Assessing Fitness for Military Enlistment Physical, Medical, and Mental Health Standards (2006) / Chapter Skim
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6 Mental Health
6 Mental Health
Pages 135-151
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From page 135... ...
Psychological adaptation is therefore a critical mental health component for military personnel. Stressors associated with transition from civilian to military life include changes in living arrangements, geographic locations, peer relationships, support systems, schedules, priorities, and control over one's life (McCraw and Bearden, 1990)
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From page 136... ...
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.
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From page 137... ...
For example, one study reported that blacks were more likely to be assigned a diagnostic code related to abuse or neglect of a child and were less likely to be diagnosed with a mood disorder when compared with non-Hispanic whites. Hispanics were more likely than non-Hispanic whites to be diagnosed with adjustment disorders, anxiety disorders, and psychotic disorders and were less likely to be diagnosed with attention deficit hyperactivity disorder (Yeh et al., 2002)
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From page 138... ...
, attention deficit hyperactivity disorder (52 percent) , mood disorder (45 percent)
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From page 139... ...
Of those adolescents with attention deficit hyperactivity disorder, roughly half will be using stimulant medication. Treatment Services In the Methods for the Epidemiology for Child and Adolescent Mental Disorders Survey, for youth with a psychiatric disorder, ambulatory services were used by 24 to 45 percent and school-based services were used by 27 to 64 percent.
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From page 140... ...
Also, of the same 10,000 adolescents, roughly 750 to 1,500 will be diagnosed with attention deficit hyperactivity disorder, and, of those, about 250 to 500 will be receiving treatment with stimulant or antidepressant medication. MENTAL HEALTH OF THE MILITARY POPULATION Lifetime prevalence rates of mental disorders were determined for the total active-duty U.S.
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From page 141... ...
A secondary mental health diagnosis also increased the risk of attrition to 27 percent at six months. Mental healthrelated separations for Air Force basic military trainees were assessed for the year 2001: 4.2 percent of separations were attributable to mental health disorders, with adjustment disorders and depressive disorders being the top diagnostic categories (Englert, Hunter, and Sweeney, 2003)
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From page 142... ...
Of these, perhaps only 750 to 1,400 will seek care for their mental illness, which is similar to the roughly 600 such personnel who seek mental illness care in general in any single year. Mental disorders are the leading cause of medical and occupational morbidity, hospitalization, and separation for a medical reason, but populationbased risk and prevalence data for such outcomes are not available.
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From page 143... ...
chief medical officer. If an applicant has been diagnosed or treated since age 12 for attention deficit disorder or attention deficit hyperactivity disorder, academic skills or perceptual deficit, or has an individual education plan, the recruiter is instructed to contact the MEPS for additional instruction.
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From page 144... ...
) , the 4,303 psychiatric failures are divided among roughly 50 diagnoses, of which roughly 25 percent are attention deficit and hyperactivity disorder and related problems, 15 percent are drug and alcohol abuse and related disorders, and the remainder are categorized among a wide range of mood and anxiety disorders (see tables in Appendix B)
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From page 145... ...
Diagnoses of physiological malfunction arising from mental factors; neurotic, mood, somatoform, dissociative or factious disorders; attention deficit hyperactivity disorder; and major depression accounted for the mental health disorders that resulted in granting of a waiver (see Table 6-1)
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From page 146... ...
146 7 9 8 9 8 9 5 8 Rank 10 % 4.0 3.2 9.2 0.8 8.9 4.1 7.8 6.1 2.0 Granted Count 17 52 91 29 350 279 210 114 100 % 2.4 2.3 6.3 2.1 5.0 4.2 5.2 4.6 1.7 2002 Applied Count 47 352 325 314 104 153 126 158 127 Services Four % 2.9 1.4 4.9 2.6 5.2 2.7 3.0 7.3 2.8 the for Granted Count 844 402 696 361 455 235 263 304 117 % 2.2 1.3 3.8 2.8 4.0 2.8 2.5 4.1 2.9 Applicants others. 1997-2001 Applied Count 845 510 969 723 607 424 373 402 288 all for Active-Duty code arising factors arising factors disorder disorder for or arising factors or deficit mood, disorders mood, disorders DoD deficit deficit mental mental mental depressive Granted Definition Physiological malfunction from Attention hyperactivity disorder Physiological malfunction from Neurotic, somatoform, dissociative factitious Physiological malfunction from Neurotic, somatoform, dissociative factitious Attention hyperactivity Attention hyperactivity Major disorder applicants; a Army Waivers for Code 306 314 733 300 733 300 314 314 296 6-1 code Force aICD-9 TABLE Service Army Navy Marines Air
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From page 147... ...
A more reasonable approach would be to use an age cutoff, similar to that used for eating disorders, such as disqualification if a mood disorder occurs after the 13th birthday. As is the case for depression, there is increased recognition of the early age of onset of anxiety disorders.
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From page 148... ...
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.
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From page 149... ...
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)
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From page 150... ...
after the age of 13, anxiety disorders after the age of 13, exposure to trauma, attention deficit hyperactivity disorder with medication treatment in the past year, schizophrenia and psychotic disorders, and hospitalization for mental illness care. A positive re sponse to this screening question would require open-ended amplifi cation regarding the specific diagnosis.
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From page 151... ...
These data should be ob tained for all the Services and should create an accurate picture of the impact of mental illness on military personnel from recruitment through separation, with a particular focus on the outcome of recruits who request and receive mental illness waivers for specific diagnoses, as well as the rates and diagnoses leading to attrition during training and active duty. Further studies using complete data sets should be designed to determine whether there are any differences in retention and performance between recruits with and without a history of psychiatric disorders, such as depression and anxiety disorders.
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