title: Alcohol problems, aggression, and other externalizing behaviors after return from deployment: understanding the role of combat exposure, internalizing symptoms, and social environment.
abstract: OBJECTIVE
  The study examined whether elevated rates of externalizing behaviors following deployment could be explained by internalizing symptoms (depression, anxiety, and PTSD symptoms), and health of the social environment (unit leadership, organizational support, and stigma/barriers to care).
  
  
  METHODS
  A model of combat exposure, social environment, internalizing symptoms, and externalizing behaviors was tested in a military unit following a fifteen-month deployment to Iraq. The sample included 1,397 soldiers assessed four month post-deployment; 589 of these soldiers were assessed again nine months post-deployment.
  
  
  RESULTS
  Externalizing behaviors were highly stable over the five-month post-deployment period. Both social environment and internalizing symptoms were significantly associated with level of externalizing behaviors at four months and nine months post-deployment, but combat exposure alone significantly predicted change in externalizing behaviors over the follow-up period.
  
  
  CONCLUSIONS
  Results suggest the need to broaden the scope of interventions targeted to combat veterans and have implications for care providers and military leaders.
authors.affiliation: U.S. Army Medical Research Unit-Europe, Walter Reed Army Institute of Research, Heidelberg, Germany. kathleen.wright@us.army.mil
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Wright
authors.forename: Heather M
authors.initials: HM
authors.lastname: Foran
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wood
authors.forename: Rachel D
authors.initials: RD
authors.lastname: Eckford
authors.forename: Dennis
authors.initials: D
authors.lastname: McGurk
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000523:psychology*; D000437:Alcoholism / Q000453:epidemiology*; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D012931:Social Environment; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult