflict and both CRP (B = .39, SE = .19, p = .050) and parent-reported child health (B = .30, SE = .13, p = .021), such that greater empathy strengthened the negative associations between interparental conflict and child health. Overall, findings suggests that there may be a biological cost of being more empathic in high-conflict environments and highlight the need for tools to help more empathic children appropriately manage vicarious emotions.

Keywords: empathy, interparental conflict, inflammation, parent-rated health, children

Children’s exposure to interparental conflict is common and has been reliably linked to numerous adverse outcomes, particularly child behavior problems and psychological well-being. For example, increased exposure to interparental conflict has been linked to greater child anxiety (Lucas-Thompson et al., 2020; Ran et al., 2021), depressive symptoms (O’Donnell et al., 2010), aggressive behaviors (Li et al., 2023), internalizing and externalizing behavior problems (Harold & Sellers, 2018), and poorer school adjustment (Sturge-Apple et al., 2008). Recent meta-analytic evidence indicates that interparental conflict influences child well-being over time and that the negative consequences of interparental conflict are not limited to overt forms of interparental conflict, but also interparental conflict marked by disengaged or withdrawn behaviors (Van Eldik et al., 2020).

By contrast, our understanding of the consequences of interparental conflict on indicators of child physical health and well-being, in particular physiological mechanisms such as indicators of systemic inflammation, is limited – despite their potential to influence longer-term health (Furman et al., 2019; Troxel & Matthews, 2004). Greater exposure to interparental conflict has been linked to adverse health behaviors among late adolescents, including less sleep and greater frequency of smoking (Michael et al., 2007). In addition, several studies link children’s exposure and response to interparental conflict to hypothalamic-pituitary-adrenal (HPA) axis reactivity. Specifically, studies have shown links between children’s distress following simulated interparental conflict and greater cortisol reactivity among six year olds (Davies et al., 2008); daily diary reports of interparental conflict and HPA axis responses to the Trier Social Stress Test, a commonly used social-evaluative stressor involving public speaking and arithmetic in front of a panel of judges, in 8–13 year olds (Kuhlman et al., 2018); and retrospective reports of interparental conflict and greater cortisol response and reactivity following an interpersonal stress task among emerging adults (Hagan et al., 2014).

Relatedly, a recent review reported on associations between a broad range of parenting behaviors and offspring inflammation (O’Brien et al., 2023). Overall, there was mixed evidence of negative parenting behaviors being either associated with increases in offspring inflammation or unrelated to offspring inflammation. Only three of the studies included in the review related specifically to conflict behaviors, however, and all focused on conflict between parent-child dyads, rather than on the effect of interparental conflict on youth inflammation. Thus, more research is needed to assess the effect of interparental conflict on child physical health specifically. Given what is known about the consequences of HPA axis dysregulation and increased inflammation on long-term health (Agorastos & Chrousos, 2022; Rohleder, 2019), changes in such outcomes may provide a link between exposure to interparental conflict and subsequent poorer health.

Exposure to interparental conflict may impact chronic inflammation in children in a number of ways related to stress. Although the inflammatory response is a hallmark of the body’s innate immune response, designed to remove pathogens and repair damaged tissue, it is also sensitive to psychosocial stressors (e.g., Danese et al., 2011; Miller & Chen, 2010; Pollitt et al., 2007). Repeated activation of the inflammatory response early in life, e.g., in response to living in harsher, more conflictual environments, may become biologically embedded and result in a more pro-inflammatory phenotype which may persist across the lifespan (Ehrlich et al., 2016; Miller et al., n.d.). Additionally, conflict may lead to perceptions of threat and self-blame (Fosco & Lydon-Staley, 2019), which have been linked to inflammation through negative mood (Renna, 2021). Similarly, interparental conflict may spill over and lead to more negative parent-child interactions, for example as a result of less sensitive and less patient parenting among parents engaged in more interparental conflict (Kopystynska et al., 2022).

