There is increased recognition of depression in children and a concomitant increase in the use of mental health treatment for this disorder in youth. The typical duration of treatment is approximately one year for a single episode of depression. The current DoD fitness standards exclude any individual who has a history of a mood disorder, including depression, who received outpatient treatment for longer than six months from a physician or mental health professional. 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. 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.
Conclusion: 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. DoD fitness standards exclude any individuals who have a history of anxiety disorders.
Conclusion: 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.
Recommendation 6-1: We recommend that disqualification for mood and anxiety disorders should occur only if disorders occur after the applicant’s 13th birthday. We recognize that the imprecision with which age cutoffs can accurately predict the likelihood of performance problems due to mental illness suggests that waivers may be commonly requested, and frequently granted, for illness occurring after age 13. However, using the 13th birthday as a cutoff allows sufficient time for clinical follow-up of a diagnosed mood or anxiety disorder to identify potential recruits with a risk of recurrence.