Reported Exposures, Stressors, and Life Events Among Gulf War Registry Veterans

Abstract

We investigated the association of 15 exposures, 10 stressors, and 18 life events with illness symptoms reported by 978 veterans who believe they suffer from Gulf War-related illnesses. A mail survey was completed by veterans (60% response rate) from the Gulf War Health Registry. Variables most associated with high symptom group membership were reported chemical/biologic warfare (CBW), concerns with infection and faulty equipment, feelings of mistrust in the military, and disability leading to work stoppage within 2 years after the war. These data suggest that belief in CBW exposure, and the experience of war stress and serious negative life events after the war, are important concomitants of Gulf War illness. Models seeking to explain Gulf War symptoms need to incorporate a range of exposure and psychosocial factors to fully account for important influences.

The challenges of exposure assessment in health studies of Gulf War veterans

“…This has been pointed out by several Gulf War investigators (Bell et al 1998;Ishoy et al 1999;McCauley et al 1999;Cherry et al 2001;Wessely et al 2003;Glass et al in press). Recall bias occurs where there is post hoc attribution of exposure more frequently by those who are sick than by those who are well (Boyd et al 2003). This may be a result of personality differences, e.g.…”

“…One difficulty with self report is that it does not allow us to distinguish between actual remembered experience and belief in the exposure (Boyd et al 2003). Belief in past exposure to chemical warfare agents has been shown to correlate with current ill health (Unwin et al 1999;Stuart et al 2003).…”

“…Belief in past exposure to chemical warfare agents has been shown to correlate with current ill health (Unwin et al 1999;Stuart et al 2003). Boyd et al (2003) point out that the number of days using a gas mask for 1-4 h, being wounded and using unsafe equipment correlates with stressful conditions and also with high numbers of symptoms. However, it is not clear whether the individual exposure(s), the stressful experience as a whole, or memory of the events is the important factor.…”

“…Recognition appears to be easier than recall for most work exposures so that accurate recall of exposure improves when prompted with specific names (Engel et al 2001). Recall is better for brand names or nicknames than for chemical names Haley & Kurt (1997), Joseph (1997), The Iowa Persian Gulf Study Group (1997), Bell et al (1998), Goss Gilroy Inc (1998), Kroenke et al (1998), Poirier et al (1998), Proctor et al (1998), Ishoy et al (1999), McCauley et al (1999), Petruccelli et al (1999), Unwin et al (1999), Kang et al (2000), Cherry et al (2001), Lange et al (2002), Wolfe et al (2002), Smith et al (2002a,b), Boyd et al (2003), Wessely et al (2003), Glass et al (in press) chemical warfare agents including nerve gas and mustard gas Haley & Kurt (1997), The Iowa Persian Gulf Study Group (1997), Bell et al (1998), Goss Gilroy Inc (1998), Kroenke et al (1998), Proctor et al (1998), Engel et al (1999), Ishoy et al (1999) (Teschke et al 1994;Stewart et al 2002). In openended interviews or questionnaires, recall has high specificity, (few false positives or incorrect recognition of a substance) but low or variable sensitivity (more false negatives or failure to identify an exposure) (Bond et al 1988;Joffe 1992;Fritschi et al 1996).…”

The occupational role of women in military service: Validation of occupation and prevalence of exposures in the Millennium Cohort Study

“…Studies from the Vietnam War and the 1991 Gulf War have documented specific exposures of concern among deployed military women, including witnessing of death and morbidity due to war, disaster, or tragic event (Hobfoll et al 1991;Orsillo et al 1998;Carson et al 2000;Carney et al 2003); exposure to prisoners of war (Benotsch et al 2000;Carney et al 2003); chemical or biological warfare or countermeasures for these agents (Gray et al 1999;Smith et al 2002;Boyd et al 2003;Carney et al 2003;Smith et al 2003Smith et al , 2004a; depleted uranium (Carney et al 2003;Macfarlane et al 2005); and pesticides (Gambel et al 1998;Carney et al 2003;Macfarlane et al 2005). These and other studies investigating exposures associated with morbidity and reproductive health outcomes (Hourani & Hilton 2000;Kang et al 2000Kang et al , 2001Reutman et al 2002;Araneta et al 2003) highlight the growing occupational challenges faced by increasing numbers of women as they serve in an evolving military work force.…”