EDUCATION SHAPES BEHAVIORAL AND BRAIN RESPONSES TO OTHERS’ PAIN ACROSS THE HEALTH-ILLNESS CONTINUUM

Socioeconomic status (SES) modulates cognitive function and emotion regulation yet its influence on social responses remains unclear. This study tested whether education and income are differentially associated with vicarious pain unpleasantness (VPU) (i.e., distress when observing someone else in pain), trait empathy, and brain activation during a validated vicarious pain fMRI task. We studied 144 women (18-65 years), including healthy controls (n=51) and women with fibromyalgia (n=61) or major depressive disorder (n=32). During the task, participants chose a significant adult (e.g., close friend) and, while viewing photos of hands/feet in painful situations, imagined that person experiencing each injury and rated VPU on a 0-10 scale. Trait empathy was assessed with the Interpersonal Reactivity Index. SES was measured via highest educational degree and household income. Higher education was associated with reduced VPU (r=−.17, p=.04) and empathic personal distress (r=−.28, p=.001). These associations did not differ between clinical and non-clinical participants. Additionally, education was linked to increased vicarious pain–evoked brain activation in key social-cognitive regions, including the midcingulate and posterior cingulate cortices, left temporoparietal junction/angular gyrus, and left inferior temporal gyrus (all family-wise error-corrected p-values<.05, see Figure 1). Greater activation in the midcingulate and posterior cingulate cortices was linked to lower VPU and personal distress. All findings were consistent across clinical and non-clinical groups. In contrast, income showed no behavioral or brain associations. These findings highlight education as a specific SES-related marker of more regulated and socially attuned behavioral and brain responses to others’ pain, independent of clinical diagnosis.