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

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.

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.

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.

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

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.