The Role of Affective Empathy

Substantial evidence supports the notion that individual differences change how people react to, as well as the extent to which their physical well-being is influenced by, the psychosocial environment in which they find themselves (Fergus & Zimmerman, 2005; Lupien et al., 2009). One key characteristic that may influence how youth are impacted by interparental conflict is their level of affective empathy, a term used to refer to “the vicarious experiencing of a range of emotions consistent with those of others” (Eisenberg & Miller, 1987; p. 91). Empathy is an important component of early socioemotional development as it facilitates meaningful interactions with others together with, for example, emotion regulation skills and the ability to take others’ perspective. Empathy-related behaviors, such as expressing interest in and concern for others in distress and asking people in distress whether they are okay, develop as early as during toddlerhood (Zahn-Waxler et al., 1992) and appear to be relatively stable across development (Eisenberg et al., 1999). Affective empathy has primarily been understood to be a desirable and adaptive prosocial trait, benefiting both empathic individuals themselves as well as those around them. For example, individuals better able to empathize with others’ positive emotions have been shown to have greater life and relationship satisfaction (Morelli et al., 2015) and more empathic children of nondepressed mothers exhibited fewer internalizing problems than their less empathic counterparts (Tully & Donohue, 2017). Conversely, children also seem to benefit from having more empathic parents as evidenced by greater psychological (i.e., better emotion regulation) and physical (i.e., lower systemic inflammation among healthy children and lower levels of stimulated cytokine production among youth with asthma) well-being (Manczak, DeLongis, et al., 2016; Manczak et al., 2017).

Recent evidence increasingly suggests, however, that rather than being uniformly beneficial, greater affective empathy may in fact be indicative of overall greater biological sensitivity to context and thus represent a phenotype that may leave individuals more susceptible to the negative effects of psychosocial stress on health (Boyce & Ellis, 2005). For example, among young adults with poor emotion regulation skills, moderate to high affective empathy was associated with an increased likelihood of depression (Tully et al., 2016). Similar findings were reported for young children who witnessed their mother’s emotions while she was participating in a simulated phone conversation as part of a laboratory visit (Tully & Donohue, 2017) - children of chronically depressed mothers who displayed more affective empathy during the laboratory task were rated to exhibit more internalizing problems than children lower on affective empathy.

Relatedly, existing research also supports the idea that these associations extend to the effect of affective empathy on physiological well-being. For example, although having more empathic parents was associated with greater well-being among adolescents, levels of systemic inflammation were higher among parents displaying greater affective empathy (Manczak, DeLongis, et al., 2016). In a different study, the association between affective empathy and inflammation among parents of adolescents was further shown to be moderated by the psychological well-being of the adolescent children (Manczak, Basu, et al., 2016); specifically, more empathic parents of youth who reported greater depressive symptoms showed evidence of more exaggerated inflammatory responses to in vitro stimulation, again lending support to the idea that greater empathy can have negative consequences for individuals who find themselves exposed to more adversity or who are close to others who are facing challenges. Finally, a recent report provides evidence of longitudinal associations between youth’s affective empathy and levels of C-reactive protein (CRP), a commonly used indicator of systemic inflammation with known clinical cut-offs and implications (Ridker, 2003), eight years later (Manczak, 2023); this association was only observed, however, among adults reporting lower levels of depressive symptoms. Despite these recent findings, to our knowledge no studies to date have examined the role of children’s affective empathy on the effect of interpersonal conflict on child physiological outcomes.

The above studies clearly show the need for a more nuanced understanding of how individuals’ characteristics as well as the social environments in which they live can alter the consequences of affective empathy on individuals’ well-being. Research regarding the consequences of greater empathy on physiological well-being and whether similar patterns are observable among children is particularly sparse. However, given that children growing up in hostile family environments are at risk of greater inflammation (Miller & Chen, 2010) and, by extension, increased chronic disease risk, it is important to understand whether children’s individual characteristics, such as empathy, may further potentiate this risk. If such associations are found, it may be desirable to provide children high in affective empathy with tools to help them lower the possible toll of greater empathy on their well-being (e.g., by also teaching children when and how to stay appropriately distanced from others and their challenges).

