Prevalence of Gulf war veterans who believe they have Gulf war syndrome: questionnaire study.

Abstract

Objectives To determine how many veterans in a random sample of British veterans who served in the Gulf war believe they have "Gulf war syndrome," to examine factors associated with the presence of this belief, and to compare the health status of those who believe they have Gulf war syndrome with those who do not.

Design Questionnaire study asking British Gulf war veterans whether they believe they have Gulf war syndrome and about symptoms, fatigue, psychological distress, post-traumatic stress, physical functioning, and their perception of health.

Participants 2961 respondents to questionnaires sent out to a random sample of 4250 Gulf war veterans (69.7%).

Main outcome measure The proportion of veterans who believe they have Gulf war syndrome.

Results Overall, 17.3% (95% confidence interval 15.9 to 18.7) of the respondents believed they had Gulf war syndrome. The belief was associated with the veteran having poor health, not serving in the army when responding to the questionnaire, and having received a high number of vaccinations before deployment to the Gulf. The strongest association was knowing another person who also thought they had Gulf war syndrome.

Conclusions Substantial numbers of British Gulf war veterans believe they have Gulf war syndrome, which is associated with psychological distress, a high number of symptoms, and some reduction in activity levels. A combination of biological, psychological, and sociological factors are associated with the belief, and these factors should be addressed in clinical practice.

Introduction

The term "Gulf war syndrome" has been used to describe a variety of symptoms and illnesses experienced by veterans of the 1991 Gulf war. There is no consensus as to how to define Gulf war syndrome, and attempts to specify and measure the syndrome have led to contradictory findings and interpretations.[1-3] In previous papers, we found that, although veterans deployed to the Gulf reported more symptoms than veterans deployed to Bosnia and those who were not deployed,[4] the constellations of symptoms in all three groups were similar.[3] We suggested that vaccination against biological warfare agents contributed to this ill health, but we also found that all military exposures were associated with all outcomes.[4 5] Several groups have confirmed that two to three times more Gulf war veterans report symptoms than appropriate controls, but conclude that there is no unique Gulf war syndrome.[2 4 6 7]

Some veterans believe that they have a condition called Gulf war syndrome and attribute their symptoms to this. We are not aware of any systematic studies investigating the views of veterans or estimating the prevalence of such a belief. This information is important as the beliefs and views of the veterans may determine symptom reporting, health perception, degree of associated disability, and help-seeking behaviour. For example, a belief that the syndrome is caused by vaccinations may hamper efforts to ensure that servicemen and servicewomen are protected against threats such as chemical and biological weapons.

The purpose of this paper was to determine how many veterans deployed to the Gulf believed they have Gulf war syndrome, to compare health outcomes between those who believed they have Gulf war syndrome and those who did not, and to examine factors associated with the belief.

Methods

Ethical approval was gained for the study. In August and September 1997, questionnaires were sent to a randomly chosen, large sample (n = 4250) of British servicemen and servicewomen who served in the Gulf war in 1991.[4] Two follow up mailings were completed by November 1998. All service personnel were asked questions about their age, sex, marital status, education, occupational factors …