Empathy as a risk factor for internalizing symptoms during war: A 10-year prospective study from toddlerhood to adolescence

While empathy is often seen as a resilience factor, emotional resonance with others' suffering may increase psychological vulnerability during mass trauma exposure, particularly in youth. Since the role of early empathy as a prospective risk factor remains understudied, we used a decade-long longitudinal design to examine whether empathic reactions in childhood predicted early adolescents' internalizing (depression and anxiety) symptoms following the October 7th attack and the Israel-Hamas war. Empathic distress was assessed at age 1.5 years and age 3 years through observational tasks. Emotional empathy and internalizing symptoms were self-reported at age 11 years, before the war, and reported again after its outbreak. Findings showed substantial internalizing symptoms during the war, with 31% of participants exceeding the clinical cutoff for anxiety and 23% for depression. Non of the empathy measures predicted internalizing symptoms before the war. However, during the war, empathic distress at age 1.5 and emotional empathy at age 11 predicted internalizing symptoms, controlling for negative emotionality and prior internalizing symptoms. Path analysis also linked empathic distress at age 3 to internalizing symptoms during war. Findings suggest that early empathic reactions may increase vulnerability to internalizing symptoms during mass trauma but not in non-traumatic contexts, aligning with a diathesis-stress model. Understanding empathy's role in risk and resilience can inform interventions for youth exposed to war.