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January 15, 1997, Vol 277, No. 3 >
ARTICLE | January 15, 1997

Self-reported Illness and Health Status Among Gulf War Veterans: Title and subTitle BreakA Population-Based Study FREE

[+] Author Affiliations

A complete list of the members of the Iowa Persian Gulf Study Group appears at the end of this article.

Reprints: David A. Schwartz, MD, MPH, Department of Internal Medicine, SE318 GH, The University of Iowa College of Medicine, Iowa City, IA 52242-1081.


JAMA. 1997;277(3):238-245. doi:10.1001/jama.1997.03540270064028
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References

Objective.  —To assess the prevalence of self-reported symptoms and illnesses among military personnel deployed during the Persian Gulf War (PGW) and to compare the prevalence of these conditions with the prevalence among military personnel on active duty at the same time, but not deployed to the Persian Gulf (non-PGW).

Design.  —Cross-sectional telephone interview survey of PGW and non-PGW military personnel. The study instrument consisted of validated questions, validated questionnaires, and investigator-derived questions designed to assess relevant medical and psychiatric conditions.

Setting.  —Population-based sample of military personnel from Iowa.

Study Participants.  —A total of 4886 study subjects were randomly selected from 1 of 4 study domains (PGW regular military, PGW National Guard/Reserve, non-PGW regular military, and non-PGW National Guard/Reserve), stratifying for age, sex, race, rank, and branch of military service.

Main Outcome Measures.  —Self-reported symptoms and symptoms of medical illnesses and psychiatric conditions.

Results.  —Overall, 3695 eligible study subjects (76%) and 91% of the located subjects completed the telephone interview. Compared with non-PGW military personnel, PGW military personnel reported a significantly higher prevalence of symptoms of depression (17.0% vs 10.9%; Cochran-Mantel-Haenszel test statistic, P<.001), posttraumatic stress disorder (PTSD) (1.9% vs 0.8%, P=.007), chronic fatigue (1.3% vs 0.3%, P<.001), cognitive dysfunction (18.7% vs 7.6%, P<.001), bronchitis (3.7% vs 2.7%, P<.001), asthma (7.2% vs 4.1%, P=.004), fibromyalgia (19.2% vs 9.6%, P<.001), alcohol abuse (17.4% vs 12.6%, P=.02), anxiety (4.0% vs 1.8%, P<.001), and sexual discomfort (respondent, 1.5% vs 1.1%, P=.009; respondent's female partner, 5.1% vs 2.4%, P<.001). Assessment of health-related quality of life demonstrated diminished mental and physical functioning scores for PGW military personnel. In almost all cases, larger differences between PGW and non-PGW military personnel were observed in the National Guard/Reserve comparison. Within the PGW military study population, compared with veterans in the regular military, veterans in the National Guard/Reserve only reported more symptoms of chronic fatigue (2.9% vs 1.0%, P=.03) and alcohol abuse (19.4% vs 17.0%, P=.004).

Conclusions.  —Military personnel who participated in the PGW have a higher self-reported prevalence of medical and psychiatric conditions than contemporary military personnel who were not deployed to the Persian Gulf. These findings establish the need to further investigate the potential etiologic, clinical, pathogenic, and public health implications of the increased prevalence of multiple medical and psychiatric conditions in populations of military personnel deployed to the Persian Gulf.

