chemical exposures and their possible health effects have been considered in previous IOM reports, but the health effects associated with deployment-related stress had yet to be considered.

A recent IOM report, Gulf War and Health, Volume 4: Health Effects of Serving in the Gulf War, reviewed the health status of Gulf War-deployed veterans. That report found that veterans of the Gulf War report higher rates of nearly all symptoms than their nondeployed counterparts; a higher prevalence not only of individual symptoms but of chronic multisymptom illnesses was also found among Gulf War-deployed veterans. Multisymptom-based medical conditions reported to occur more frequently among deployed Gulf War veterans include fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity. The literature also demonstrates that deployment places veterans at increased risk for symptoms that meet diagnostic criteria for a number of psychiatric illnesses, particularly posttraumatic stress disorder (PTSD), anxiety disorders, depressive disorders, and substance abuse. In light of the 1991 Gulf War and the nature of OEF and OIF, the Department of Veterans Affairs (VA) requested that IOM comprehensively review, evaluate, and summarize the peer-reviewed scientific and medical literature regarding the association between deployment-related stress and long-term adverse health effects in Gulf War veterans. In response to VA’s request, IOM appointed the Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress to conduct the review.

COMMITTEE’S INTERPRETATION OF ITS CHARGE

Given the committee’s charge from VA—to assess the long-term health effects of deployment-related stress—the committee began by defining the deployment in question as “deployment to a war zone.” Combat is one of the most potent stressors that a person can experience, but as military conflicts have evolved to include more guerilla warfare and insurgent activities, restricting the definition of deployment-related stressors to combat may fail to acknowledge other potent stressors experienced by military personnel in a war zone or in the aftermath of combat. Those stressors include constant vigilance against unexpected attack, the absence of a defined front line, the difficulty of distinguishing enemy combatants from civilians, the ubiquity of improvised explosive devices, caring for the badly injured or dying, duty on the graves registration service, and being responsible for the treatment of prisoners of war. Deployment stressors associated with armed conflict include not only combat stressors but noncombat stressors. Non-combat-related stressors that might be experienced by deployed personnel are separation from family, friends, and colleagues; loss of or reduction in income; and concern over employment status when deployment ends. Therefore, the committee considered that military personnel deployed to a war zone, even if direct combat was not experienced, have the potential for exposure to deployment-related stressors and that the emotional and physical reactions of military personnel to those stressors can vary widely.

COMMITTEE’S APPROACH TO ITS CHARGE

The committee’s charge was the comprehensive review, evaluation, and summary of the peer-reviewed scientific and medical literature regarding the association between deployment-related stress and long-term adverse health effects in Gulf War veterans. Specifically, the committee was to study the physiologic, psychologic, and psychosocial effects of stress. Noted in



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