struggling with conflicting personal views, being unable to identify a clear enemy, and questionable lasting impact of the mission (Bartone, Adler, and Vaitkus, 1998; Lundin and Otto, 1996; Henshaw, 1993; Maguen et al., 2004).

This chapter examines the mental health standards currently in place, to characterize the youth population in terms of these standards, and to assess the current system for tracking the progress of enlistees with preexisting mental health conditions during their first term of enlistment. The focus is on such mental conditions as depression and anxiety disorders and their effects on the individual’s ability to function in a military context. (An examination of normal personality measures related to job performance is outside the scope of the committee’s charge.)

According to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 1999), almost 21 percent of children ages 9 to 17 in the United States have a diagnosable mental or addictive disorder associated with at least minimum impairment. The prevalence rate is 11 percent when significant functional impairment is required as part of the diagnostic criteria. This means that a total of 4 million children have a major mental illness resulting in significant impairment at school, at home, and with peers.

In 1991-1992 the National Institute of Mental Health conducted the Methods for the Epidemiology for Child and Adolescent Mental Disorders Survey with a sample of 1,285 youth ages 9 to 17. It found that 11.5 percent met criteria for a psychiatric disorder with moderate impairment: anxiety disorders (7.2 percent), depression (4.2 percent), disruptive behavior disorders (6 percent), and substance use disorder (2 percent) (Shaffer et al., 1996). As is evident from the sum of the individual rates of prevalence, there is substantial psychiatric comorbidity in this population, in particular between anxiety disorders and depression and substance abuse and depression. Demographic features were as follows: female (44.6 percent) and male (55.4 percent), Caucasian or other (64 percent), black (20 percent), and Hispanic (15.7 percent) (Narrow et al., 1998).

Estimates of the prevalence rate of attention deficit hyperactivity disorder (ADHD) among youth range from 7 to 16 percent (Faraone et al., 2003). Prevalence rates in boys have been found to be two to three times higher than for girls (Ford, Goodman, and Meltzer, 2003; Dulcan et al., 1997). Recent evidence demonstrates that childhood ADHD is a predictor for adolescent substance use (Molina and Pelham, 2003). Stimulant therapy for childhood ADHD has been shown to reduce the risk of subsequent adolescent drug and alcohol use disorders (Wilens et al., 2003).