News article: VA Mental Health Experts Urge Intensive Pre-Enlistment Schizophrenia Screening

Link to the news article

Link to the study referenced in the article

From the study paper

Schizophrenia is one of the top 25 disabling diseases in the world [3]. For young men and women who wish to have careers in the United States armed forces, schizophrenia will usually end their dreams and aspirations for a career in the military and/or a productive and satisfying life [4]. The disease removes soldiers from active duty and creates a monetary and medical burden for the United States military and the United States economy [5]. It is noteworthy that in 2002, the estimated total cost of schizophrenia in the United States was $62.7 billion [6]. In 2007, veterans with mental health diagnoses accounted for 15 percent of the Veterans Affairs (VA) patients; however, their care consumed 33 percent of the total Veterans Health Administration (VHA) medical costs [7]. Recently, more than one-third of Veterans returning from Iraq or Afghanistan that have entered the VHA have been diagnosed with mental health disorders including schizophrenia, PTSD, depression and bipolar disorder. Consequently, the VHA has been funding more than 20 projects to improve the treatment and decrease schizophrenia morbidity [8].

From the news article

The most common age for diagnosis of schizophrenia is late teens to early 30s. Research suggests that symptoms tend to show up earlier in men, often in the early 20s but slightly later in women, the late 20s or early 30s.

A new study pointed out, that at least in males, those ages match up with most military recruits.

The researchers suggested the issue is personal for them, explaining, “As clinicians who have worked with active duty soldiers, reserve duty soldiers and veterans with the diagnosis of schizophrenia, in this paper we suggest an improved schizophrenia screening protocol to be employed for pre- and post-enlistment, including the identification of schizophrenia among combat troops being evaluated for PTSD in the battle field or after returning to garrison in addition to veterans entering the VA medical system.”

Currently, the U.S. Army uses only educational achievement, cognitive testing and a brief psychiatric screening for mental illnesses, according to the authors, who pointed out that “confidential surveys and interviews with 5,428 soldiers at Army bases in the United States revealed that 20 percent of these soldiers had a mental illness (e.g., depression, panic disorder, ADHD, intermittent explosive disorder, substance use disorder) prior to enlisting in the Army.”

Further complicating diagnosis is the large number of troops who have PTSD. “In the most recent combat theaters, the prevalence of PTSD has been relatively similar: 11-20 percent in a given year for Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF); 12 percent in a given year for the Persian Gulf intervention (Desert Storm); and 15 percent in a given year for the Vietnam military action. It is estimated that about 30 percent of Vietnam veterans will have had PTSD in their lifetime. It is now understood that PTSD may mask the early stages of comorbid schizophrenia.”

The researchers discussed how, during the Iraq and Afghanistan conflicts, it was difficult to diagnosis schizophrenia among active duty and reserve duty soldiers in active combat because of overlap with PTSD symptoms. “In part this is due to the fact that the primary objective of the United States armed forces medical services has been to identify PTSD at its earliest stages to reduce morbidity. Therefore, it would be helpful to have a more aggressive and consistent screening protocol for schizophrenia to accompany every PTSD screen in active duty soldiers. If comorbid schizophrenia is missed or the diagnosis delayed, the underlying schizophrenia most often progresses and worsens the prognosis,” they wrote.