BackgroundPrevious studies have shown associations between internalizing and externalizing symptoms, executive functions, and empathy. However, the mechanisms that affect this relationship remain unclear. This study employed regression analysis to explore the relationships between empathy, executive functions, and internalizing and externalizing symptoms.MethodOur study consisted of three consecutive stages. In the first stage, we assessed 2150 adolescents' parents aged 10–12 using the Strengths and Difficulties Questionnaire to determine which participants should be included in the subsequent stages. In the second stage, we conducted a pilot study with 50 participants to assess the validity of the assessment system and the six film scenes to be used in the following stage. Finally, in the third stage, we obtained 170 participants' state empathy, trait empathy, and executive functioning.ResultsThe regression analysis showed that working memory (β = 0.261) and externalizing symptoms (β = -0.157) predicted cognitive empathy, but only externalizing symptoms predicted affective empathy (β = -0.193). The regression analysis also showed that cognitive empathy (β = -0.513) and affective empathy (β = -0.535) predicted externalizing symptoms, but only inhibition predicted internalizing symptoms (β = 0.158).ConclusionThis population-based study highlights the reciprocal effects of externalizing symptoms on cognitive and affective empathy. No significant relationship was found between internalizing symptoms and empathy. This study also highlights the effect of working memory on cognitive empathy. These findings may inform psychological interventions to improve empathic abilities in early adolescence.
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