Home Journal Excerpts Gulf War Syndrome The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study
The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study PDF Print E-mail
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Saturday, 14 September 2002 00:00
“Objectives - To examine the prevalence of psychiatric disorders in veterans of the Gulf war with or without unexplained physical disability (a proxy measure of ill health) and in similarly disabled veterans who had not been deployed to the Gulf war (non-Gulf veterans). Conclusions - Most disabled Gulf veterans do not have a formal psychiatric disorder. Post-traumatic stress disorder is not higher in Gulf veterans than in other veterans. Psychiatric disorders do not fully explain self reported ill health in Gulf veterans; alternative explanations for persistent ill health in Gulf veterans are needed.”

“Population based studies have consistently found that veterans of the 1990-1 Persian Gulf conflict report symptoms around two to three times more often than appropriate controls. The symptoms reported are multisystem and non-specific, such as fatigue, sleeping difficulties, and irritability, which at present are medically unexplained. Markers of serious physical morbidity, such as admission to hospital and mortality, are not increased in Gulf veterans, with the exception of accidents. Complex multivariate statistical analyses have failed to identify a cluster of symptoms, conditions, or causal factors consistent with a new syndrome.”

“Common psychiatric disorders also seem to be increased in Gulf veterans. Depression, tension headache, and post-traumatic stress disorder accounted for a major proportion of clinical diagnoses in voluntary registers, but these were likely to have been over-represented by veterans who perceived themselves as ill. Population based studies have also shown that symptoms of depression and post-traumatic stress disorder are reported more commonly in Gulf veterans, but self reported more commonly in Gulf veterans, but self reported symptoms may over-estimate of underestimate psychiatric morbidity and have poor concordance with clinical ratings.”

“In civilian populations, medically unexplained symptoms are associated with increased rates of psychiatric disorders. This may also be the case in Gulf veterans. An association was found between number of symptoms and post-traumatic stress disorder and depression in one sample of US Gulf veterans by using structured psychiatric interviews, but a control group of non-Gulf veterans was not used to test whether this was unique to the Gulf experience.”

“We found a negative association: three quarters of Gulf veterans with disability do not have formal psychiatric disorders, such as depression, anxiety, or alcohol related problems, although the prevalence was more than double that of Gulf veterans with no (or minimal) disability. We also found that disabled Gulf veterans are not much different in their pattern of mental health problems to similarly disabled non-Gulf veterans except that they have a threefold increase in somatoform disorders. The prevalence of post-traumatic stress disorder was no different in the three groups, suggesting that whatever the nature of ill health in Gulf veterans, it was not explained by events or exposures conventionally understood to be psychologically traumatic.”

“The prevalence of common psychiatric disorders are not increased in Gulf veterans who report no physical disability, and it is reassuring that even in those selected by their level of disability the rates are note substantially increased. These findings contrast with most previous research, which has used self report measures. The increase in somatoform disorders that we found should be treated cautiously. Although it confirms there is an increase in symptomatic distress in Gulf veterans, redefining medically unexplained symptoms as somatoform disorders may to some extent be tautological and is anyhow a controversial psychiatric disorder. Most somatoform disorders were of the undifferentiated type, a diagnosis that falls short of somatisation disorder, which is the more severe and rare form. Undifferentiated somatoform disorder described here represents multiple unexplained symptoms that are distressing but not so severe that Gulf veterans are seeking multiple medical advice or reassurance to establish their cause.”

“We continue to find an effect of the Gulf conflict manifested as increased symptomatic distress. In our study, the modest increase in psychiatric disorders do not fully explain ill health in Gulf veterans.”

Khalida Ismail; Kate Kent; Traolach Brugha; Matthew Hotopf; Lisa Hull; Paul Seed; Ian Palmer; Steve Reid; Catherine Unwin; Anthony S. David; and Simon Wessley, "The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study", BMJ (British Medical Journal), September 14, 2002, Vol. 325, Num. 0, pp. 576-579


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