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War-related psychological stressors and risk of psychological disorders in Australian veterans of the 1991 Gulf War

  • Jillian F. Ikin (a1), Malcolm R. Sim (a1), Mark C. Creamer (a2), Andrew B. Forbes (a1), Dean P. McKenzie (a1), Helen L. Kelsall (a1), Deborah C. Glass (a1), Alexander C. McFarlane (a3), Michael J. Abramson (a1), Peter Ittak (a1), Terry Dwyer (a4), Leigh Blizzard (a4), Kerry R. Delaney (a5), Keith W. A. Horsley (a6), Warren K. Harrex (a6) and Harry Schwarz (a7)...

Abstract

Background

Questions remain about the long-term health impacts of the 1991 Gulf War on its veterans.

Aims

To measure psychological disorders in Australian Gulf War veterans and a military comparison group and to explore any association with exposure to Gulf War-related psychological stressors.

Method

Prevalences of DSM–IV psychological disorders were measured using the Composite International Diagnostic Interview. Gulf War-related psychological stressors were measured using a service experience questionnaire.

Results

A total of 31% of male Gulf War veterans and 21% of the comparison group met criteria for a DSM–IVdisorder first present in the post-Gulf War period. The veterans were at greater risk of developing post-Gulf War anxiety disorders including post-traumatic stress disorder, affective disorders and substance use disorders. The prevalence of such disorders remained elevated a decade after deployment. The findings can be explained partly as a ‘war-deployment effect‘. There was a strong dose–response relationship between psychological disorders and number of reported Gulf War-related psychological stressors.

Conclusions

Service in the 1991 Gulf War is associated with increased risk of psychological disorders and these are related to stressful experiences.

Copyright

Corresponding author

Jillian Ikin, Monash University, Department of Epidemiology and Preventive Medicine, Central and Eastern Clinical School, Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia. Tel: +613 9903 0555; Fax: +61 3 9903 0556; e-mail: jill.ikin@med.monash.edu.au

Footnotes

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Declaration of interest

Supported by the Australian Government–Department of Veterans' Affairs.

