This study has 2 important strengths. First, we used cases that were diagnosed and discharged from the military after a careful evaluation process. 40 A record review conducted on a sample of study subjects demonstrated a high level of concordance between the diagnoses documented in the military records and those assigned by 2 psychiatrist reviewers. 55 Also, because military applicants receive an extensive administrative and medical examination prior to accession, are directly supervised while on active duty, and have access to health care, we assumed that cases were not psychotic on accession and that the onset of psychosis would generally result in a mental health hospitalization for an expedited psychiatric evaluation. This assumption was validated by the record review. 55 Therefore, we are confident that diagnostic misclassification is not a major source of error in our findings.