Psychiatric diagnoses and punishment for misconduct: the effects of PTSD in combat-deployed Marines.
BACKGROUND
Research on Vietnam veterans suggests an association between psychological problems, including posttraumatic stress disorder (PTSD), and misconduct; however, this has rarely been studied in veterans of Operation Iraqi Freedom or Operation Enduring Freedom. The objective of this study was to investigate whether psychological problems were associated with three types of misconduct outcomes (demotions, drug-related discharges, and punitive discharges.)


METHODS
A population-based study was conducted on all U.S. Marines who entered the military between October 1, 2001, and September 30, 2006, and deployed outside of the United States before the end of the study period, September 30, 2007. Demographic, psychiatric, deployment, and personnel information was collected from military records. Cox proportional hazards regression analysis was conducted to investigate associations between the independent variables and the three types of misconduct in war-deployed (n = 77,998) and non-war-deployed (n = 13,944) Marines.


RESULTS
Marines in both the war-deployed and non-war-deployed cohorts with a non-PTSD psychiatric diagnosis had an elevated risk for all three misconduct outcomes (hazard ratios ranged from 3.93 to 5.65). PTSD was a significant predictor of drug-related discharges in both the war-deployed and non-war-deployed cohorts. In the war-deployed cohort only, a specific diagnosis of PTSD was associated with an increased risk for both demotions (hazard ratio, 8.60; 95% confidence interval, 6.95 to 10.64) and punitive discharges (HR, 11.06; 95% CI, 8.06 to 15.16).


CONCLUSIONS
These results provide evidence of an association between PTSD and behavior problems in Marines deployed to war. Moreover, because misconduct can lead to disqualification for some Veterans Administration benefits, personnel with the most serious manifestations of PTSD may face additional barriers to care.
Highfill-McRoy
Robyn M
RM
Behavioral Science and Epidemiology Program, Naval Health Research Center, San Diego, California, USA. Robyn.McRoy@med.navy.mil
Larson
Gerald E
GE
Booth-Kewley
Stephanie
S
Garland
Cedric F
CF
D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D003130:Combat Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D008889:Military Personnel / Q000331:legislation & jurisprudence* / Q000523:psychology / Q000706:statistics & numerical data; D008890:Military Psychiatry / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011678:Punishment; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D014857:Warfare