Can socioeconomic status moderate the effect of a conflictive family environment on brain structure and externalizing/internalizing behavior in children and adolescents?

Trejos-Castillo, Elizabeth; Mastergeorge, Ann; Cogo-Moreira, Hugo; Santana, Vinicius Oliveira; Zugman, André; de Araújo, Célia Maria; Pan, Pedro Mario; Picon, Felipe; Rohde, Luis Augusto Paim; Jackowski, Andrea P.

doi:10.47626/1516-4446-2025-4195

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ORIGINAL ARTICLE • Braz J Psychiatry 47 • 2025 • https://doi.org/10.47626/1516-4446-2025-4195 linkcopy

Can socioeconomic status moderate the effect of a conflictive family environment on brain structure and externalizing/internalizing behavior in children and adolescents?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: This study examined the effects of socioeconomic status as a possible moderator of the effects of family conflict on externalizing/internalizing behavior and hippocampal and amygdala volume.

Methods: A longitudinal complete-case analysis of 714 children and adolescents (mean age: 11.2 years; 46.2% female) was conducted using data from the Brazilian High-Risk Cohort Study for Psychiatric Disorders in Childhood. At baseline, parents/guardians completed the Family Environment Scale and a socioeconomic status scale. Three years after baseline assessment, the same participants underwent brain magnetic resonance imaging, and the Child Behavior Checklist was administered. Automated segmentation of the amygdala and hippocampus was performed in FreeSurfer 5.1.

Results: Although family conflict at baseline predicted externalizing/internalizing behavior at follow-up, we found no evidence that family conflict and socioeconomic status affected brain structure or that family conflict had a moderating effect on psychopathology and brain outcomes conditioned on socioeconomic status.

Conclusion: These results are consistent with emerging evidence that family conflict is a risk factor for externalizing/internalizing behavior in youth. These findings warrant further attention, focusing on prevention and intervention efforts and social policy development.

Keywords:
Child behavior; socioeconomic status; family conflict; brain structure

Variable	Minimum	Maximum	Mean ± SD
Age at baseline (years)	5.83	14.34	9.92±1.85
SES	6.00	36.00	18.21±4.37
FES – Conflict Score	0.00	10.00	3.44±2.23
CBCL – Internalizing Score	0.00	55.00	13.79±9.78
CBCL – Externalizing Score	0.00	51.00	12.93±10.14
Left hippocampus (mm³)	2,501.00	5,090.00	3,818.76±366.11
Right hippocampus (mm³)	2,536.00	5,159.20	3,918.59±374.71
Left amygdala (mm³)	832.90	2,114.30	1,459.95±196.14
Right amygdala (mm³)	879.80	2,464.80	1,574.46±214.04
Intracranial volume (mm³)	919,993.00	1,864,950.00	1,394,864.48±131,792.09

	1	2	3	4	5	6	7	8	9	10
Age (years) (1)
Pearson correlation	1
Sig. (2-tailed)
SES (2)
Pearson correlation	0.031	1
Sig. (2-tailed)	0.41
FES: conflict score (3)
Pearson correlation	0.037	-0.152**	1
Sig. (2-tailed)	0.33	<0.01
CBCL Neuro: internalizing (4)
Pearson correlation	0.062	-0.135**	0.242**	1
Sig. (2-tailed)	0.10	< 0.01	< 0.01
CBCL Neuro: externalizing (5)
Pearson correlation	0.061	-0.134**	0.355**	0.591**	1
Sig. (2-tailed)	0.11	< 0.01	< 0.01	< 0.01
Left hippocampus (6)
Pearson correlation	0.181**	0.081*	-0.074*	-0.006	-0.044	1
Sig. (2-tailed)	< 0.01	0.03	0.05	0.87	0.24
Right hippocampus (7)
Pearson correlation	0.177**	0.068	-0.060	0.001	-0.047	0.833**	1
Sig. (2-tailed)	< 0.01	0.07	0.11	0.97	0.21	< 0.01
Left amygdala (8)
Pearson correlation	0.182**	0.067	-0.070	-0.118**	-0.124**	0.567**	0.571**	1
Sig. (2-tailed)	< 0.01	0.07	0.06	<0.01	<0.01	< 0.01	< 0.01
Right amygdala (9)
Pearson correlation	0.206**	0.046	-0.036	-0.066	-0.065	0.565**	0.581**	0.776**	1
Sig. (2-tailed)	< 0.01	0.21	0.34	0.08	0.08	< 0.01	< 0.01	< 0.01
Intracranial volume (10)
Pearson correlation	0.210**	0.049	-0.030	-0.036	-0.064	0.624**	0.620**	0.588**	0.588**	1
Sig. (2-tailed)	< 0.01	0.19	0.42	0.33	0.09	< 0.01	< 0.01	< 0.01	< 0.01

