One of the first epidemiologic studies of US Gulf War veterans was a congressionally mandated study of more than 4,000 active-duty and reserve personnel from bases in Pennsylvania and Hawaii. The main purpose of the study was a focus on psychologic health, but the first publication also dealt with physical health (Stretch et al. 1995). It found that veterans deployed to the Gulf War reported higher prevalence of 21 of 23 symptoms on a symptom checklist than nondeployed veterans. Overall, deployed veterans were about 2-4 times more likely than nondeployed veterans to report each symptom. In a later publication (Stretch et al. 1996a), the authors reported that deployed veterans commonly reported significant levels of stress, including operating in desert climates, long duty days, extended periods in chemical-protective clothing, lack of sleep, crowding, lack of private time, physical workload, and boredom. Another publication examined PTSD as measured by the Impact of Event Scale and the Brief Symptom Inventory (Stretch et al. 1996b). The prevalence of PTSD symptoms in the deployed veterans was 8.0-9.2% vs 1.3-2.1% in the nondeployed. The low overall response rate, 30.6%, limits the generalizability of the three studies.
A series of studies by Sutker and colleagues analyzed psychologic outcomes in a cohort of New Orleans reservists (n = 1,520). The cohort consisted of Louisiana National Guard and reservists from the Army, Air Force, and Navy. The overall response rate was 83.7%. Of the 1,272 who responded, 876 had been deployed and 396 had not been deployed. Deployed veterans, assessed by survey at an average of 9 months (time 1) after the war, had higher scores on depression and anxiety symptom scales12 than nondeployed veterans (Brailey et al. 1998). Twenty-five months after the war (time 2), the researchers studied only the deployed group (n = 349), which represented 88.1 % of the original group of deployed veterans studied at time 1. Responses at time 2 revealed higher rates of PTSD, depression, and hostility than at time 1. The increasing prevalence of PTSD was linked to symptom clusters of hyperarousal and numbing (Thompson et al. 2004). Hyperarousal and numbing were also associated with development of depression, anxiety, hostility, and physical symptoms. Higher wartime stress exposure vs low-stress exposure was related to PTSD and somatic problems (Brailey et al. 1998; Sutker et al. 1993). The personality and coping factors found to increase the likelihood of PTSD were low personality hardiness, high avoidance coping, and low perceived family cohesion (Sutker et al. 1995b).
Female Air Force veterans were studied by Pierce (1997), who examined a stratified sample of 525 women (active-duty, National Guard, and reserve) drawn from all 88,415 women who served in the Air Force during the Gulf War era. Women deployed to the Gulf War reported rash, cough, depression, unintentional weight loss, insomnia, and memory problems more frequently than women deployed elsewhere. The pattern of symptom reporting was similar to that reported by men and women in other Gulf War studies (Carney et al. 2003; Unwin et al.