Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution

Jones, Edgar; Hodgins-Vermaas, Robert; McCartney, Helen B.; Everitt, Barry J.; Beech, Charlotte; Poynter, Denise; Palmer, Ian; Hyams, Kenneth C.; Wessely, Simon

doi:10.1136/bmj.324.7333.321

Cited by 132 publications

(80 citation statements)

References 16 publications

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“…In the study by Jones et al (2002b), it is significant that cluster analysis did not reveal a gastrointestinal group composed in the main of veterans of the Second World War. Indeed, soldiers diagnosed with non-ulcer dyspepsia were distributed between all three clusters, though to a lesser extent in the neuropsychiatric group.…”

Section: Discussionmentioning

confidence: 99%

“…An analysis of the military records of servicemen in the Jones et al (2002b) study revealed that the proportion involved in actual fighting fell over time as numbers in combat-support roles has risen. Of the Boer War veterans, 77% had been in combat, of the First World War pensioners 73.4%, of the Second World War sample 52%, while only 19.8% of the Gulf War sample had seen action.…”

Section: Discussionmentioning

confidence: 99%

“…Cluster analysis of the 25 most common symptoms showed that no particular war syndrome stood apart ( Jones et al 2002b). Three groups were identified: a debility syndrome largely without psychological or cognitive symptoms, a somatic syndrome focused on the heart, and a neuropsychiatric syndrome with a range of associated somatic symptoms: (i) Debility cluster (nZ847): Fatigue, difficulty completing tasks, shortness of breath and weakness were prominent symptoms.…”

Section: Gulf War Syndromementioning

confidence: 99%

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Historical approaches to post-combat disorders

Jones¹

2006

Phil. Trans. R. Soc. B

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Almost every major war in the last century involving western nations has seen combatants diagnosed with a form of post-combat disorder. Some took a psychological form (exhaustion, combat fatigue, combat stress reaction and post-traumatic stress disorder), while others were characterized by medically unexplained symptoms (soldier's heart, effort syndrome, shell shock, non-ulcer dyspepsia, effects of Agent Orange and Gulf War Syndrome). Although many of these disorders have common symptoms, the explanations attached to them showed considerable diversity often reflected in the labels themselves. These causal hypotheses ranged from the effects of climate, compressive forces released by shell explosions, side effects of vaccinations, changes in diet, toxic effects of organophosphates, oil-well fires or depleted-uranium munitions. Military history suggests that these disorders, which coexisted in the civilian population, reflected popular health fears and emerged in the gaps left by the advance of medical science. While the current Iraq conflict has yet to produce a syndrome typified by medically unexplained symptoms, it is unlikely that we have seen the last of post-combat disorders as past experience suggests that they have the capacity to catch both military planners and doctors by surprise.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Gulf War Syndromementioning

confidence: 99%

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Historical approaches to post-combat disorders

Jones¹

2006

Phil. Trans. R. Soc. B

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“…Controversial syndromes have occurred during and after virtually every major war dating back at least as far as the Crimean War of the 1850s and the US Civil War (Hyams et al 1996;Jones et al 2002). These postulated illnesses have gone by a variety of different names, including Da Costa's syndrome, soldier's heart, shell shock, effort syndrome, neurocirculatory asthenia and battle fatigue.…”

Section: Introductionmentioning

confidence: 99%

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

Engel

Hyams

Scott

2006

Phil. Trans. R. Soc. B

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After the 1991 Gulf War, veterans of the conflict from the United States, United Kingdom, Canada, Australia and other nations described chronic idiopathic symptoms that became popularly known as 'Gulf War Syndrome'. Nearly 15 years later, some 250 million dollars in United States medical research has failed to confirm a novel war-related syndrome and controversy over the existence and causes of idiopathic physical symptoms has persisted. Wartime exposures implicated as possible causes of subsequent symptoms include oil well fire smoke, infectious diseases, vaccines, chemical and biological warfare agents, depleted uranium munitions and post-traumatic stress disorder. Recent historical analyses have identified controversial idiopathic symptom syndromes associated with nearly every modern war, suggesting that war typically sets into motion interrelated physical, emotional and fiscal consequences for veterans and for society. We anticipate future controversial war syndromes and maintain that a population-based approach to care can mitigate their impact. This paper delineates essential features of the model, describes its public health and scientific underpinnings and details how several countries are trying to implement it. With troops returning from combat in Afghanistan, Iraq and elsewhere, the model is already getting put to the test.

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“…The ravages of war cause more morbidity, disability, and mortality than any disease (Murthy & Lakshminarayana, 2006). In addition to physical injuries associated with military conflicts, psychological consequences have been recognized following all the major wars in the world (Jones et al, 2002). Military organizations in several nations strived to identify barriers to mental care, especially in delineating the potential stigma and cultural differences between Armed Forces (Gould et al, 2010).…”

Section: Background and Significancementioning

confidence: 99%

An Interprofessional Education Project to Address Veterans’ Healthcare Needs

Peterson¹,

Brommelsiek²,

Amelung³

2016

IJHE

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Background/Objective: The number of veterans and their families seeking healthcare and support within civilian communities is increasing worldwide. There is a need for healthcare providers to provide sensitive, comprehensive care for veterans with both physical and behavioral health conditions. Many civilian providers are unfamiliar with veterans' issues and need training on military culture and combat experiences in order to provide compassionate, high quality care. An interprofessional (IPE) course to increase health professional students' understanding of military culture and the associated health problems of veterans was implemented and evaluated.

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Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution

Abstract: Objectives To discover whether post-combat syndromes have existed after modern wars and what relation they bear to each other.

Cited by 132 publications

References 16 publications

Historical approaches to post-combat disorders

Historical approaches to post-combat disorders

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

An Interprofessional Education Project to Address Veterans’ Healthcare Needs

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