					95% CI
Outcome/covariates	B	SE	t	p-value	Lower bound	Upper bound	Partial eta squared
Left hippocampus
Intercept	1.336.414	131.372	10.173	< 0.001	1.078.488	1.594.340	0.128
Male	13.753	23.826	0.577	0.564	-33.024	60.531	0.000
Age	11.647	5.943	1.960	0.050	-0.022	23.316	0.005
FES conflict	-8.778	4.850	-1.810	0.071	-18.300	0.744	0.005
ICV	0.002	9.151E-05	18.238	0.000	0.001	0.002	0.320
SES	3.347	2.477	1.352	0.177	-1.515	8.210	0.003
Right hippocampus
Intercept	1.413.081	135.183	10.453	< 0.001	1.147.673	1.678.489	0.134
Male	24.399	24.517	0.995	0.320	-23.735	72.534	0.001
Age	12.687	6.116	2.074	0.038	0.679	24.694	0.006
FES conflict	-7.034	4.991	-1.409	0.159	-16.832	2.764	0.003
ICV	0.002	9.417E-05	17.850	< 0.001	0.001	0.002	0.310
SES	2.479	2.549	0.973	0.331	-2.524	7.483	0.001
Left amygdala
Intercept	290.432	71.822	4.044	< 0.001	149.423	431.441	0.023
Male	62.210	13.026	4.776	< 0.001	36.637	87.784	0.031
Age	8.279	3.249	2.548	0.011	1.899	14.658	0.009
FES conflict	-5.168	2.651	-1.949	0.052	-10.374	0.037	0.005
ICV	0.001	5.003E-05	15.004	< 0.001	0.001	0.001	0.241
SES	1.221	1.354	0.902	0.368	-1.438	3.879	0.001
Right amygdala
Intercept	274.930	78.598	3.498	< 0.001	120.616	429.243	0.017
Male	61.697	14.255	4.328	< 0.001	33.711	89.683	0.026
Age	11.703	3.556	3.291	0.001	4.722	18.685	0.015
FES conflict	-2.723	2.902	-0.938	0.348	-8.420	2.974	0.001
ICV	0.001	5.475E-05	15.030	< 0.001	0.001	0.001	0.242
SES	0.516	1.482	0.348	0.728	-2.393	3.425	0.000
Internalizing
Intercept	11.343	4.325	2.622	0.009	2.851	19.834	0.010
Male	-1.987	0.784	-2.534	0.012	-3.528	-0.447	0.009
Age	0.461	0.196	2.355	0.019	0.077	0.845	0.008
FES conflict	0.989	0.160	6.196	< 0.001	0.676	1.303	0.051
ICV	-1.159E-07	3.013E-06	-0.038	0.969	-6.031E-06	5.800E-06	0.000
SES	-0.232	0.082	-2.843	0.005	-0.392	-0.072	0.011
Externalizing
Intercept	15.766	4.339	3.634	< 0.001	7.247	24.285	0.018
Male	1.276	0.787	1.622	0.105	-0.269	2.821	0.004
Age	0.489	0.196	2.490	0.013	0.103	0.874	0.009
FES conflict	1.511	0.160	9.435	< 0.001	1.197	1.826	0.112
ICV	-7.229E-06	3.023E-06	-2.392	0.017	-1.316E-05	-1.295E-06	0.008
SES	-0.194	0.082	-2.377	0.018	-0.355	-0.034	0.008

	Conditional model			Unconditional model
Outcome/covariates	Standardized beta	SE	p-value	Standardized beta	SE	p-value
Left hippocampus
Sex	-0.017	0.031	0.583	0.006	0.025	0.818
Age	0.059	0.030	0.047	0.038	0.025	0.132
SES	-0.010	0.052	0.844	0.032	0.024	0.181
FES conflict	-0.193	0.113	0.087	-0.055	0.030	0.064
ICV	0.589	0.035	< 0.001	0.625	0.020	< 0.001
Interaction (SES*FES)	0.150	0.120	0.210	0.006	0.025	0.818
Right hippocampus
Sex	-0.028	0.031	0.363	-0.012	0.025	0.626
Age	0.061	0.030	0.039	0.042	0.025	0.089
SES	-0.042	0.050	0.400	0.024	0.024	0.305
FES conflict	-0.233	0.107	0.030	-0.046	0.029	0.111
ICV	0.571	0.039	< 0.001	0.627	0.020	< 0.001
Interaction (SES*FES)	0.206	0.113	0.069	-	-	-
Left amygdala
Sex	-0.163	0.035	0.000	-0.179	0.027	< 0.001
Age	0.082	0.032	0.011	0.071	0.026	0.006
SES	0.044	0.056	0.434	0.029	0.025	0.247
FES conflict	-0.023	0.131	0.858	-0.052	0.030	0.076
ICV	0.522	0.030	< 0.001	-0.179	0.024	< 0.001
Interaction (SES*FES)	-0.039	0.137	0.778	0.545	0.027	< 0.001
Right amygdala
Sex	-0.148	0.034	< 0.001	-0.167	0.026	< 0.001
Age	0.108	0.032	0.001	0.086	0.025	0.001
SES	0.058	0.054	0.287	0.021	0.024	0.396
FES conflict	0.100	0.126	0.425	-0.023	0.029	0.425
ICV	0.515	0.035	< 0.001	0.563	0.023	< 0.001
Interaction (SES*FES)	-0.140	0.130	0.281	-0.167	0.026	< 0.001
Internalizing
Sex	0.108	0.038	0.005	0.102	0.030	0.001
Age	0.087	0.037	0.017	0.139	0.030	< 0.001
SES	-0.138	0.067	0.040	-0.111	0.029	< 0.001
FES conflict	0.178	0.147	0.227	0.221	0.034	< 0.001
ICV	0.001	0.040	0.982	0.010	0.032	0.747
Interaction (SES*FES)	0.047	0.158	0.764	0.102
Externalizing
Sex	-0.069	0.036	0.054	-0.060	0.030	0.043
Age	0.083	0.035	0.017	0.112	0.030	< 0.001
SES	-0.065	0.065	0.314	-0.111	0.028	< 0.001
FES conflict	0.389	0.116	0.001	0.327	0.033	< 0.001
ICV	-0.096	0.038	0.011	-0.055	0.033	0.093
Interaction (SES*FES)	-0.088	0.142	0.536	-0.060	-	-

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[TFN01t01] CBCL = Child Behavior Checklist; FES = Family Environment Scale; SES = socioeconomic status.