The Present Study

The present study investigates whether child empathy moderates the association between interparental conflict and child health outcomes, specifically, inflammatory markers and parent-reported child health. Based on prior research, we hypothesized that children reporting greater empathy would be more sensitive to interparental conflict and thus exhibit greater levels of inflammation as well as poorer parent-reported health in the context of greater interparental conflict. To examine these associations, we leverage data from multiple informants (children and parents) as well as inflammatory markers measured in peripheral blood as part of an ongoing prospective cohort study.

Methods

Participants

Participating families were recruited into a randomized controlled trial of the Family Foundations intervention (clinicaltrials.gov identifier: NCT01907412) starting in 2008 via childbirth education programs, OBGYN clinics, media advertisements and fliers distributed near partner health care systems in Maryland, Pennsylvania, Delaware, and Texas. Heterosexual couples who were at least 18 years old and expecting their first child were eligible. The present manuscript is based on data from home visits when children were 7 to 9 years old and that were completed prior to the emergence of the COVID-19 pandemic, i.e., between March 2017 and March 2020 (n = 175; n = 72 who had been randomly assigned to the comparison group, n = 103 who had been randomly assigned to the Family Foundation intervention group). One hundred and six participating children agreed to provide a peripheral blood sample via finger stick. Parent-reported child health was available for n = 162 children. Children who agreed to provide a blood sample had marginally larger waist-hip ratios than children who did not agree to provide blood (t(162) = −1.78, p = .076) and were marginally older (t(171) = −1.97, p = .051) but did not differ on other key study variables (all ps > .10). At the time of the home visits, mothers and fathers were 28.9 ± 4.1 and 30.7 ± 4.8 years old, respectively; children were 7.8 ± 0.5 years old and 57% male. For detailed sample characteristics, see Table 1. For additional information about the development and effects of the Family Foundations interventions, see (Feinberg, 2002, 2003; Feinberg et al., 2010; Jones et al., 2018).

Table 1.

Participant Characteristics

M ± SD n (%)
Child age 7.80 ± 0.48
Child gender
 Male		 92 (52.9)
 Female 82 (47.1)
Child race
 White		 157 (89.7)
 Other 18 (10.3)
Household income (23-point scale) 19.28 ± 4.56
Waist-hip ratio 0.87 ± 0.09
Perceived interparental conflict 1.71 ± 0.62
Affective empathy 4.15 ± 0.85
IL-6 (raw; pg/mL) 0.72 ± 0.58
CRP (raw; mg/L) 0.82 ± 2.47
Parent-reported health 1.52 ± .71
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Note. Bin 19 of 23 on the annual total pretax income scale was equivalent to $90,000-$94,999.

Procedure

The current wave of home visits took place approximately eight years following baseline visits and followed the overall format of prior home visits. Specifically, parents and children provided informed consent and assent, respectively. Next, children’s dried blood spot (DBS) samples were collected via fingerstick and anthropometric measures were taken. Both parents and children also completed a set of psychosocial questionnaires on tablets. At the end of the visit, participating families were reimbursed for their time and effort. The Institutional Review Board of The Pennsylvania State University reviewed and approved the study.

Measures

Perceived Interparental Conflict

Children completed the Children’s Perception of Interparental Conflict Scale for Younger Children (McDonald & Grych, 2006) which includes questions pertaining to conflict properties (e.g., My dad and mom get really mad when they have a disagreement), threat (e.g., When my dad and mom argue I’m afraid something bad will happen), and self-blame (e.g., It’s usually my fault when my dad and mom argue). Children were asked to indicate on a four-point scale ranging from Not True, A Little Bit True, Sort of True, to True the extent to which each statement described their family over the course of the past month. Items were averaged and higher scores indicate greater perceived interparental conflict. Seven children did not complete this questionnaire and were excluded from analyses. The reliability and validity of the measure in children have been previously established (McDonald & Grych, 2006; Moura et al., 2010). Internal reliability in the present sample was very good with Cronbach’s alpha = 0.89.

