Impact of adverse childhood experiences on the development and expression of empathy among university students: a cross-sectional study

BACKGROUND: Adverse childhood experiences (ACEs) are associated with adverse physical and mental health outcomes and may influence the development of empathy. Although previous studies have reported inconsistent relationships between ACEs and empathy, this association has not been examined among university students in Saudi Arabia. OBJECTIVE: To examine the association between adverse childhood experiences (ACEs) and the development and expression of empathy among students at King Abdulaziz University, Jeddah. METHODS: A cross-sectional study was conducted among 1,693 students aged 18–30 years at King Abdulaziz University using an Arabic questionnaire that included socio-demographic characteristics, the Adverse Childhood Experiences questionnaire, and the Interpersonal Reactivity Index (IRI). Data were analyzed using Pearson’s correlation, analysis of variance (ANOVA) with post hoc tests, and a General Linear Model. Internal consistency was evaluated using Cronbach’s alpha. RESULTS: The mean ACE score was 3.23 ± 2.5. Students in the high-risk ACE group demonstrated significantly higher scores in Perspective-Taking (16.49 ± 4.8), Fantasy (17.49 ± 5.7), Empathic Concern (19.21 ± 4.5), and Personal Distress (15.27 ± 4.8) compared with low-risk participants (all p < 0.001). ACE scores showed weak to moderate positive correlations with all IRI domains (r = 0.111–0.252, p < 0.001). Variables significantly associated with higher ACE risk included income level, Perspective‑Taking, Fantasy, and Personal Distress. CONCLUSION: Higher ACE exposure was associated with increased empathy, particularly in Perspective-Taking and Personal Distress, indicating both adaptive empathic abilities and heightened emotional burden. The present study underscores the importance of addressing ACEs within public health and educational strategies.