Exploring Risky Decision-Making in Depressed Patients with High Aggression: An Event-Related Potential Study.

Background: Beyond self-injurious and suicidal behaviors, depressed patients may show outward aggression. However, it remains unclear whether high levels of aggression in depressed patients are associated with abnormalities in decision-making processes and altered sensitivity to feedback.

Methods: Ninety-six depressed patients were recruited and divided into two groups (n = 48 patients each) based on aggression. Patients completed psychological tests (Balloon Analog Risk Task and Iowa Gambling Task [IGT]), with event-related potentials recorded during the IGT to measure neural responses to feedback.

Results: Depressed patients with high aggression showed stronger risk aversion on the IGT compared to those with low aggression. Electrophysiological findings indicated that depressed patients with high aggression generate larger feedback-related negativity (FRN) components in response to losses, as well as greater FRN amplitude differences between loss and win. The FRN difference wave (loss-win) was significantly correlated with higher scores on the anger dimension of the Buss-Perry Aggression Questionnaire, trait anger scale, emotion regulation difficulties, and depression severity, supporting heightened feedback sensitivity as a mechanism underlying aggression in depression.

Limitations: The cross-sectional design limits causal inference, and the relatively small ERP subsample may affect generalizability of electrophysiological findings.

Conclusion: Depressed patients with high aggression exhibited stronger electrophysiologic responses to negative feedback during risky decision-making. This hypersensitivity may contribute to aggression in depression, highlighting a potential clinical target for interventions that modulate feedback sensitivity or emotional reactivity.