REFERENCES

1 +
 NIH Technology Assessment Workshop Panel. The Persian Gulf experience and health . JAMA . 1994;;272:391-396.
2 +
Persian Gulf Veterans Coordinating Board.  Unexplained illnesses among Desert Storm veterans: a search for causes, treatment, and cooperation . Arch Intern Med . 1995;;155:262-268.
3 +
Office of the Under Secretary of Defense for Acquisition and Technology. Report of the Defense Science Board Task Force on Persian Gulf War Health Effects . Washington, DC: US Dept of Defense; 1994;.
4 +
Committee to Review the Health Consequences of Service During the Persian Gulf War. Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action . Washington, DC: National Academy Press; 1994;.
5 +
Presidential Advisory Committee on Gulf War Veterans' Illnesses. Interim Report. Washington, DC: US Government Printing Office; 1996.
6 +
Office of the Assistant Secretary of Defense for Health Affairs. Comprehensive Clinical Evaluation Program for Persian Gulf War Veterans: CCEP Report on 18,598 Participants . Washington, DC: US Dept of Defense; 1996;.
7 +
 Questionnaires from the National Health Interview Survey, 1985-89: series I: programs and collection procedures . Vital Health Stat 1 . August 1993;; No. (31) .
8 +
Behavioral Risk Factor Surveillance Survey (BRFSS). Atlanta, Ga: Centers for Disease Control and Prevention; 1995.
9 +
Health Status of Vietnam Veterans: Volume II: Telephone Interview: The Centers for Disease Control Vietnam Experience Study, January 1989. Atlanta, Ga: Center for Environmental Health and Injury Control, Centers for Disease Control; 1989.
10 +
National Medical Expenditure Survey: Questionnaires and Data Collection Methods for the Household Survey and the Survey of American Indians and Alaska Natives. Rockville, Md: National Center for Health Services Research and Health Care Technology Assessment; September 1989. Publication PHS 89-3450.
11 +
Spitzer RL, Williams JBW, Kroenke K, et al.  Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study . JAMA . 1994;;272:1749-1756.
12 +
Derogatis LR, Melsaratos N.  The Brief Symptom Inventory (B.S.I): an introductory report . Psychol Med . 1983;;13:595-605.
13 +
Ewing JA.  Detecting alcoholism: the CAGE questionnaire . JAMA . 1984;;252:1905-1907.
14 +
Weathers F, Litz BT, Heran DS, Huska JA, Kean TM. The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility . San Antonio, Tex: International Society of Traumatic Stress Studies; October 1993;.
15 +
Fukuda K, Strauss SE, Hickie I, Sharpe MC, Komaroff A, and the International Chronic Fatigue Syndrome Study Group.  The chronic fatigue syndrome: a comprehensive approach to its definition and study . Ann Intern Med . 1994;;121:953-959.
16 +
Chalder T, Berelowitz G, Pawlikowska T, et al.  Development of a fatigue scale . J Psychosom Res . 1993;;37:147-153.
17 +
Ferris BG Jr.  Epidemiology standardization project . Am Rev Respir Dis . 1978;;118:55-88.
18 +
Bergner N, Bobbit RA, Kressel S, et al.  The Sickness Impact Profile: conceptual formulation and methodology for the development of a health status measure . Int J Health Serv . 1976;;6:393-415.
19 +
Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L.  The prevalence and characteristics of fibromyalgia in the general population . Arthritis Rheum . 1995;;38:19-28.
20 +
Reynolds CF, Frank E, Thase MD, et al.  Assessment of sexual function in depressed, impotent, and healthy men: factor analysis of a brief sexual function questionnaire for men . Psychol Res . 1988;;24:231-250.
21 +
Female and Family Health Questionnaire: Agricultural Health Study. Iowa City: University of Iowa; 1993.
22 +
Illness in Persian Gulf Veterans, Lebanon, Pennsylvania (Questionnaire). Atlanta, Ga: National Center for Infectious Diseases, Centers for Disease Control and Prevention; 1994.
23 +
