Occupational risk factors for ill health in Gulf veterans of the United Kingdom

Abstract

Objectives-To study the association between occupational factors specific to the Armed Forces (rank, functional roles, Service, regular or reservist status and deployment factors) and symptomatic health problems in Gulf veterans, after sociodemographic and lifestyle factors have been accounted for. Design-A postal cross sectional survey of randomly selected UK Gulf veterans was conducted six to seven years after the Gulf conflict. Physical ill health was measured using the Fatigue Questionnaire and a measure of the Centers for Disease Control and Prevention (CDC) multisymptom syndrome. Psychological ill health was measured using the General Health Questionnaire and a posttraumatic stress measure. Setting-Population of servicemen who were serving in the UK Armed Forces during the Gulf conflict between 1 September 1990 and 30 June 1991. Participants-3297 Gulf veterans.Main results-In multivariate logistic regression, there was an inverse relation between higher rank and psychological and physical ill health (test of trend: General Health Questionnaire, p=0.004 ; posttraumatic stress, p=0.002; fatigue, p=0.015; CDC case, p=0.002). Having left the Armed Forces was associated with a two to three times increase in reporting ill health. Of the deployment factors, there was a weak association between being deployed as an individual reinforcement in a combat role and post-traumatic stress but there was no association between receiving pre-deployment training or post-deployment leave and ill health. Marital status and smoking were associated with psychological and physical ill health. Conclusions-Rank was the main occupational factor associated with both psychological and physical ill health in Gulf veterans. This may parallel the associations between socioeconomic status and morbidity in civilian populations. Ill health seems to be greater in those who return to civilian life. Sociodemographic factors also seem to be important in ill health in Gulf veterans. (J Epidemiol Community Health 2000;54:834-838) There is now good evidence from populationbased studies that veterans of the Gulf conflict report more health problems than military personnel not deployed to the Gulf.

Psychological health of Australian veterans of the 1991 Gulf War: an assessment using the SF-12, GHQ-12 and PCL-S

“…The highest-ranking officers had the highest scores (higher levels of psychological distress), reflecting possible differences in age, experience, or level of responsibility. Ismail et al (2000) found an inverse relationship between rank and GHQ-12 caseness for UK Gulf War veterans (a comparison group was not used), with lower ranks exhibiting higher caseness. In addition, Ismail et al (2000) found such a relationship between rank and PTSD, as measured using several items from the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (Keane et al 1988), and suggested that rank could be a proxy for socio-economic status.…”

“…Ismail et al (2000) found an inverse relationship between rank and GHQ-12 caseness for UK Gulf War veterans (a comparison group was not used), with lower ranks exhibiting higher caseness. In addition, Ismail et al (2000) found such a relationship between rank and PTSD, as measured using several items from the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (Keane et al 1988), and suggested that rank could be a proxy for socio-economic status. The latter is associated with psychological morbidity in civilian populations (McCabe et al 1996).…”

Health Status and Clinical Diagnoses of 3000 UK Gulf War Veterans

“…It also compares with a reported 8% lifetime prevalence of PTSD in the American population and 30% among US Vietnam veterans 6 . In assessing occupational risk factors for ill-health among Gulf veterans, Ismail found that generally combat duties did not predispose to post-traumatic stress reaction any more than combat support or logistic duties 7 . Eleven years after the conflict, we continue to recognize cases of Gulf-related PTSD not previously diagnosed 8 .…”

Occurrence of delayed-onset post-traumatic stress disorder: a systematic review and meta-analysis of prospective studies

“…Delayed-onset PTSD, diagnosed >6 months after the traumatic event or termination of a long-term exposure, has in particular been described among war veterans who develop symptoms during the years after returning home from war (7)(8)(9)(10)(11)(12). Some of the PTSD symptoms such as disability (distress at a level causing impairment of social or occupational functioning), numbing and hyperarousal (sleep disturbance, irritability, hypervigilance, and cognitive problems) are non-specific complaints common in the general population.…”