veterans (OR 1.8, 95% CI excludes 1.0, p < 0.05); similar results were found on examination (OR 1.9, 95% CI excludes 1.0). On examination, 10.2% of theater veterans and 6.2% of era veterans had somatic symptoms, which included nervousness, fatigue, gastrointestinal tract ailments, dizziness, and headaches for a significant OR of 1.7 (95% CI excludes 1.0); symptoms of peripheral neuropathy (numbness, tingling, burning sensation, or weakness of arms or legs) were found in 3.5% of the theater veterans and 1.9% of the era veterans (OR 1.5, 95% CI 1.0-2.2). The OR was adjusted for age at enlistment, race, year of enlistment, enlistment status, score on a general technical test, and primary military occupational specialty. The study had the advantage of including a physical examination and a large study population; the response rate was 75% for theater veterans and 63% for era veterans.

Ishoy et al. (1999) assessed the health status of 686 Danish peacekeepers deployed to the Persian Gulf during 1991-1996 and compared them with 231 nondeployed military personnel. All study participants underwent a health examination in 1997-1998. The deployed veterans had significantly (p < 0.001) more repeated headaches (19.2% vs 6.5%), balance disturbances or dizziness (13.65 vs 3.9%), concentration or memory difficulties (31.2% vs 8.2%), abnormal fatigue (26.4% vs 10.8%), sleep problems (19.8% vs 6.9%), and feeling nervous, irritable, or agitated (21.0% vs 9.1%) with onset during or after deployment than the nondeployed controls.

Some surveys have asked veterans about more than 95 symptoms and found that for all symptoms—ranging from the less severe, such as loss of appetite, to the more severe, such as chest infections and abscesses—deployed veterans report having more symptoms and being more troubled by the symptoms than nondeployed veterans (Cherry et al. 2001a). In a telephone survey conducted in 2000-2002, 674 World War II veterans, 983 Korean War veterans, 1420 Vietnam War veterans, and 137 Gulf War veterans living in southern California and Nevada were asked about their health and activities of daily living (Villa et al. 2002). World War II and Korean veterans reported the best mental health, but World War II veterans were also more likely to report their health status as poor and to have more impairment in activities of daily living than the other veteran groups even when socioeconomic status, disease prevalence, and mental-health status were held constant. Vietnam veterans, however, were more likely than Korean War or Gulf War veterans to report difficulty in performing activities of daily living.

In a comprehensive review, Barrett et al. (2002b) examined symptom prevalence in various Gulf War veteran populations. They concluded that reports of symptoms were higher in Gulf War veterans than in controls but the pattern of symptoms being reported was neither abnormal for, nor peculiar to, a veteran population.

The primary precipitating event for increased reporting of adverse health effects after deployment is combat experience. Combat stressors were discussed in Chapter 3. McFarlane (1997) reported on World War II veterans who were followed until the age of 65 years for PTSD. They found that men who had experienced heavy combat had died earlier, and this finding was independent of PTSD. Of the men who experienced heavy combat, 56% were dead or chronically ill by the age of 65 years compared with only 39% of the men who had not experienced heavy combat (Lee et al. 1995). Increasing combat exposure results in an increase in the reporting of stress-related symptoms (Sutker et al. 1993b; Wolfe et al. 1998).

Kulka et al. (1990) found that male Vietnam veterans who had experienced high war-zone stress were twice as likely to report their physical health as poor as were veterans who experienced low war-zone stress (25% vs 13%). In a study of Australian Vietnam veterans; however, O’Toole et al. (1996b) did not find a significant increase in symptoms, signs, and ill-



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