Chronic Multisymptom Illness Affecting Air Force Veterans of the Gulf War

Abstract

Context.-Gulf War (GW) veterans report nonspecific symptoms significantly more often than their nondeployed peers. However, no specific disorder has been identified, and the etiologic basis and clinical significance of their symptoms remain unclear.Objectives.-To organize symptoms reported by US Air Force GW veterans into a case definition, to characterize clinical features, and to evaluate risk factors. Design.-Cross-sectional population survey of individual characteristics and symptoms and clinical evaluation (including a structured interview, the Medical Outcomes Study Short Form 36, psychiatric screening, physical examination, clinical laboratory tests, and serologic assays for antibodies against viruses, rickettsia, parasites, and bacteria) conducted in 1995. Participants and Setting.-The cross-sectional questionnaire survey included 3723 currently active volunteers, irrespective of health status or GW participation, from 4 air force populations.The cross-sectional clinical evaluation included 158 GW veterans from one unit, irrespective of health status. Main Outcome Measures.-Symptom-based case definition; case prevalence rate for GW veterans and nondeployed personnel; clinical and laboratory findings among veterans who met the case definition.Results.-We defined a case as having 1 or more chronic symptoms from at least 2 of 3 categories (fatigue, mood-cognition, and musculoskeletal). The prevalence of mild-to-moderate and severe cases was 39% and 6%, respectively, among 1155 GW veterans compared with 14% and 0.7% among 2520 nondeployed personnel. Illness was not associated with time or place of deployment or with duties during the war. Fifty-nine clinically evaluated GW veterans (37%) were noncases, 86 (54%) mild-to-moderate cases, and 13 (8%) severe cases. Although no physical examination, laboratory, or serologic findings identified cases, veterans who met the case definition had significantly diminished functioning and well-being.Conclusions.-Among currently active members of 4 Air Force populations, a chronic multisymptom condition was significantly associated with deployment to the GW. The condition was not associated with specific GW exposures and also affected nondeployed personnel.

Acetylcholinesterase inhibitors and Gulf War illnesses

“…Fatigue, mood-cognitive, and musculoskeletal symptoms are often involved. The presumptive Centers for Disease Control and Prevention (CDC) definition for Gulf War illness requires chronic symptoms in two or more of those three domains (2). Similar proportions of GWV and nonGWV report low levels of assessed symptoms, with the excess in GWV comprising those with moderate, severe, or multiple symptoms within a symptom category (1).…”

Managing future Gulf War Syndromes: international lessons and new models of care

“…Military and veteran programmes for 1991 Gulf War veterans, imperfect as they were, led to many lessons regarding post-war healthcare delivery ( Institute of Medicine 1997, 1998, research priorities Kroenke et al 1998;Roy et al 1998;Engel & Katon 1999) and individual needs of veterans (Institute of Medicine 1997) in the USA, UK and Canada. In response, the US Defense Department in 1999 established the Deployment Health Clinical Center with the mission of improving postdeployment healthcare using specialized clinical programmes, health services research and educational approaches.…”

Self-Reported Reproductive Outcomes Among Male and Female 1991 Gulf War era US Military Veterans

“…Since returning from the 1991 Gulf War, many veterans have reported diverse health problems they attribute to war exposures [1][2][3][4]. In response, numerous studies have described self-reported symptoms [5][6][7][8][9][10][11][12], hospitalizations [13][14][15][16][17][18], mortality [19][20][21][22], and specific wartime exposures [18,[23][24][25][26] in 1991 Gulf War veterans (GWVs).…”