ArticlesHealth of UK servicemen who served in Persian Gulf War
Introduction
From late 1990, the UK deployed 53·462 military personnel to the Persian Gulf War. In the months after the end of the war, anecdotal reports emerged in the USA of various disorders affecting Gulf War veterans. In the UK, similar observations surfaced in 1993, after a television broadcast in June. Some UK Gulf War veterans have experienced health problems since their return. Such anecdotal reports cannot, however, establish whether these complaints have any particular pattern, nor whether they are related to Gulf War service.
Previous studies of the health of Gulf War veterans have had limitations. Comparisons with non-military populations may be misleading, since military recruitment involves medical screening. Clinical assessment programmes for non-randomly selected veterans with symptoms cannot provide epidemiological information or answer questions about links to active service.1 Some of these limitations have been addressed. A large-scale study of US veterans found no substantial differences in admissions between Gulf War veterans and military controls.2 However, only admissions to military hospitals were included, without contact with outpatients, primary-care physicians, or civilian hospitals, which may have led to bias towards sicker veterans.3 One cohort study used complete outcome data from an unselected military population, but looked only at mortality.4 The Centers for Disease Control and Prevention (CDC) study5 was restricted to serving air-force personnel. Sicker veterans are more likely to have left the services because of ill health. To date, only one study has used a random sample of veterans and tried to follow up still serving and discharged personnel.6
We investigated, among UK male Gulf War veterans from army, navy, and air force, whether there was a relation between ill health and the Gulf War.
Section snippets
Methods
We carried out a cross-sectional epidemiological survey to compare the health profiles of three randomly selected UK military cohorts.
Responses
We received 8195 (65·1%) questionnaire replies (2961 [70·4%] Gulf War cohort, 2620 [61·9%] Bosnia cohort, 2614 [62·9%] Era cohort). Addresses were not available for 152 participants. 503 (4·0%) servicemen refused to respond. 980 (7·9%) questionnaires were returned undelivered to the research team by the Post Office at the end of the three mailings (figure 1). If the undelivered questionnaires are taken into account, the minimum effective response rate was 70·6%. The characteristics of the Gulf
Discussion
UK veterans of the Gulf War report higher rates of many symptoms and disorders and have a decreased perception of well being than servicemen who were not deployed to the Gulf War, despite no evidence of increased frequencies and no excess of objective outcomes, such as birth defects, cancers, or death.1, 2, 4 By contrast, we report that servicemen in the Gulfwere about three times more likely to fulfil criteria for chronic fatigue, post-traumatic stress reaction, or the CDC multisymptom
Study limitations
As in similar studies, the most important factor for participation in the survey was our ability to find accurate addresses.5, 6, 13, 14 The second factor influencing response was demography. Young men generally change addresses frequently and are not inclined to respond to lengthy questionnaire surveys,15 which has been experienced in previous studies of Gulf War veterans.
A key question is whether or not participation was biased towards those with health complaints. Responders were more likely
Implications
The finding that active military service has led to long-term adverse health effects is not new and has been reported in US and Australian Vietnam veterans,22, 23 and inferred after earlier conflicts.24 Furthermore, the US study of Gulf veterans most comparable to ours reported a similar decline in self-reported health status and higher rates of various symptoms and disorders.6
The most obvious explanation for this increase in symptoms in the Gulf War veterans is that it relates to different
References (35)
- et al.
Development of a fatigue scale
J Psychosom Res
(1993) - et al.
Gulf War syndrome: is it due to a systemic shift in cytokine balance towards a Th2 profile?
Lancet
(1997) - et al.
Post-traumatic stress disorder and somatization symptoms: a prospective study
Psychiatry Res
(1998) A comprehensive clinical evaluation of 20,000 Persian Gulf War veterans
Milit Med
(1997)- et al.
The postwar hospitalization experience of U.S. veterans of the Persian Gulf War
N Engl J Med
(1996) Point: bias from the "healthy warrior effect" and unequal follow up in three government studies of health effects of the Gulf War
Am J Epidemol
(1998)- et al.
Mortality among U.S. veterans of the Persian Gulf War
N Engl J Med
(1996) - et al.
Chronic multisymptom illness affecting air force veterans of the gulf war
JAMA
(1998) Self-reported illness and health status among Persian Gulf War veterans: a population-based study
JAMA
(1997)- et al.
Mississippi Scale for combat-related posttraumatic stress disorder: three studies in reliability and validity
J Consult Clin Psychol
(1988)
The MOS 36-item short-form health survey (SF-36): conceptual framework and item selection
Med Care
The detection of psychiatric illness by questionnaire
Measuring chemical sensitivity prevalence: a questionnaire for population studies
Am J Public Health
Recall of psychiatric history in cross-sectional surveys: implications for epidemiologic research
Epidemiol Rev
The Australian Vietnam veterans health study, I: study design and response bias
Int J Epidemiol
Response rate to mailed epidemiologic questionnaires: a population-based randomized trial of variations in design and mailing routines
Am J Epidemiol
Cited by (489)
A review of pre-clinical models for Gulf War Illness
2021, Pharmacology and TherapeuticsThe ambivalence about accepting the prevalence somatic symptoms in PTSD: Is PTSD a somatic disorder?
2021, Journal of Psychiatric ResearchThe role of inhibitory processes in the relationship between subsyndromal PTSD symptoms and aggressive behaviour
2021, Journal of Psychiatric Research