© 1998 Oxford University Press
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Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress
aBoston Environmental Hazards Center (116B-4), 150 South Huntington Ave, Boston, MA 02130-4893, USA
bSchool of Public Health (Environmental Health), Boston University Boston, MA, USA
cSchool of Medidne (Neurology), Boston University Boston, MA, USA
dSchool of Public Health (Epidemiology and Biostatistics), Boston University Boston, MA, USA
ePsychology Service, Boston VAMC Boston, MA, USA
fOdense University, Department of Environmental Medicine Odense, Denmark
gNational Center for PTSD, Boston VAMC Boston, MA, USA
hBoston University School of Medicine (Psychiatry) Boston, MA, USA
iJohn Snow Institute, Inc. Boston, MA, USA
jPsychology Service, New Orleans VAMC New Orleans, LA, USA
kTulane University School of Medicine (Psychiatry and Neurology) New Orleans, LA, USA
lMedicine Service, Boston VAMC Boston, MA, USA
BACKGROUND: Most US troops returned home from the Persian Gulf War (PGW) by Spring 1991 and many began reporting increased health symptoms and medical problems soon after. This investigation examines the relationships between several Gulf-service environmental exposures and health symptom reporting, and the role of traumatic psychological stress on the exposure-health symptom relationships.
METHODS: Stratified, random samples of two cohorts of PGW veterans, from the New England area (n = 220) and from the New Orleans area (n = 71), were selected from larger cohorts being followed longitudinally since arrival home from the Gulf. A group of PGW-era veterans deployed to Germany (n = 50) served as a comparison group. The study protocol included questiormaires, a neuropsychological test battery, an environmental interview, and psychological diagnostic interviews. This report focuses on self-reported health symptoms and exposures of participants who completed a 52-item health symptom checklist and a checklist of environmental exposures.
RESULTS: The prevalence of reported symptoms was greater in both Persian Gull-deployed cohorts compared to the Germany cohort. Analyses of the body-system symptom scores (BSS), weighted to account for sampling design, and adjusted by age, sex, and education, indicated that Persian Gull-deployed veterans were more likely to report neurological, pulmonary, gastrointestinal, cardiac, dermatological, musculoskeletal, psychological and neuropsychological system symptoms than Germany veterans. Using a priori hypotheses about the toxicant effects of exposure to specific toxicants, the relationships between self-reported exposures and body-system symptom groupings were examined through multiple regression analyses, controlling for war-zone exposure and post-traumatic stress disorder (PTSD). Self- reported exposures to pestiddes, debris from Scuds, chemical and biological warfare (CBW) agents, and smoke from tent heaters each were significantly related to increased reporting of specific predicted BSS groupings.
CONCLUSIONS: Veterans deployed to the Persian Gulf have higher self-reported prevalence of health symptoms compared to PGW veterans who were deployed only as far as Germany. Several Gulf-service environmental exposures are associated with increased health symptom reporting involving predicted body-systems, after adjusting for war-zone stressor exposures and PTSD.
Keywords Gulf War veterans, health symptoms, environmental exposures, stress
Accepted 2 June 1998
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