Screening for Schizophrenia in Recruits, Active Duty Soldiers and Veterans: Can we do a Better Job?

The United States military continues to have difficulty maintaining the number of troops they need to accomplish their global military missions. The United States military medical service has been struggling with methods of identifying mental disorders, including schizophrenia, during recruitment and, if possible, no later than basic training. From World War I, the United States military medical service has continually worked to improve their ability to evaluate military recruits with prodromal or mild schizophrenia symptoms at enlistment or early in their training in order to limit military and personal disruptions during active duty and especially during deployment to combat theaters. It is known that the longer the recruit progresses through training to active duty, the greater the disruption for the military command when schizophrenia is diagnosed and the soldier is withdrawn from active duty. In particular, the diagnosis of combat troops with schizophrenia results in key military unit members being withdrawn from their combat team. This results in short-term and long-term problems for the military command and its mission, in addition to the career and lifetime quality of life changes for the soldier. The economic burden to the United States military and the United States Government continues for the lifetime of the soldier who has been diagnosed with schizophrenia at any point during their training which leads to lifetime service connected disability. We review the history of the United States armed forces medical service and its efforts to minimize the number of recruits from entering the military and becoming active duty before being diagnosed with schizophrenia. A more aggressive screening protocol for schizophrenia based on existing tests and technology is presented.