The current medical evaluation does not include a formal psychiatric assessment. The medical evaluation provides an opportunity to identify in person individuals who have psychiatric disorders that may adversely affect their performance in the military or lead to attrition or discharge. A brief standardized mental status examination that would address mood, anxiety, psychotic symptoms, and suicide would be important to include as a routine component of the medical evaluation. The addition of this examination has the potential to identify individuals who did not reveal a preexisting condition on the screening forms either through conscious omission or lack of awareness.

CONCLUSIONS AND RECOMMENDATIONS

Disqualifying Criterion

The current DoD fitness standards exclude any individual who has a history of a mood disorder for which outpatient treatment has been rendered for longer than six months by a physician or mental health professional. Consideration should be given to altering the disqualifying criterion for depression because (1) there will be increasing numbers of applicants who have received treatment for depressive disorders and (2) there is no evidence base to support exclusion of individuals who have received outpatient care for longer than six months.

As is the case for depression, there is increased recognition of the early age of onset of anxiety disorders. The DoD fitness standards exclude any individuals who have a history of anxiety disorders. Given the high prevalence of anxiety disorders in youth and the lack of scientific rationale for the exclusion of an individual with a history of anxiety disorders, consideration should be given to altering this disqualifying criterion. The committee’s determination of a reasonable cutoff was based on clinical evidence from the civilian youth population. For an adolescent, it takes one to two years to recover from an episode of major depression (Emslie, Mayes, and Ruberu, 2005). Following discontinuation of medication, the period of relapse is greatest during the first year of medication withdrawal. Because relapse rates are high in adolescents, a medication-free period of two years (e.g., ages 16-17) would allow time to assess the clinical response. A cutoff for disqualification of the 13th birthday is a conservative stance designed to decrease the likelihood of a recurrent episode of depression during combat duty. A similar clinical logic applies to anxiety disorders.

Recommendation 6-1: We recommend that disqualification for mood and anxiety disorders should occur only if disorders occur after the



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