Ware J.  Appendix C: script for personal interview SF-36 administration . In: SF-36 Health Survey Manuals and Interpretation Guide . Boston, Mass: Nimrod Press; 1993;.
24 +
Strahan R, Gerbasi KC.  Short, homogenous versions of the Marlow-Crowne Social Desirability Scale . J Clin Psychol . 1972;;28:191-193.
25 +
Computer-Assisted Survey Execution System (CASES), Computer-Assisted Survey Methods Program (CSM), Release 2.4. Berkeley: University of California; February 1994.
26 +
Shah BV, Barnwell BG, Bieler GS. SUDAAN User's Manual: Software for Analysis of Correlated Data, Release 6.40 . Research Triangle Park, NC: Research Triangle Institute; 1992;.
27 +
SAS Institute Inc. SAS/IML Software: Usage and Reference, Version 6 . 1st ed. Cary, NC: SAS Institute Inc; 1990;.
28 +
Sato T.  Confidence intervals for effect parameters common in cancer epidemiology . Environ Health Perspect . 1990;;87:95-101.
29 +
Greenland S.  Interpretation and estimation of summary ratios under heterogeneity . Stat Med . 1982;;1:217-227.
30 +
Fleiss J. Statistical Methods for the Analysis of Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1991;.
31 +
McHorney CA, Kosinski M, Ware JE.  Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from the national survey . Med Care . 1994;;32:551-567.
32 +
Kizer KW, Joseph S, Moll M, Rankin JT.  Unexplained illness among Persian Gulf War veterans in an Air National Guard unit: preliminary report— August 1990-March 1995 . MMWR Morb Mortal Wkly Rep . 1995;;44:443-447.
33 +
Magill AJ, Grögl M, Gasser RA Jr, Sun W, Oster CN.  Visceral infection caused by Leishmania tropica in veterans of Operation Desert Storm . N Engl J Med . 1993;;328:1383-1387.
34 +
Abou-Donia MB, Wilmarth KR, Jensen KF, Oehme FW, Kurt TL.  Neurotoxicity resulting from co-exposure to pyridostigmine bromide, DEET, and permethrin: implications of Gulf War chemical exposures . J Toxicol Environ Health . 1996;;48:35-56.
35 +
Hyams KC, Wignall S, Roswell R.  War syndromes and their evaluation: from the U.S. Civil War to the Persian Gulf War . Ann Intern Med . 1996;;125:398-405.
36 +
Coughlin SS.  Recall bias in epidemiologic studies . J Clin Epidemiol . 1990;;43:87-91.
37 +
Neugebauer R, Ng S.  Differential recall as a source of bias in epidemiologic research . J Clin Epidemiol . 1990;;43:1337-1341.
38 +
Chouinard E, Walter S.  Recall bias in casecontrol studies: an empirical analysis and theoretical framework . J Clin Epidemiol . 1995;;48:245-254.
39 +
Drews CD, Greenland S.  The impact of differential recall on the results of case-control studies . Int J Epidemiol . 1990;;19:1107-1112.
40 +
The Centers for Disease Control Vietnam Experience Study.  Postservice mortality among Vietnam veterans . JAMA . 1987;;257:790-795.
41 +
The Centers for Disease Control Vietnam Experience Study.  Health status of Vietnam veterans, I: psychosocial characteristics . JAMA . 1988;;259:2701-2707.
42 +
The Centers for Disease Control Vietnam Experience Study.  Health status of Vietnam veterans, II: physical health . JAMA . 1988;;259:2708-2714.
43 +
The Centers for Disease Control Vietnam Experience Study.  Health status of Vietnam veterans, III: reproductive outcomes and child health . JAMA . 1988;;259:2715-2719.
44 +
Decoufle P, Holmgreen P, Boyle C, Stroup NE.  Self-reported health status of Vietnam veterans in relation to perceived exposure to herbicides and combat . Am J Epidemiol . 1992;;135:312-323.
45 +
Penman AD, Tarver RS, Currier MM.  No evidence of increase in birth defects and health problems among children born to Persian Gulf War veterans in Mississippi . Mil Med . 1996;;161:1-6.
46 +
Kang HK, Bullman TA.  Mortality among U.S. veterans of the Persian Gulf War . N Engl J Med . 1996;;335:1498-1504.
47 +
Gray GC, Coate BD, Anderson CM, et al.  The postwar hospitalization experience of U.S. veterans of the Persian Gulf War . N Engl J Med . 1996;;335:1505-1513.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
