Psychological Conditions Diagnosed Among Veterans Seeking Department of Defense Care for Gulf War-Related Health Concerns

Abstract

The Comprehensive Clinical Evaluation Program is a US military program that provides a voluntary, clinically oriented evaluation for Gulf War health concerns. This article presents administrative data on psychological conditions (as coded using the International Classification of Diseases, 9th Revision) from the first year of the program. The most commonly diagnosed psychological conditions were medically unexplained physical-symptom syndromes; depression and anxiety, including post-traumatic stress disorder; and alcohol abuse or dependence. Psychological conditions were significantly related to a higher number of workdays lost, and the 19% of veterans with a primary diagnosis of a psychological condition reported 28% of the lost workdays among veteran who participated. Stressful Gulf War experiences were weakly but significantly related to psychological conditions. We conclude that among Gulf War veterans seeking evaluation for Gulf War-related health concerns, psychological conditions are common and are associated with important occupational morbidity.

The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis

“…Whether such approaches are more effective than immediate trauma-focused treatment remains a matter of debate. These findings highlight the need to develop interventions that target this poor outcome group since these patients place a considerable cost and burden on the health care system in terms of ongoing needs for care, as well as associated disability benefits and work productivity loss (Engel et al, 1999;Sayer et al, 2010;Wald & Taylor, 2009).…”

Mental health of regular and reserve military veterans

“…In the military population (theatre-specific studies aside), those with mental health problems are more likely to leave service prematurely (Hoge 2002), experience lost work days (Engel 1999) and to end up socially excluded (e.g. homeless) (Rosenheck 1994).…”

The challenges of exposure assessment in health studies of Gulf War veterans

“…Recognition appears to be easier than recall for most work exposures so that accurate recall of exposure improves when prompted with specific names (Engel et al 2001). Recall is better for brand names or nicknames than for chemical names Haley & Kurt (1997), Joseph (1997), The Iowa Persian Gulf Study Group (1997), Bell et al (1998), Goss Gilroy Inc (1998), Kroenke et al (1998), Poirier et al (1998), Proctor et al (1998), Ishoy et al (1999), McCauley et al (1999), Petruccelli et al (1999), Unwin et al (1999), Kang et al (2000), Cherry et al (2001), Lange et al (2002), Wolfe et al (2002), Smith et al (2002a,b), Boyd et al (2003), Wessely et al (2003), Glass et al (in press) chemical warfare agents including nerve gas and mustard gas Haley & Kurt (1997), The Iowa Persian Gulf Study Group (1997), Bell et al (1998), Goss Gilroy Inc (1998), Kroenke et al (1998), Proctor et al (1998), Engel et al (1999), Ishoy et al (1999) (Teschke et al 1994;Stewart et al 2002). In openended interviews or questionnaires, recall has high specificity, (few false positives or incorrect recognition of a substance) but low or variable sensitivity (more false negatives or failure to identify an exposure) (Bond et al 1988;Joffe 1992;Fritschi et al 1996).…”