Inhibition of the Constructive Aggression Behavioral System (CABS) is associated with poor short- and long-term treatment outcomes and readmission among patients with major depression: a naturalistic study

Abstract Background The Constructive Aggression Behavioral System (CABS) has been conceptualized as an evolutionarily grounded pattern of behavior that enables individuals to assert their needs, interests, and boundaries in a non-violent and socially adaptive manner. It is theoretically distinct from destructive forms of aggression. Inhibition of CABS has been proposed as a clinically relevant construct in emotional disorders. The present study aimed to examine the role of CABS inhibition in treatment outcomes and longer-term prognosis in patients with major depressive disorder (MDD). Methods A total of 416 inpatients diagnosed with MDD were assessed using the Aggressionshemmungs-Inventar (AHI) to measure CABS inhibition and the revised Beck Depression Inventory (BDI-II) at admission and discharge. Three hierarchical multiple regression analyses were conducted to examine whether AHI scores at discharge were associated with change in depressive symptoms from admission to discharge and whether they predicted depressive symptoms at 6-month follow-up as well as psychiatric readmission within one year. Covariates included age, gender, suicidality, unemployment, comorbid anxiety, and antidepressant use. Results At admission, patients showed elevated AHI scores (mean z = 1.40), indicating substantial inhibition of constructive aggression. During treatment, both depressive symptoms and AHI scores decreased significantly. AHI scores at discharge were associated with symptom change during treatment and with depressive symptoms at 6-month follow-up as well as readmission within one year. Conclusions The findings indicate that CABS inhibition represents a clinically relevant correlate of treatment outcome and is associated with follow-up outcomes in MDD. Given the observational design, the results do not allow conclusions regarding causal effects. Future longitudinal and experimental studies are needed to examine whether changes in CABS inhibition are associated with changes in clinical outcomes and to further clarify its potential role in the onset and maintenance of emotional disorders. Clinical trial number Not applicable.