 NIH Technology Assessment Workshop Panel. The Persian Gulf experience and health . JAMA . 1994;;272:391-396.
2 +
Persian Gulf Veterans Coordinating Board.  Unexplained illnesses among Desert Storm veterans: a search for causes, treatment, and cooperation . Arch Intern Med . 1995;;155:262-268.
3 +
Office of the Under Secretary of Defense for Acquisition and Technology. Report of the Defense Science Board Task Force on Persian Gulf War Health Effects . Washington, DC: US Dept of Defense; 1994;.
4 +
Committee to Review the Health Consequences of Service During the Persian Gulf War. Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action . Washington, DC: National Academy Press; 1994;.
5 +
Presidential Advisory Committee on Gulf War Veterans' Illnesses. Interim Report. Washington, DC: US Government Printing Office; 1996.
6 +
Office of the Assistant Secretary of Defense for Health Affairs. Comprehensive Clinical Evaluation Program for Persian Gulf War Veterans: CCEP Report on 18,598 Participants . Washington, DC: US Dept of Defense; 1996;.
7 +
 Questionnaires from the National Health Interview Survey, 1985-89: series I: programs and collection procedures . Vital Health Stat 1 . August 1993;; No. (31) .
8 +
Behavioral Risk Factor Surveillance Survey (BRFSS). Atlanta, Ga: Centers for Disease Control and Prevention; 1995.
9 +
Health Status of Vietnam Veterans: Volume II: Telephone Interview: The Centers for Disease Control Vietnam Experience Study, January 1989. Atlanta, Ga: Center for Environmental Health and Injury Control, Centers for Disease Control; 1989.
10 +
National Medical Expenditure Survey: Questionnaires and Data Collection Methods for the Household Survey and the Survey of American Indians and Alaska Natives. Rockville, Md: National Center for Health Services Research and Health Care Technology Assessment; September 1989. Publication PHS 89-3450.
11 +
Spitzer RL, Williams JBW, Kroenke K, et al.  Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study . JAMA . 1994;;272:1749-1756.
12 +
Derogatis LR, Melsaratos N.  The Brief Symptom Inventory (B.S.I): an introductory report . Psychol Med . 1983;;13:595-605.
13 +
Ewing JA.  Detecting alcoholism: the CAGE questionnaire . JAMA . 1984;;252:1905-1907.
14 +
Weathers F, Litz BT, Heran DS, Huska JA, Kean TM. The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility . San Antonio, Tex: International Society of Traumatic Stress Studies; October 1993;.
15 +
Fukuda K, Strauss SE, Hickie I, Sharpe MC, Komaroff A, and the International Chronic Fatigue Syndrome Study Group.  The chronic fatigue syndrome: a comprehensive approach to its definition and study . Ann Intern Med . 1994;;121:953-959.
16 +
Chalder T, Berelowitz G, Pawlikowska T, et al.  Development of a fatigue scale . J Psychosom Res . 1993;;37:147-153.
17 +
Ferris BG Jr.  Epidemiology standardization project . Am Rev Respir Dis . 1978;;118:55-88.
18 +
Bergner N, Bobbit RA, Kressel S, et al.  The Sickness Impact Profile: conceptual formulation and methodology for the development of a health status measure . Int J Health Serv . 1976;;6:393-415.
19 +
Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L.  The prevalence and characteristics of fibromyalgia in the general population . Arthritis Rheum . 1995;;38:19-28.
20 +
Reynolds CF, Frank E, Thase MD, et al.  Assessment of sexual function in depressed, impotent, and healthy men: factor analysis of a brief sexual function questionnaire for men . Psychol Res . 1988;;24:231-250.
21 +
Female and Family Health Questionnaire: Agricultural Health Study. Iowa City: University of Iowa; 1993.
22 +
Illness in Persian Gulf Veterans, Lebanon, Pennsylvania (Questionnaire). Atlanta, Ga: National Center for Infectious Diseases, Centers for Disease Control and Prevention; 1994.
23 +
