Medical Prescreen of Medical History Report

Unlike most other items on the medical prescreen, which lists specific disorders, the one item that is related to mental health is a treatment item. The item is very broad and includes any psychiatric disorder or mental health concern and any treatment. Because this item is so broad and sweeping, disorders that would be of more concern regarding enlistment in the military service have equal weight with minor mental health issues. The medical prescreen should include mental health items of clinical importance, which can be explained more fully as noted in the instructions in Item 2B if the applicant responds affirmatively. Potential prescreen items include a history of suicide attempts, depression, bipolar disorder (manic depressive illness), anxiety disorder, attention deficit hyperactivity disorder requiring medication treatment within the past year, schizophrenia and psychotic conditions, and psychiatric hospitalization.

DoD has issued a small business innovative research request for proposals to develop a screening test for detection of major psychiatric disorders in young adults. The aim is to develop a reliable screening instrument to identify individuals at risk of having a mental health problem prior to entering the military. However, there is significant controversy about the utility and value of mass screening for mental health conditions in the military. Rona and colleagues (Rona, Hyams, and Wessely, 2005) emphasize the need for caution, citing the lack of acceptability of screening instruments, obstacles to confidentiality, questionable validity of available instruments, potential to cause more harm than benefit, and diversion of resources from more effective mental health care programs. On the basis of a literature review relating to World Wars I and II, Jones, Hyams, and Wessely (2003) concluded that screening programs did not succeed in reducing the incidence of mental health problems.

Medical Evaluation

In addition to a medical history form, it would be reasonable to have recruits complete a brief questionnaire regarding current symptoms of mental disorders, which could subsequently be reviewed by the medical officer at the MEPS. The Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire (PHQ) is a self-administered instrument that has high sensitivity (75 percent) and specificity (90 percent) (Spitzer et al., 1999). The questionnaire includes items related to depression, anxiety, and somatic symptoms and alcohol abuse. It takes approximately three minutes for a physician to review it. This screening questionnaire or others selected should be studied specifically in military populations with regard to performance characteristics.

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