Child Empathy

Children completed six items drawn from the Interpersonal Reactivity Index (Davis, 1983; Sometimes I feel very sorry for other people when they are having problems), the Middle Years Development Instrument (Schonert-Reichl et al., 2013; I often feel sorry for people who don’t have the things I have; When I see someone being treated in a mean way, it bothers me; I am a person who cares about the feelings of others) and the Eisenberg Child-Report Sympathy Scale (Zhou et al., 2003; When I see someone being picked on, I feel kind of sorry for them; I often feel sorry for other children who are sad or in trouble). All items were answered on a five-point Likert scale ranging from Not at All True to Very True. Responses were averaged such that higher scores represent greater affective empathy. Three children did not complete this questionnaire and were excluded from analyses. Internal reliability across these items was good at Cronbach’s alpha = .79; further, correlations between individual item scores and total scores were high (ranging from r = .63 to r = .78) and a principal components analysis carried out on the six items supported a one-factor solution.

Inflammation

Children’s capillary whole blood was drawn via finger-stick. After cleaning the puncture site with alcohol swabs, the interviewer pricked the side of the child’s finger (middle or ring finger of the non-dominant hand) with a single-use micro-lancet (BD Microtainer). Five blood spots were collected onto filter paper cards and allowed to air dry for four hours. Subsequently, DBS cards were placed in biohazard bags and shipped (using 2-day shipping) to the laboratory of Dr. Schreier where they were stored at −30C. For analysis, cards were shipped in batches to the Laboratory for Human Biology Research at Northwestern University. CRP was measured in duplicate using an established protocol for use with enzyme-linked immunosorbent assay kits for human CRP (McDade et al., 2004). CRP concentrations obtained via this protocol have been compared to plasma CRP concentrations and demonstrated good reliability, precision, and sensitivity (McDade et al., 2004). Samples were rerun if intra-assay coefficients of variation (CVs) exceeded 10%. Inter-assay CVs for low, medium, and high control samples were 10.23%, 10.33%, and 10.21% respectively. Interleukin-6 (IL-6) was measured in duplicate using an established protocol for use with MSD V-plex human IL-6 kits (K151QXD-1, Mesoscale Diagnostics; McDade et al., 2021). Most samples were run in duplicate (78.9%) with the remainder (21.1%) run in singlicate due to insufficient remaining sample. Samples were repeated if intra-assay CVs exceeded 15% and the inter-assay CVs for low, medium and high control samples were 14.68%, 5.41%, and 3.51% respectively. Because CRP was prioritized at the assay stage, IL-6 data were not available for nine children due to insufficient sample.

Parent-rated Child Health

One of the participating parents, selected at random, indicated their perception of their child’s overall health on a 7-point scale ranging from 1 = Excellent to 7 = Poor. Data regarding overall child health was missing for thirteen families.

Covariates

Parents reported on child sociodemographics as well as the annual total pretax household income using a 23-point scale ranging from 1 = <$5k to 23 = > $150k. Children’s waist and hip circumference was measured using a cloth measuring tape by the interviewer. Measures were taken until two measures were within 0.5 cm of each other. Waist-hip ratio was calculated as waist circumference in cm divided by hip circumference in cm.

Analyses

As is common, circulating levels of CRP and IL-6 were not normally distributed and thus log-transformed to reduce skewness. Following log-transformation, data were normally distributed; thus, no data points were excluded or winsorized. Multiple linear regression analyses were performed to separately assess the main effects of child empathy and perceived interparental conflict on outcomes of interest. Due to overall low rates of missingness, analyses were based on participants with complete data. Subsequently, the PROCESS version 4.2 macro for SPSS (Hayes, 2022) was used to examine the possible interaction effect of child empathy x perceived interparental conflict on outcomes of interest. All analyses adjusted for child age, sex, race, ethnicity, and family income due to their known relevance for inflammatory outcomes (O’Connor et al., 2009), as well as waist-to-hip ratio when predicting inflammatory outcomes as obesity is known to impact inflammation (Schwarzenberg & Sinaiko, 2006). Additionally, although the intervention itself was not of interest for the present analyses, all analyses adjusted for intervention group (0 = control; 1 = Family Foundations intervention). All analyses were conducted using SPSS version 28.0 (IBM Corp., Armonk, NY).

