BMJ 1999;318:290-294 ( 30 January )

Papers

Clinical findings for the first 1000 Gulf war veterans in the Ministry of Defence's medical assessment programme

Editorial by Murphy

W J Coker, consultant physician, a B M Bhatt, consultant physician, b N F Blatchley, statistician, c J T Graham, consultant in public health medicine. c

a British Defence Staff (RAF), British Embassy, Washington BFPO2, b Duchess of Kent Hospital, Catterick Garrison, North Yorkshire DL9 4DF, c Gulf Veterans Illnesses Unit, Room 8276, Ministry of Defence, London SW1A 2HB

Correspondence to: Mr Blatchley sma-mod.uk{at}btinternet.com

Objective: To review the clinical findings in the first 1000 veterans seen in the Ministry of Defence's Gulf war medical assessment programme to examine whether there was a particular illness related to service in the Gulf.
Design: Case series of 1000 veterans who presented to the programme between 11 October 1993 and 24 February 1997.
Subjects: Gulf war veterans.
Main outcome measures: Diagnosis of veterans' conditions according to ICD-10 (international classification of diseases, 10th revision). Cases referred for psychiatric assessment were reviewed for available diagnostic information from consultant psychiatrists.
Results: 588 (59%) veterans had more than one diagnosed condition, 387 (39%) had at least one condition for which no firm somatic or psychological diagnosis could be given, and in 90 (9%) veterans no other main diagnosis was made. Conditions characterised by fatigue were found in 239 (24%) of patients. At least 190 (19%) patients had a psychiatric condition, which in over half was due to post-traumatic stress disorder. Musculoskeletal disorders and respiratory conditions were also found to be relatively common (in 182 (18%) and 155 (16%) patients respectively).
Conclusion: Many Gulf war veterans had a wide variety of symptoms. This initial review shows no evidence of a single illness, psychological or physical, to explain the pattern of symptoms seen in veterans in the assessment programme. As the veterans assessed by the programme were all self selected, the prevalence of illness in Gulf war veterans cannot be determined from this study. Furthermore, it is not known whether the veterans in this study were representative of sick veterans as a group.


Key messages

  • Many Gulf war veterans present with a wide variety of symptoms

  • No single cause has been found to explain these symptoms

  • From a clinical standpoint the variety and multiplicity of symptoms makes it unlikely that any single cause will be found to underlie Gulf war illness

  • Some of the illnesses may be an example of a postwar syndrome




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