Post-traumatic stress impact on health outcomes in Gulf War Illness

Abstract

Background Gulf War Illness (GWI) is a chronic, multi-symptomatic disorder affecting an estimated 25–32% of the returning military veterans of the 1990–1991 Persian Gulf War. GWI presents with a wide range of symptoms including fatigue, muscle pain, cognitive problems, insomnia, rashes and gastrointestinal issues and continues to be a poorly understood illness. This heterogeneity of GWI symptom presentation complicates diagnosis as well as the identification of effective treatments. Defining subgroups of the illness may help alleviate these complications. Our aim is to determine if GWI can be divided into distinct subgroups based on PTSD symptom presentation. Methods Veterans diagnosed with GWI (n = 47) and healthy sedentary veteran controls (n = 52) were recruited through the Miami Affairs (VA) Medical Health Center. Symptoms were assessed via the RAND short form health survey (36), the multidimensional fatigue inventory, and the Davidson trauma scale. Hierarchal regression modeling was performed on measures of health and fatigue with PTSD symptoms as a covariate. This was followed by univariate analyses conducted with two separate GWI groups based on a cut-point of 70 for their total Davidson Trauma Scale value and performing heteroscedastic t-tests across all measures. Results Overall analyses returned two symptom-based subgroups differing significantly across all health and trauma symptoms. These subgroups supported PTSD symptomatology as a means to subgroup veterans. Hierarchical models showed that GWI and levels of PTSD symptoms both impact measures of physical, social, and emotional consequences of poor health (ΔR2 = 0.055–0.316). However, GWI appeared to contribute more to fatigue measures. Cut-point analysis retained worse health outcomes across all measures for GWI with PTSD symptoms compared to those without PTSD symptoms, and healthy controls. Significant differences were observed in mental and emotional measures. Conclusions Therefore, this research supports the idea that comorbid GWI and PTSD symptoms lead to worse health outcomes, while demonstrating how GWI and PTSD symptoms may uniquely contribute to clinical presentation.

Self‐reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder

“…This pattern is consistent with prior studies that have shown that GW veterans with PTSD report both a greater number and severity of physical symptoms and medical conditions 33–36 . Additionally, Jeffrey et al (2021) recently showed that GW male veterans with both GWI and PTSD reported worse physical and mental health than veterans with only GWI 37 . Shastry et al (2022) showed the same pattern of results in female veterans 38 .…”

“…[33][34][35][36] Additionally, Jeffrey et al ( 2021) recently showed that GW male veterans with both GWI and PTSD reported worse physical and mental health than veterans with only GWI. 37 Shastry et al (2022) showed the same pattern of results in female veterans. 38 Taken together, these findings suggest that PTSD as a comorbidity identifies a subgroup of GW veterans-including those with GWI-that suffer from a particularly high burden of poor health.…”

“…Alternatively, this pattern may represent an overall increased level of medical care and diagnostic workup that veterans with both GWI and PTSD receive given their particularly high symptom burden and low health-related quality of life. [33][34][35][36][37][38] Nonetheless, it remains unknown if this increase in incidence or detection is associated with long-term cancer outcomes, or if more frequent diagnostic testing simply increases cost and incidental detection of clinically insignificant findings.…”

Modeling Neuroimmune Interactions in Human Subjects and Animal Models to Predict Subtype-Specific Multidrug Treatments for Gulf War Illness

“…Ultimately, these processes have effects beyond the CNS, affecting immune and endocrine function in the periphery and ultimately giving rise to the symptom presentations in the illness. As the presence of PTSD symptoms exacerbates the overall clinical symptoms of GWI [19], and PTSD shows its immunological dysfunction [21][22][23][24], it is reasonable to assume that past trauma may be used to delineate two biological GWI subgroups. In the context of the neuroimmune model presented here, the high and low trauma GWI group blood profiles at rest share the closest proximity with the same altered regulatory state marked by elevated HPA axis activity, depressed HPG activity, depressed NK activity, and increased MK2, CK1, CK17, MK1, MK2, MK6, MK15, CTL, Th17B, and Th17(23) activity, albeit not with complete agreement.…”

“…Veterans suffering from GWI are often also diagnosed with post-traumatic stress disorder (PTSD) [16,17]. A population-based study estimates that 35% of veterans with GWI also suffer from PTSD [18], which exacerbates all the overall clinical symptoms of GWI [19]. As there is a substantial overlap of PTSD symptoms with the symptoms defining GWI [20], with both PTSD [21][22][23][24] and GWI [6,25,26] exhibiting immunological dysfunction and abnormal neural synchrony [14], this suggests that GWI and PTSD share several core pathophysiological processes and that these processes may be altered in the context of co-morbidity.…”