Results

Main Effects of Interparental Conflict and Child Empathy on Health

There were significant main effects of child empathy on both child CRP (B = .26, SE = .11, p = .026) and IL-6 (B = .20, SE = .10, p = .045) levels, such that greater empathy was associated with greater levels of inflammation. Child empathy was not related to parent-rated overall child health (p > .40).

Interparental conflict was not associated with child IL-6 levels or parent-rated overall child health (ps > .10); greater perceived interparental conflict was associated with marginally greater CRP levels (B = .28, SE = .15, p = .072).

Interaction Effects of Interparental Conflict and Child Empathy on Health

There was a significant empathy x interparental conflict interaction effect on both child CRP levels (B = .39, SE = .19, p = .050; Figure 1) and parent-rated overall child health (B = .30, SE = .13, p = .021; Figure 2). In both cases, the perception of greater interparental conflict was associated with worse health, i.e., greater CRP levels and worse parent-rated overall child health, only among children who also reported greater levels of empathy. Child empathy and perceived interparental conflict did not interact to predict levels of child IL-6 (p > .60).

Figure 1. The Interaction Between Child Empathy and Perceived Interparental Conflict on Child CRP Levels.

Figure 1

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Note. Both empathy and perceived interparental conflict are depicted at the 16th, 50th, and 84th percentile.

Figure 2. The Interaction Between Child Empathy and Perceived Interparental Conflict on Parent-reported Overall Child Health.

Figure 2

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Note. Both empathy and perceived interparental conflict are depicted at the 16th, 50th, and 84th percentile.

Finally, correlations across all main study variables can be found in Table 5.

Table 5.

Correlation Matrix of Main Study Variables

1 2 3 4 5 6 7 8 9 10 11
1. Interparental conflict 1
2. Child empathy .046 1
3. IL-6 (log) .105 .205* 1
4. CRP (log) .200 .213* .310** 1
5. Parent-reported child health .057 .093 .036 .038 1
6. Intervention group −.144 .039 .064 −.061 .092 1
7. Age −.086 −.106 .022 .061 −.017 .164* 1
8. Gender (female) .054 .125 .036 −.072 −.021 −.165* −.215** 1
9. Race (White) .043 .060 −.078 .047 −.004 −.092 −.072 .018 1
10. Waist-hip ratio .095 −.008 .016 .088 −.080 −.170* −.006 −.188* −.072 1
11. Income −.115 −.138 .167 −.145 −.081 −.061 .059 −.094 .017 .021 1
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*

p < .05;

**

p < .01. IL-6 = Interleukin-6; CRP = C-reactive protein

Discussion

To our knowledge, this is the first study showing that children’s levels of affective empathy moderate associations between perceived interparental conflict and child physical health outcomes, specifically, markers of systemic inflammation and parent-reported overall child health. Although there were no significant main effects of interparental conflict on child physical health outcomes, perceived interparental conflict was associated with greater CRP levels and worse parent-reported overall child health among those children who rated themselves higher in affective empathy. Additionally, we observed main effects of child affective empathy on child inflammation, such that children reporting greater affective empathy also had greater levels of systemic inflammation (both CRP and IL-6).

Our finding that living in a family context marked by more interparental conflict was associated with adverse child health outcomes, both in terms of greater systemic inflammation (CRP) as well as parent-reported overall health, only among children with greater self-reported affective empathy lend support to the notion that children’s levels of empathy may come at a physiological cost, especially for children in more adverse environments. Although prior research has shown that children’s health can be positively impacted by greater parent empathy (Manczak, DeLongis, et al., 2016), the role of children’s own empathy on their health, in particular in more conflictual environments, has yet to be clearly established. Given that the current sample of families is drawn from the general population and represents a relatively low risk sample, our findings may represent a conservative estimate of the potential impact of interparental conflict on children’s physiological well-being among more empathic children. Future research should replicate these findings in higher-risk samples, especially children growing up in families marked by greater levels of interparental conflict.

