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Gulf war illness—better, worse, or just the same? A cohort study

BMJ 2003; 327 doi: (Published 11 December 2003) Cite this as: BMJ 2003;327:1370
  1. Matthew Hotopf, reader (m.hotopf{at},
  2. Anthony S David, professor1,
  3. Lisa Hull, research assistant1,
  4. Vasilis Nikalaou, statistician1,
  5. Catherine Unwin, study coordinator1,
  6. Simon Wessely, professor1
  1. 1Gulf War Illnesses Research Unit, Department of Psychological Medicine, Guy's, King's, and St Thomas's School of Medicine, London SE5 8AZ
  1. Correspondence to: M Hotopf


    Objectives Firstly, to describe changes in the health of Gulf war veterans studied in a previous occupational cohort study and to compare outcome with comparable non-deployed military personnel. Secondly, to determine whether differences in prevalence between Gulf veterans and controls at follow up can be explained by greater persistence or greater incidence of disorders.

    Design Occupational cohort study in the form of a postal survey.

    Participants Military personnel who served in the 1991 Persian Gulf war; personnel who served on peacekeeping duties to bosnia; military personnel who were deployed elsewhere (“Era” controls). All participants had responded to a previous survey.

    Setting United Kingdom.

    Main outcome measures Self reported fatigue measured on the Chalder fatigue scale; psychological distress measured on the general health questionnaire, physical functioning and health perception on the SF-36; and a count of physical symptoms.

    Results Gulf war veterans experienced a modest reduction in prevalence of fatigue (48.8% at stage 1, 43.4% at stage 2) and psychological distress (40.0% stage 1, 37.1% stage 2) but a slight worsening of physical functioning on the SF-36 (90.3 stage 1, 88.7 stage 2). Compared with the other cohorts Gulf veterans continued to experience poorer health on all outcomes, although physical functioning also declined in bosnia veterans. Era controls showed both lower incidence of fatigue than Gulf veterans, and both comparison groups showed less persistence of fatigue compared with Gulf veterans.

    Conclusions Gulf war veterans remain a group with many symptoms of ill health. The excess of illness at follow up is explained by both higher incidence and greater persistence of symptoms.


    • Contributors MH, ASD, and SW designed the study. CU snf LH were responsible for data collection under the supervision of SW, ASD, and MH. MH and VN ptrformed the statistical analyses. MH wrote the paper and is the guarantor. All authors provided comments

    • Funding US Department of Defense, UK Medical Research Council

    • Competing interests None declared

    • Ethical approval The study received approval from the relevant research ethics committees

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