Ware J.  Appendix C: script for personal interview SF-36 administration . In: SF-36 Health Survey Manuals and Interpretation Guide . Boston, Mass: Nimrod Press; 1993;.
24 +
Strahan R, Gerbasi KC.  Short, homogenous versions of the Marlow-Crowne Social Desirability Scale . J Clin Psychol . 1972;;28:191-193.
25 +
Computer-Assisted Survey Execution System (CASES), Computer-Assisted Survey Methods Program (CSM), Release 2.4. Berkeley: University of California; February 1994.
26 +
Shah BV, Barnwell BG, Bieler GS. SUDAAN User's Manual: Software for Analysis of Correlated Data, Release 6.40 . Research Triangle Park, NC: Research Triangle Institute; 1992;.
27 +
SAS Institute Inc. SAS/IML Software: Usage and Reference, Version 6 . 1st ed. Cary, NC: SAS Institute Inc; 1990;.
28 +
Sato T.  Confidence intervals for effect parameters common in cancer epidemiology . Environ Health Perspect . 1990;;87:95-101.
29 +
Greenland S.  Interpretation and estimation of summary ratios under heterogeneity . Stat Med . 1982;;1:217-227.
30 +
Fleiss J. Statistical Methods for the Analysis of Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1991;.
31 +
McHorney CA, Kosinski M, Ware JE.  Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from the national survey . Med Care . 1994;;32:551-567.
32 +
Kizer KW, Joseph S, Moll M, Rankin JT.  Unexplained illness among Persian Gulf War veterans in an Air National Guard unit: preliminary report— August 1990-March 1995 . MMWR Morb Mortal Wkly Rep . 1995;;44:443-447.
33 +
Magill AJ, Grögl M, Gasser RA Jr, Sun W, Oster CN.  Visceral infection caused by Leishmania tropica in veterans of Operation Desert Storm . N Engl J Med . 1993;;328:1383-1387.
34 +
Abou-Donia MB, Wilmarth KR, Jensen KF, Oehme FW, Kurt TL.  Neurotoxicity resulting from co-exposure to pyridostigmine bromide, DEET, and permethrin: implications of Gulf War chemical exposures . J Toxicol Environ Health . 1996;;48:35-56.
35 +
Hyams KC, Wignall S, Roswell R.  War syndromes and their evaluation: from the U.S. Civil War to the Persian Gulf War . Ann Intern Med . 1996;;125:398-405.
36 +
Coughlin SS.  Recall bias in epidemiologic studies . J Clin Epidemiol . 1990;;43:87-91.
37 +
Neugebauer R, Ng S.  Differential recall as a source of bias in epidemiologic research . J Clin Epidemiol . 1990;;43:1337-1341.
38 +
Chouinard E, Walter S.  Recall bias in casecontrol studies: an empirical analysis and theoretical framework . J Clin Epidemiol . 1995;;48:245-254.
39 +
Drews CD, Greenland S.  The impact of differential recall on the results of case-control studies . Int J Epidemiol . 1990;;19:1107-1112.
40 +
The Centers for Disease Control Vietnam Experience Study.  Postservice mortality among Vietnam veterans . JAMA . 1987;;257:790-795.
41 +
The Centers for Disease Control Vietnam Experience Study.  Health status of Vietnam veterans, I: psychosocial characteristics . JAMA . 1988;;259:2701-2707.
42 +
The Centers for Disease Control Vietnam Experience Study.  Health status of Vietnam veterans, II: physical health . JAMA . 1988;;259:2708-2714.
43 +
The Centers for Disease Control Vietnam Experience Study.  Health status of Vietnam veterans, III: reproductive outcomes and child health . JAMA . 1988;;259:2715-2719.
44 +
Decoufle P, Holmgreen P, Boyle C, Stroup NE.  Self-reported health status of Vietnam veterans in relation to perceived exposure to herbicides and combat . Am J Epidemiol . 1992;;135:312-323.
45 +
Penman AD, Tarver RS, Currier MM.  No evidence of increase in birth defects and health problems among children born to Persian Gulf War veterans in Mississippi . Mil Med . 1996;;161:1-6.
46 +
Kang HK, Bullman TA.  Mortality among U.S. veterans of the Persian Gulf War . N Engl J Med . 1996;;335:1498-1504.
47 +
Gray GC, Coate BD, Anderson CM, et al.  The postwar hospitalization experience of U.S. veterans of the Persian Gulf War . N Engl J Med . 1996;;335:1505-1513.

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