The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study

doi:10.1136/bmj.325.7364.576

BMJ 2002;325:576 ( 14 September )

Papers

The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study

Khalida Ismail, clinical lecturer, ^a Kate Kent, research nurse, ^a Traolach Brugha, professor, ^b Matthew Hotopf, reader, ^a Lisa Hull, research assistant, ^a Paul Seed, statistician, ^a Ian Palmer, military psychiatrist, ^c Steve Reid, research fellow, ^a Catherine Unwin, study coordinator, ^a Anthony S David, professor, ^a Simon Wessely, professor. ^a

^a Gulf War Illnesses Research Unit, Guy's, King's, and St Thomas's School of Medicine, London SE5 8AZ, ^b Section of Social and Epidemiological Psychiatry, University of Leicester Department of Psychiatry, Leicester General Hospital, Leicester LE5 4PW, ^c Royal Defence Medical College, Fort Blockhouse, Gosport

Correspondence to: K Ismail khalida.ismail{at}iop.kcl.ac.uk

Objectives: To examine the prevalence of psychiatric disordersin veterans of the Gulf war with or without unexplained physicaldisability (a proxy measure of ill health) and in similarly disabledveterans who had not been deployed to the Gulf war (non-Gulfveterans).
Design: Two phase cohortstudy.
Setting: Current and ex-service UK militarypersonnel.
Participants: Phase 1 consisted of three randomly selectedsamples of Gulf veterans, veterans of the 1992-7 Bosnia peacekeepingmission, and UK military personnel not deployed to the Gulf war(Era veterans) who had completed a postal health questionnaire.Phase 2 consisted of randomly selected subsamples from phase 1of Gulf veterans who reported physical disability (n=111) or whodid not report disability (n=98) and of Bosnia (n=54) and Era(n=79) veterans who reported physicaldisability.
Main outcome measure: Psychiatric disorders assessed by the schedulefor clinical assessment in neuropsychiatry and classified by theDiagnostic and Statistical Manual of Mental Disorders, fourthedition.
Results: Only 24% (n=27) of the disabled Gulf veteranshad a formal psychiatric disorder (depression, anxiety, or alcoholrelated disorder). The prevalence of psychiatric disorders innon-disabled Gulf veterans was 12%. Disability and psychiatricdisorders were weakly associated in the Gulf group when confoundingwas adjusted for (adjusted odds ratio 2.4, 99% confidence interval0.8 to 7.2, P=0.04). The prevalence of psychiatric disorders wassimilar in disabled non-Gulf veterans and disabled Gulf veterans( 19% v 24%; 1.3, 0.5 to 3.4). All groups had rates for post-traumaticstress disorder of between 1% and 3%.
Conclusions: Most disabled Gulf veterans do not have aformal psychiatric disorder. Post-traumatic stress disorder isnot higher in Gulf veterans than in other veterans. Psychiatricdisorders do not fully explain self reported ill health in Gulfveterans; alternative explanations for persistent ill health inGulf veterans areneeded.

What is already known on this topic
Gulf veterans report medically unexplained symptoms more often than non-Gulf veterans

The clinical characteristics of ill health in Gulf veterans are not well known, and factors associated with ill health in Gulf veterans are poorly understood

What this study adds
Most ill Gulf veterans do not have a formal psychiatric disorder

The rates for post-traumatic stress disorder are low

Psychiatric morbidity is not strongly associated with ill health in Gulf veterans

The rates for somatoform disorders are three times greater in disabled Gulf veterans than they are in disabled non-Gulf veterans

© BMJ 2002

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

Consent, confidentiality, and the Data Protection Act: Amy Iversen, Kathleen Liddell, Nicola Fear, Matthew Hotopf, and Simon Wessely
BMJ 2006 332: 165-169. [Full Text] [PDF]

Disabled Gulf veterans have high rates of psychiatric disorder
BMJ 2002 325: 0. [Full Text]

This article has been cited by other articles:

O'Toole, B. I., Catts, S. V., Outram, S., Pierse, K. R., Cockburn, J. (2009). The Physical and Mental Health of Australian Vietnam Veterans 3 Decades After the War and Its Relation to Military Service, Combat, and Post-Traumatic Stress Disorder. Am J Epidemiol 0: kwp146v1-kwp146 [Abstract] [Full text]
Iversen, A. C., Greenberg, N. (2009). Mental health of regular and reserve military veterans. Adv. Psychiatr. Treat. 15: 100-106 [Abstract] [Full text]
Tarn, M., Greenberg, N., Wessely, S. (2008). Gulf War syndrome - has it gone away?. Adv. Psychiatr. Treat. 14: 414-422 [Abstract] [Full text]
ENGELHARD, I. M., VAN DEN HOUT, M. A., WEERTS, J., ARNTZ, A., HOX, J. J. C. M., MCNALLY, R. J. (2007). Deployment-related stress and trauma in Dutch soldiers returning from Iraq: Prospective study. Br. J. Psychiatry 191: 140-145 [Abstract] [Full text]
Toomey, R., Kang, H. K., Karlinsky, J., Baker, D. G., Vasterling, J. J., Alpern, R., Reda, D. J., Henderson, W. G., Murphy, F. M., Eisen, S. A. (2007). Mental health of US Gulf War veterans 10 years after the war. Br. J. Psychiatry 190: 385-393 [Abstract] [Full text]
Sartin, J. S. (2006). Gulf War Syndrome: The Final Chapter?. Mayo Clin Proc. 81: 1425-1426 [Full text]
FIEDLER, N., OZAKINCI, G., HALLMAN, W., WARTENBERG, D., BREWER, N. T., BARRETT, D. H., KIPEN, H. M. (2006). Military deployment to the Gulf War as a risk factor for psychiatric illness among US troops. Br. J. Psychiatry 188: 453-459 [Abstract] [Full text]
Ismail, K., Lewis, G. (2006). Multi-symptom illnesses, unexplained illness and Gulf War Syndrome. Phil Trans R Soc B 361: 543-551 [Abstract] [Full text]
Gifford, R. K, Ursano, R. J, Stuart, J. A, Engel, C. C (2006). Stress and stressors of the early phases of the Persian Gulf War. Phil Trans R Soc B 361: 585-591 [Abstract] [Full text]
Kilshaw, S. (2006). On being a Gulf veteran: an anthropological perspective. Phil Trans R Soc B 361: 697-706 [Abstract] [Full text]
Iversen, A., Liddell, K., Fear, N., Hotopf, M., Wessely, S. (2006). Consent, confidentiality, and the Data Protection Act. BMJ 332: 165-169 [Full text]
Gackstetter, G. D, Hooper, T. I, Al Qahtani, M. S, Smith, T. C, Memish, Z. A, Schlangen, K. M, Cruess, D. F, Barrett, D. H, Ryan, M. A., Gray, G. C (2005). Assessing the potential health impact of the 1991 Gulf War on Saudi Arabian National Guard Soldiers. Int J Epidemiol 34: 801-808 [Abstract] [Full text]
WESSELY, S. (2005). Risk, psychiatry and the military. Br. J. Psychiatry 186: 459-466 [Abstract] [Full text]
IVERSEN, A., DYSON, C., SMITH, N., GREENBERG, N., WALWYN, R., UNWIN, C., HULL, L., HOTOPF, M., DANDEKER, C., ROSS, J., WESSELY, S. (2005). 'Goodbye and good luck': the mental health needs and treatment experiences of British ex-service personnel. Br. J. Psychiatry 186: 480-486 [Abstract] [Full text]
Iversen, A., Nikolaou, V., Greenberg, N., Unwin, C., Hull, L., Hotopf, M., Dandeker, C., Ross, J., Wessely, S. (2005). What happens to British veterans when they leave the armed forces?. Eur J Public Health 15: 175-184 [Abstract] [Full text]
Rose, M. R., Sharief, M. K., Priddin, J., Nikolaou, V., Hull, L., Unwin, C., Ajmal-Ali, R., Sherwood, R. A., Spellman, A., David, A., Wessely, S. (2004). Evaluation of neuromuscular symptoms in UK Gulf War veterans: A controlled study. Neurology 63: 1681-1687 [Abstract] [Full text]
Wessely, S. (2004). The Long Aftermath of the 1991 Gulf War. ANN INTERN MED 141: 155-156 [Full text]
Spence, V. A., Sharief, M.K., Priddin, J., Delamont, R.S., Unwin, C., Rose, M.R., David, A., Wessely, S. (2003). Neurophysiologic analysis of neuromuscular symptoms in UK Gulf War veterans. Neurology 61: 1827-1827 [Full text]
WESSELY, S., UNWIN, C., HOTOPF, M., HULL, L., ISMAIL, K., NICOLAOU, V., DAVID, A. (2003). Stability of recall of military hazards over time: Evidence from the Persian Gulf War of 1991. Br. J. Psychiatry 183: 314-322 [Abstract] [Full text]
Wilson-Ing, A H, Lee, H. A, Gabriel, R., Bolton, J P. G, Bale, A. J, Jackson, M. (2003). The health of Gulf War veterans * Authors' reply. JRSM 96: 155-156 [Full text]
(2002). Psychiatric Illness in Gulf War Syndrome. JWatch General 2002: 3-3 [Full text]

Rapid Responses:

Read all Rapid Responses

Engage with the all the evidence on gulf war syndrome: Malcolm Hooper
bmj.com, 15 Sep 2002 [Full text]
Toss a coin or adjust the facts?: Gurli Bagnall
bmj.com, 15 Sep 2002 [Full text]
Qualitative research may bridge the quantitative Gulf: Andrew J Ashworth
bmj.com, 15 Sep 2002 [Full text]
Gulf War Syndrome ? a Learned Response.: Robert L Miller, et al.
bmj.com, 19 Sep 2002 [Full text]