OBJECTIVE To determine if psychiatric hospitalization precluded a return to occupational status in United States Air Force aviators. METHODS A 7-yr retrospective review that joined hospitalization and occupational databases using individual identifiers. METHODS From a population of over 35,000 USAF rated aviation officers present between January 1986 and December 1990, 214 were both psychiatrically hospitalized and on flying status the quarter prior. METHODS Return to flying duties during a minimum follow-up period of 2 yr. RESULTS Within 2 yr from psychiatric admission, 138 (64.5%) aviators returned to flying status; 141 (65.9%) returned over 7 yr. In this patient population, an affective disorder diagnosis predicted poor outcome (chi 2 = 12.86; df = 1; p = 0.0003), independent of length of hospitalization. CONCLUSIONS Psychiatric hospitalization did not prevent a return to flying status for a majority of these high functioning aviators. Although an affective disorder diagnosis negatively affected occupational outcome, it is unclear whether institutional policy or poor prognosis was etiologic.