title: Objective predictors of delayed-onset post-traumatic stress disorder occurring after military discharge.
abstract: BACKGROUND
  Post-traumatic stress disorder (PTSD) that develops after military personnel have been discharged may lead to severe impairment. We investigated whether personnel who develop PTSD after discharge can be identified by independent evidence of internalizing signs such as depression or of externalizing signs such as disciplinary offences while still serving.
  
  
  METHODS
  Veterans in receipt of a war pension who only developed PTSD post-discharge were compared with matched veterans who developed PTSD in service or never suffered from PTSD. Contemporaneous medical and personnel records were searched for objective evidence of internalizing and externalizing disorder.
  
  
  RESULTS
  Service personnel who developed PTSD post-discharge were indistinguishable from controls with no PTSD on their psychiatric presentation in service. Those with post-discharge PTSD had significantly more disciplinary offences, specifically absence without leave, disobedience, and dishonesty, than the no-PTSD group, and this excess of offences was present before any exposure to trauma.
  
  
  CONCLUSIONS
  This is the first study to find objective evidence independent of self-report for the claimed link between externalizing disorder and vulnerability to PTSD. Early signs of externalizing disorders may play an important role in helping to identify service personnel at risk of PTSD after military discharge.
authors.affiliation: Clinical, Educational and Health Psychology, University College London, London, UK. c.brewin@ucl.ac.uk
authors.forename: C R
authors.initials: CR
authors.lastname: Brewin
authors.forename: B
authors.initials: B
authors.lastname: Andrews
authors.forename: J
authors.initials: J
authors.lastname: Hejdenberg
authors.forename: L
authors.initials: L
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003130:Combat Disorders / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology*; D006113:United Kingdom / Q000453:epidemiology; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D014857:Warfare