Developmentally, middle childhood is marked by children’s continued cognitive development, e.g., stronger problem-solving abilities, the beginning of meaningful involvement in household tasks, such as helping with chores or simple caretaking responsibilities, and increased learning about social and cultural norms and values (Del Giudice, 2018). Thus, it stands to reason that children at this age may be particularly attuned to the social interactions around them, especially their parents’, as they are learning to navigate social roles and expectations in their own lives and how to integrate themselves into the social environments in which they find themselves. Consequently, from a developmental point of view, greater affective empathy at this life stage may facilitate children’s interactions with others and, by extension, their social integration while also potentially leaving them at risk of being particularly sensitive to negative interpersonal interactions they may witness.

Overall, observed interaction effects between affective empathy and perceived interparental conflict were stronger for child CRP than IL-6 levels. This may in part be due to the slightly reduced sample size of analyses predicting IL-6. Similarly, a subset of samples could only be assayed for IL-6 in singlicate, which may have resulted in more noise in the data. At the same time, although both CRP and IL-6 are commonly used markers of systemic inflammation, there are important differences between the two. For example, CRP is released from the liver in response to IL-6 signaling but CRP and IL-6 levels can be differentially impacted by other physiological processes, e.g., effects of cortisol, which can have anti-inflammatory effects on IL-6 while, somewhat counterintuitively, also increasing the production of CRP (Del Giudice & Gangestad, 2018). Future research should further examine possible physiological mechanisms underlying differential effects of psychosocial experiences on different markers of inflammation.

This study further adds to the existing literature on how different parenting behaviors can impact child physiological well-being, including inflammation (O’Brien et al., 2023). In the present study, we observed only a marginal main effect of perceived interparental conflict on child CRP levels, such that greater perceived interparental conflict was associated with marginally greater levels of CRP. The absence of significant main effects of interparental conflict is somewhat contradictory to prior literature suggesting worse health outcomes, including increased systemic inflammation, among children exposed to adversity (Slopen et al., 2013). A possible explanation for this may be the relatively low-risk nature of our sample. In line with the stress-inoculation theory, prior research suggests that exposure to moderate adversity, in particular in the context of an overall safe environment, may increase resilience (Seery et al., 2013). Thus, it is possible that the levels of interparental conflict reported by children in this study were not severe enough to result in direct adverse physiological consequences in the absence of additional contributing factors, such as high levels of empathy. Given the marginal nature of our finding relating to interparental conflict and child CRP, we are hesitant to interpret if further but, if supported by future research, such associations may further reflect that other contextual factors as well as individual differences among children, such as levels of affective empathy, play a role in the extent to which (or during which circumstances), exposure to interparental conflict influences child physiological well-being. Importantly, although several studies have examined the impact of positive and negative parenting behaviors on child outcomes such as inflammation (Beach et al., 2015; Byrne et al., 2017; Miller & Chen, 2010; Oshri et al., 2020), relatively little work has focused on the impact of family conflict on inflammation specifically. Further, studies focused on effects on youth inflammation within the broader realm of family conflict have almost exclusively focused on parent-child conflict, rather than interparental conflict, and on older youth, specifically older children and adolescents (O’Brien et al., 2023). Thus, the present study also extends downward the age at which we see associations between family conflict, specifically, interparental conflict, and child health and suggests that, even among seven- to nine-year-old children, physiological consequences of interparental conflict on markers of systemic inflammation are already observable.

We also note that although there was variation in parent-rated overall child health, all participating children were rated as having health in the good to excellent range. It is of interest, however, that even within this range, children who rated themselves as more empathic and perceived greater interparental conflict in their home were rated by their parents as being in relatively poorer health. This underlines the effect that child affective empathy can have on child well-being although, as alluded to above, it remains to be seen whether higher-risk empathic children may be even more adversely impacted by exposure to interparental conflict.