Footnotes

References

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American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (DSM—IV). Washington, DC: APA.
Australian Bureau of Statistics (1998) Mental Health and Wellbeing: Profile of Adults, Australia 1997. Canberra: Australian Capital Territory.
Branchey, L., Davis, W. & Leiber, C. (1984) Alcoholism in Vietnam and Korea veterans: a long term follow-up. Alcoholism, Clinical and Experimental Research, 8, 572575.
Creamer, M., Burgess, P. & McFarlane, A. C. (2001) Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being. Psychological Medicine, 31, 12371247.
CYTEL Software Corporation (2000) LogXact 4 for Windows. Cambridge, MA: CYTEL Software Corporation.
De Fraites, R. F., Wanat, E. R., Norwood, A. E., et al (1992) Investigation of a Suspected Outbreak of an Unknown Disease among Veterans of Operation Desert Shield/Storm, 123rd Army Reserve Command, Fort Benjamin Harrison, Indiana, April 1992. Washington, DC: Walter Reed Army Institute of Research.
Enserink, M. (2003) War in Iraq: bracing for Gulf War Syndrome 11. Science, 299, 19661967.
Erickson, D. J., Wolfe, J., King, D. W., et al (2001) Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: a prospective analysis. Journal of Consulting and Clinical Psychology, 69, 4149.
Farmer, A., Katz, R., McGuffin, P., et al (1987) A comparison between the Present State Examination and the Composite International Diagnostic Interview. Archives of General Psychiatry, 44, 10641068.
Gallops, M., Laufer, R. S. & Yager, T. (1981) The combat scale revised. In Legacies of Vietnam: Comparative Adjustment of Veterans and their Peers (eds Egendorf, A., Kadushin, C., Laufer, R. S., Rothbart, G. & Sloan, L.), pp. 125129. New York: Center for Policy Research.
Goss Gilroy Inc. (1998) Health Study of Canadian Forces Personnel Involved in the 1991 Conflict in the Persian Gulf. Ottawa: Goss Gilroy Inc.
Gray, G. C., Hawksworth, A. W., Smith, T. C., et al (1998) Gulf War veterans' health registries. Who is most likely to seek evaluation? American Journal of Epidemiology, 148, 343349.
Haley, R. W. (2003) Gulf War syndrome: narrowing the possibilities. Lancet Neurology, 2, 272273.
Holmes, D., Tariot, P. & Cox, C. (1998) Preliminary evidence of psychological distress among reservists in the Persian Gulf War. Journal of Nervous and Mental Disease, 186, 166173.
Hosmer, D. W. & Lemeshow, S. (2000) Applied Logistic Regression. New York: Wiley
Hunt, N. & Robbins, I. (2001) The long-term consequences of war: the experience of World War 11. Aging and Mental Health, 5, 183190.
Hyams, K. C., Wignall, S. & Rosewell, R. (1996) War syndromes and their evaluation: from the US Civil War to the Persian Gulf War. Annals of Internal Medicine, 125, 398405.
Iowa Persian Gulf Study Group (1997) Self-reported illness and health status among Gulf War veterans: a population-based study. JAMA, 277, 238245.
Ishoy, T., Suadicani, P., Guldager, B., et al (1999) State of health after deployment in the Persian Gulf. The Danish Gulf War Study. Danish Medical Bulletin, 46, 416419.
Ismail, K., Everitt, B., Blatchley, N., et al (1999) Is there a Gulf War syndrome? Lancet, 353, 179182.
Ismail, K., Blatchley, N., Hotopf, M., et al (2000) Occupational risk factors for ill health in Gulf veterans of the United Kingdom. Journal of Epidemiology and Community Health, 54, 834838.
Ismail, K., Kent, K., Brugha, T., et al (2002) The mental health of UK Gulf War veterans: phase 2 of a two phase cohort study BMJ, 325, 525576.
Janca, A., Robins, L., Cottler, L. B., et al (1992) Clinical observation of assessment using the Composite International Diagnostic Interview (CIDI). An analysis of the CIDI Field Trials — Wave II at the St Louis site. British Journal of Psychiatry, 160, 815818.
Joseph, S. C. & Comprehensive Clinical Evaluation Program Evaluation Team (1997) A comprehensive clinical evaluation of 20,000 Persian Gulf War veterans. Military Medicine, 162, 149155.
Kang, H. K., Mahan, C. M., Lee, K. Y., et al (2000) Illnesses among United States veterans of the Gulf War: a population-based survey of 30,000 veterans. Journal of Occupational and Environmental Medicine, 42, 491501.
Kang, H. K., Natelson, B. H., Mahan, C. M., et al (2003) Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. American Journal of Epidemiology, 157, 141148.
Keane, T. M., Fairbank, J. A., Caddell, J. M., et al (1989) Clinical evaluation of a measure to assess combat exposure. Psychological Assessment, 1, 5355.
Kessler, R., McGonagle, K., Zhao, S., et al (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Study. Archives of General Psychiatry, 51, 819.
Kessler, R., Berglund, P., Demler, O., et al (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey — Replication (NCS-R). Journal of the American Medical Association, 289, 30953105.
Oumeish, O. Y., Oumeish, I. & Parish, J. L. (2002) Gulf war syndrome. Clinics in Dermatology, 20, 401412.
Persian Gulf Veterans Coordinating Board (1995) Unexplained illnesses among Desert Storm veterans. Archives of Internal Medicine, 55, 262268.
Proctor, S. P., Heeren, T., White, R. F., et al (1998) Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress. International Journal of Epidemiology, 27, 10001010.
Roemer, L., Litz, B. T., Orsillo, S. M., et al (1998) Increases in retrospective accounts of war-zone exposure over time: the role of PTSD symptom severity. Journal of Traumatic Stress, 11, 597605.
Shapiro, S. E., Lasarev, M. R. & McCauley, L. (2002) Factor analysis of Gulf War illness: what does it add to our understanding of possible health effects of deployment? American Journal of Epidemiology, 156, 578585.
Southwick, S. M., Morgan, C. A., Nicolaou, A. L. 3rd, et al (1997) Consistency of memory for combat-related traumatic events in veterans of Operation Desert Storm. American Journal of Psychiatry, 154, 173177.
Stata Corp (2001) Stata Statistical Software: Release 7.0. College Station, TX: Stata Corporation.
Stimpson, N. J., Thomas, H. V., Weightman, A. L., et al (2003) Psychiatric disorder in veterans of the Persian Gulf War of 1991: systematic review. British Journal of Psychiatry, 182, 391403.
Sutker, P. B., Uddo, M., Brailey, K., et al (1994) Psychopathology in war-zone deployed and nondeployed Operation Desert Storm troops assigned graves registration duties. Journal of Abnormal Psychology, 103, 383390.
Sutker, P. B., Davis, J. M., Uddo, M., et al (1995) War zone stress, personal resources, and PTSD in Persian Gulf War returnees. Journal of Abnormal Psychology, 104, 444452.
Unwin, C., Blatchley, N., Coker, W., et al (1999) Health of UK servicemen who served in Persian Gulf War. Lancet, 353, 169178.
Ware, J. E., Kosinski, M. & Keller, S. D. (1996) A 12-item Short-Form Health Survey. Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220233.
Ware, J. E., Kosinski, M. A. & Keller, S. D. (1998) SF-12: How to Score the SF-12 Physical and Mental Health Summary Scales. Lincoln, R1: Qualtiy Metric Inc.
Wessely, S., Unwin, C., Hotopf, M., et al (2003) Stability of recall of military hazards over time. Evidence from the Persian Gulf War of 1991. British Journal of Psychiatry, 183, 314322
Wittchen, H.-U., Robins, L. N., Cottler, L. B., et al (1991) Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CID). The Multicentre WHO/ ADAMHA Field Trials. British Journal of Psychiatry, 159, 645653.
Wolfe, J., Brown, P. J. & Kelley, J. M. (1993) Reassessing war stress: exposure and the Persian Gulf War. Journal of Social Issues, 49, 1531.
Wolfe, J., Proctor, S. P., Erickson, D. J., et al (1999) Relationship of psychiatric status to Gulf War veterans' health problems. Psychosomatic Medicine, 61, 5325440.
World Health Organization (1997) Composite International Diagnostic Interview CIDI-Auto 2.1 Administrator's Guide and Reference. Geneva: WHO.

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War-related psychological stressors and risk of psychological disorders in Australian veterans of the 1991 Gulf War

  • Jillian F. Ikin (a1), Malcolm R. Sim (a1), Mark C. Creamer (a2), Andrew B. Forbes (a1), Dean P. McKenzie (a1), Helen L. Kelsall (a1), Deborah C. Glass (a1), Alexander C. McFarlane (a3), Michael J. Abramson (a1), Peter Ittak (a1), Terry Dwyer (a4), Leigh Blizzard (a4), Kerry R. Delaney (a5), Keith W. A. Horsley (a6), Warren K. Harrex (a6) and Harry Schwarz (a7)...
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