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A chronic multisymptom illness affecting Air Force veterans of the Persian Gulf War
Fukuda K, Nisenbaum R, Stewart G, Thompson WW, Robin L, Washko RM, Noah DL, Barrett DH, Randall B, Herwaldt BL, Mawle AC, Reeves WC.A chronic multisymptom illness affecting Air Force veterans of the Persian Gulf War
JAMA 280:981-988, 1998.
Summary
The results of this study indicate that a substantial proportion of currently active Air Force GW veterans have a chronic multisymptom illness, which is accompanied by significant decreases in functioning and well-being. The illness was not associated with physical examination, clinical laboratory abnormalities, or with infection by assorted agents that are found in the region or to which troops in combat may have been exposed. Poorly characterized illness, including fatigue, neurocognitive, and musculoskeletal complaints, has affected veterans of many other wars and also affect civilian populations. The empirically based approach used in the study provides a method for assessing the prevalence of multiple chronic symptoms and exploring the clinical basis of such conditions. Future studies of GWI should use similarly rigorous analytic methods to classify cases and standardized measures of function and well-being to collect data. Further, future studies should enroll personnel from other branches of the military in order to assess if our findings are generalizable.
Abstract
Context: Gulf War (GW) veterans report nonspecific symptoms significantly more often than nondeployed peers. However, no specific disorder has been identified and the etiologic basis and clinical significance of their symptoms remain unclear.
Objectives: 1) To organize symptoms reported by Air Force GW veterans into a case definition; 2) to characterize clinical features; and, 3) to evaluate risk factors.
Design: Cross-sectional population survey.
Participants and Setting: 1) Cross-sectional questionnaire survey - 3723 currently active volunteers, irrespective of health status or GW participation, from four Air Force populations who completed an anonymous questionnaire. 2) Cross-sectional clinical evaluation - 158 GW veterans from one unit, irrespective of health status.
Main Outcome Measures: 1) Questionnaire Survey - Presence, duration, and severity of symptoms; demographic, and military characteristics. A symptom-based case definition was developed. Case prevalence was calculated for GW veterans and nondeployed. 2) Clinical Evaluation - Structured interview; the Medical Outcomes Study Short Form 36; psychiatric screening; physical examination; clinical laboratory tests; and serologic assays for antibodies against viruses, rickettsia, parasites, and bacteria.
Results: 1) Questionnaire Survey - We defined a case as one or more chronic symptoms from at least two of three categories (fatigue, mood-cognition, and musculoskeletal). The prevalence of mild-moderate and severe cases was 39% and 6%, respectively, among GW veterans compared with 14% and 0.7% among nondeployed. Illness was not associated with time or place of deployment, or duties during the war. 2) Clinical Evaluation - Fifty-nine (37%) clinically evaluated GW veterans were noncases, 86 (55%) mild-moderate, and 13 (8%) severe cases. No physical examination, laboratory, or serologic findings identified cases. However, cases had significantly diminished functioning and well-being.
Conclusions: Among currently active members of four Air Force populations, a chronic multisymptom condition was significantly associated with deployment to the GW. The condition was not associated with specific GW exposures and also affected nondeployed personnel, indicating it was not unique to GW veterans.
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