The impact of post-traumatic stress on quality of life and fatigue in women with Gulf War Illness

Abstract

Background Gulf War Illness (GWI) is a chronic, multi-symptomatic disorder characterized by fatigue, muscle pain, cognitive problems, insomnia, rashes, and gastrointestinal issues affecting an estimated 30% of the ~ 750,000 returning military Veterans of the 1990–1991 Persian Gulf War. Female Veterans deployed to combat in this war report medical symptoms, like cognition and respiratory troubles, at twice the rate compared to non-deployed female Veterans of the same era. The heterogeneity of GWI symptom presentation complicates diagnosis as well as the identification of effective treatments. This is exacerbated by the presence of co-morbidities. Defining subgroups of the illness may help alleviate these complications. One clear grouping is along the lines of gender. Our aim is to determine if women with GWI can be further subdivided into distinct subgroups based on post-traumatic stress disorder (PTSD) symptom presentation. Methods Veterans diagnosed with GWI (n = 35) and healthy sedentary controls (n = 35) were recruited through the Miami Veterans Affairs Medical Health Center. Symptoms were assessed via the RAND short form health survey, the multidimensional fatigue inventory, and the Davidson trauma scale. Hierarchal regression modeling was performed on measures of health and fatigue with PTSD symptoms as a covariate. This was followed by univariate analyses conducted with two separate GWI groups based on a cut-point of 70 for their total Davidson trauma scale value and performing heteroscedastic t-tests across all measures. Results Based on the distinct differences found in PTSD symptomology regarding all health and trauma symptoms, two subgroups were derived within female GWI Veterans. Hierarchical regression models displayed the comorbid effects of GWI and PTSD, as both conditions had measurable impacts on quality of life and fatigue (ΔR2 = 0.08–0.672), with notable differences in mental and emotional measures. Overall, a cut point analysis indicated poorer quality of life and greater fatigue within all measures for women with GWI and PTSD symptoms in comparison to those women with GWI without PTSD symptoms and healthy controls. Conclusions Our current findings support the understanding that comorbid symptoms of GWI and PTSD subsequently result in poorer quality of life and fatigue, along with establishing the possibility of varying clinical presentations.

Self‐reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder

“…37 Shastry et al (2022) showed the same pattern of results in female veterans. 38 Taken together, these findings suggest that PTSD as a comorbidity identifies a subgroup of GW veterans-including those with GWI-that suffer from a particularly high burden of poor health. This is corroborated by our finding that, among veterans with GWI, those with comorbid PTSD are much more likely to also meet criteria for severe GWI than those without.…”

“…Additionally, Jeffrey et al (2021) recently showed that GW male veterans with both GWI and PTSD reported worse physical and mental health than veterans with only GWI 37 . Shastry et al (2022) showed the same pattern of results in female veterans 38 . Taken together, these findings suggest that PTSD as a comorbidity identifies a subgroup of GW veterans—including those with GWI—that suffer from a particularly high burden of poor health.…”

“…Alternatively, this pattern may represent an overall increased level of medical care and diagnostic workup that veterans with both GWI and PTSD receive given their particularly high symptom burden and low health-related quality of life. [33][34][35][36][37][38] Nonetheless, it remains unknown if this increase in incidence or detection is associated with long-term cancer outcomes, or if more frequent diagnostic testing simply increases cost and incidental detection of clinically insignificant findings.…”

Military exposures and Gulf War illness in veterans with and without posttraumatic stress disorder

“…J. Gifford et al, 2022;Jeffrey et al, 2021), and higher levels of pain and symptoms of depression (E. J. Gifford et al, 2022;Jeffrey et al, 2021;Shastry et al, 2022). Although the etiology of GWI is not completely understood, researchers have hypothesized that it is due to the many military exposures veterans experienced while deployed, which include nerve agents, pyridostigmine (PB) pills, pesticides, depleted uranium, and smoke from oil well fires.…”

“…Gulf War illness (GWI) is a chronic multisymptom illness that affects veterans who deployed in support of the 1990–1991 Gulf War and is characterized by alterations in mood and cognition, fatigue, and musculoskeletal problems (Fukuda et al., 1998). GWI is a debilitating health condition that is associated with increased health care utilization (Gwini et al., 2017), lower physical and mental health–related quality of life (Fukuda et al., 1998; E. J. Gifford et al., 2022; Jeffrey et al., 2021), and higher levels of pain and symptoms of depression (E. J. Gifford et al., 2022; Jeffrey et al., 2021; Shastry et al., 2022). Although the etiology of GWI is not completely understood, researchers have hypothesized that it is due to the many military exposures veterans experienced while deployed, which include nerve agents, pyridostigmine (PB) pills, pesticides, depleted uranium, and smoke from oil well fires.…”