psychiatric diagnoses and punishment for misconduct the effects of ptsd in combat-deployed marines精神病诊断和处罚不当行为的影响ptsd combat-deployed海军陆战队.pdfVIP

Highfill-McRoy et al. BMC Psychiatry 2010, 10:88 /1471-244X/10/88 RESEARCH ARTICLE Open Access Psychiatric diagnoses and punishment for misconduct: the effects of PTSD in combat- deployed Marines Robyn M Highfill-McRoy1*†, Gerald E Larson1†, Stephanie Booth-Kewley1†, Cedric F Garland1,2† Abstract 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 punit