Importantly, the current study did not take into account all facets of interest with regards to interparental conflict. Some research suggests that the quality of arguments between parents (e.g., the extent to which arguments are negative vs. constructive) influences the extent to which children are affected by exposure to interparental conflict (Van Eldik et al., 2020). Given that our measure of children’s perceived interparental conflict did not include questions to assess constructive conflict, it remains to be seen whether children, especially children higher in affective empathy, are less impacted, physiologically speaking, by witnessing constructive conflict among their parents. Similarly, future research should examine whether other family or contextual factors might buffer more empathic children from the adverse physiological consequences of living in a family marked by more interparental conflict.

This study has several strengths, most notably the availability of data from multiple sources, which reduces concerns regarding shared method variance. Specifically, children themselves reported on perceived interparental conflict and their own levels of empathy, parents reported on overall child health, and markers of inflammation were assessed in peripheral blood samples obtained from children. Additionally, we were able to examine the above associations in children who were younger than youth typically studied when assessing the influence of youth characteristics and youth’s psychosocial environment on youth health, in particular when the collection of peripheral blood is involved.

Nonetheless, the current findings also need to be considered in the context of several limitations. First, the study did not include an established measure of affective empathy but rather a collection of six items drawn from relevant questionnaires. In addition to having good face validity, however, we note that internal reliability across these items was high and that all were drawn from established questionnaires used for the assessment of affective empathy. Second, a large subset of children did not agree to participate in the collection of peripheral blood samples via finger stick and dried blood spot collection. Third, the sample was primarily White, non-Hispanic, and middle class and participating children were generally healthy. Thus, the findings from the present work should be replicated in more diverse samples, and in particular among families from more vulnerable backgrounds. Finally, we were only able to analyze cross-sectional data; thus, it remains to be seen whether child affective empathy levels continue to affect child physical health over time and whether the association between child empathy and health varies across development. For example, it is possible that, as children grow older and learn to manage their emotions more effectively or learn to put their parents’ conflict into context, they are less impacted by being more empathic.

Overall, the current findings suggest that more empathic children may be at greater risk of poorer health in the context of living in more conflictual homes, as indicated by greater levels of systemic inflammation and parent-reported overall physical health. This has important implications for intervention efforts focused on helping children avoid the possible adverse consequences of being more empathic, in particular when confronted with difficult situations, such as interparental conflict. Although being empathic is in many ways a desirable trait, providing children with ways to manage the impact others’ emotions can have on their well-being is also necessary. Understanding the associations described here is particularly important given that children have limited control over their immediate home environment. It may also be that children who are more empathic are more likely to be negatively impacted by difficult, e.g., negative or conflict-laden, situations and relationships outside of their homes, including at school and within their peer networks. Future research should more broadly investigate connections between child empathy and child health across the major domains of children’s lives.

Table 2.

Main Effects of Linear Regression Analyses Predicting Child Health Outcomes from Perceived Interparental Conflict

CRP IL-6 Parent-rated health
b SE p b SE p b SE p
Constant −2.533 2.035 0.217 −1.670 1.626 0.308 2.151 1.335 0.110
Intervention group −0.273 0.226 0.230 0.141 0.181 0.437 0.169 0.133 0.207
Child age 0.186 0.204 0.366 0.007 0.161 0.966 −.0.037 0.136 0.785
Household income −0.030 0.021 0.168 0.035 0.018 0.058 −0.011 0.014 0.411
Child race 0.120 0.324 0.713 −0.185 0.263 0.484 0.052 0.232 0.823
Child gender −0.014 0.220 0.949 0.154 0.182 0.400 −0.054 0.131 0.679
Waist-hip ratio 0.267 1.043 0.799 0.104 0.841 0.902 −0.357 0.706 0.614
Perceived interparental conflict 0.280 0.153 0.072 0.189 0.124 0.132 0.033 0.099 0.743
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Note. b = unstandardized beta coefficient, SE = standard error, CRP = C-reactive protein, IL-6 = Interleukin-6; significant effects (p < .05) are bolded. Sample sizes were n = 88, n = 81, and n = 135 for analyses predicting CRP, IL-6, and parent-rated health, respectively.

Table 3.

Main Effects of Linear Regression Analyses Predicting Child Health Outcomes from Affective Empathy

CRP IL-6 Parent-rated health
b SE p b SE p b SE p
Constant −2.846 2.019 0.162 −2.100 1.606 0.195 1.958 1.374 0.156
Intervention group −0.207 0.209 0.326 0.158 0.167 0.345 0.160 0.129 0.217
Child age 0.147 0.198 0.461 −0.009 0.155 0.954 −0.031 0.135 0.818
Household income −0.032 0.020 0.120 0.031 0.017 0.062 −0.014 0.013 0.280
Child race 0.056 0.318 0.861 −0.167 0.255 0.514 0.071 0.230 0.757
Child gender −0.114 0.208 0.584 0.095 0.171 0.579 −0.065 0.127 0.607
Waist-hip ratio 0.423 0.996 0.672 0.252 0.791 0.751 −0.350 0.689 0.612
Affective empathy 0.258 0.114 0.026 0.198 0.097 0.045 0.063 0.074 0.400
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Note. b = unstandardized beta coefficient, SE = standard error, CRP = C-reactive protein, IL-6 = Interleukin-6; significant effects (p < .05) are bolded.Sample sizes were n = 94, n = 86, and n = 141 for analyses predicting CRP, IL-6, and parent-rated health, respectively.

Table 4.

Moderation Effects of Children’s Perceived Interparental Conflict and Affective Empathy on Child Health Outcomes

CRP IL-6 Parent-rated health
b SE p b SE p b SE p
Constant −1.997 2.22 0.372 −2.341 1.835 0.206 3.210 1.510 0.036
Intervention group −0.155 0.223 0.491 0.179 0.183 0.333 0.212 0.133 0.113
Child age 0.271 0.201 0.182 0.032 0.162 0.842 0.032 0.137 0.815
Household income −0.027 0.021 0.193 0.035 0.018 0.055 −0.008 0.013 0.543
Child race 0.124 0.315 0.696 −.167 0.262 0.527 0.001 0.229 0.996
Child gender −0.037 0.214 0.864 0.106 0.182 0.562 −0.052 0.129 0.684
Waist-hip ratio 0.678 1.026 0.511 0.319 0.850 0.709 −0.214 0.697 0.759
Perceived interparental conflict −1.278 0.800 0.114 −0.145 0.677 0.831 -1.220 0.544 0.027
Affective empathy −0.424 0.343 0.220 0.058 0.291 0.842 −0.422 0.227 0.065
Interparental conflict x empathy 0.387 0.195 0.050 0.082 0.165 0.619 0.300 0.128 0.021
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Note. b = unstandardized beta coefficient, SE = standard error, CRP = C-reactive protein, IL-6 = Interleukin-6; significant effects (p < .05) are bolded. Sample sizes were n = 88, n = 81, and n = 135 for analyses predicting CRP, IL-6, and parent-rated health, respectively.

Highlights.

  • We examined effects of interparental conflict and children’s empathy on their health

  • Outcomes were C-reactive protein, Interleukin-6, parent-reported child health

  • Greater child empathy was associated with greater inflammation

  • Interparental conflict and child empathy interacted to predict child health

  • Empathic children may be more likely to experience poorer health in the face of conflict

Author Note

Mark Feinberg created the Family Foundations program and is the owner of a private company, Family Gold, which disseminates the Family Foundations program. His financial interest has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at The Pennsylvania State University. Research presented here was supported via funding from the National Heart, Lung, and Blood Institute (R01 HL137809 (Schreier)) and Eunice Kennedy Shriver National Institute of Child Health & Human Development (R01s HD058529 and HD084476 (Feinberg); T32HD101390 (Ganguli)).

Footnotes

The other authors declare no conflicts of interest.

Declaration of Generative AI and AI-assisted technologies in the writing process Statement: No AI-assisted technologies were used in the preparation of this manuscript.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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