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Maternal cognitive and affective empathy related to preschoolers’ emotional-behavioral problems: moderation of maternal depression

Pediatric Research volume 98, pages 551–558 (2025)Cite this article

Abstract

Background

Low maternal cognitive empathy and higher affective empathy have been linked to increased emotional-behavioral problems (EBPs) in young children, but it remains unclear whether the associations are distinct according to maternal depression. This study aims to explore the moderating role of maternal depression in the association between maternal empathy and EBPs in preschoolers.

Methods

Cross-sectional and representative data were from 19,965 Chinese preschoolers. Maternal cognitive and affective empathy and depression were evaluated with Questionnaire of Cognitive and Affective Empathy and World Health Organization Five Well-Being Index, respectively. The Strengths and Difficulties Questionnaire was used to assess child EBPs.

Results

Lower maternal cognitive empathy was associated with increased child EBPs (aOR: 0.97, 95% CI: 0.96–0.97) with moderation of maternal depression (p = 0.002), and was slightly stronger in mothers at low risk for depression (aOR: 0.96, 95% CI: 0.95–0.97). Higher maternal affective empathy was associated with increased child EBPs (aOR: 1.03, 95% CI: 1.02–1.04), without significant moderation (p = 0.79).

Conclusions

Lower maternal cognitive empathy and higher affective empathy were associated with more EBPs in preschoolers. Maternal depression moderated only the cognitive empathy-EBPs association. Tailored strategies targeting maternal empathy according to various depression levels should be considered in clinical practices.

Impact

  • We found lower maternal cognitive empathy and higher maternal affective empathy were associated with more emotional-behavioral problems (EBPs) in a large-scale and representative sample of preschoolers in Shanghai.

  • We demonstrated the moderating role of maternal depression in the association between maternal cognitive empathy and EBPs in preschoolers, with the association being slightly stronger in mothers at low risk for depression than in mothers with depressive symptoms.

  • The study highlights that, aside from maternal depression, promoting interventions on inappropriate maternal empathy may confer significant benefits on the psychological well-being of preschool children.

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Fig. 1: Participant profile.
Fig. 2: Moderation effects of maternal depression on the association between maternal cognitive/affective empathy and child EBPs.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to shared ownership of Shanghai Municipal Education Commission but are available from the corresponding author on reasonable requests.

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Funding

The study was funded by the National Natural Science Foundation of China (No. 82071493), the Shanghai Municipal Education Commission (No. 2022you1-2), the Science and Technology Commission of Shanghai Municipality (No. 2018SHZDZX05), and the Innovative Research Team of High-level Local Universities in Shanghai (No. SHSMU-ZDCX20211900, SHSMU-ZDCX20211100). Shanghai Municipal Health Commission (No. 2020CXJQ01).

Author information

Author notes

  1. These authors contributed equally: Zichen Zhang, Yujiao Deng.

  2. These authors jointly supervised this work: Guanghai Wang, Fan Jiang.

Authors and Affiliations

  1. Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Zichen Zhang, Tingyu Rong, Yiding Gui, Jin Zhao, Guanghai Wang & Fan Jiang

  2. Pediatric Translational Medicine Institution, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Zichen Zhang, Tingyu Rong, Yiding Gui, Qi Zhu, Guanghai Wang & Fan Jiang

  3. MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Zichen Zhang, Tingyu Rong, Yiding Gui, Guanghai Wang & Fan Jiang

  4. Department of Neurology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Yujiao Deng

  5. Child Health Advocacy Institute, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Yunting Zhang & Jin Zhao

  6. Department of International Clinic, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Wenjie Shan

  7. Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China

    Guanghai Wang & Fan Jiang

Authors
  1. Zichen Zhang
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Contributions

Zichen Zhang conceptualized the study; contributed to the data collection, design, and conduct of data analysis; and drafted the initial manuscript. Yujiao Deng contributed to the conduct of data analysis and drafted and revised the manuscript. Tingyu Rong, Yiding Gui, Yunting Zhang, Jin Zhao, Wenjie Shan, and Qi Zhu contributed to the data collection and revision of the draft. Guanghai Wang supervised the data collection, conceptualized and designed the study, and critically reviewed and revised the manuscript. Fan Jiang coordinated and supervised the data collection, conceptualized and designed the study, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Guanghai Wang or Fan Jiang.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study received approval from the institutional review board of the Shanghai Children’s Medical Center, Shanghai Jiao Tong University (SCMCIRB-K2016022-01). Parents of the involved children signed the informed consent before participating in the study.

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Zhang, Z., Deng, Y., Rong, T. et al. Maternal cognitive and affective empathy related to preschoolers’ emotional-behavioral problems: moderation of maternal depression. Pediatr Res 98, 551–558 (2025). https://doi.org/10.1038/s41390-024-03770-8

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