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INDEX A Accidental death, 237â247 primary studies, 237â241, 245â247 PTSD and, 242â243 secondary studies, 241â242 ACR. See American College of Rheumatology ACTH. See Adrenocorticotrophic hormone, corticotropin Adrenocorticotrophic hormone (ACTH). See Corticotropin Afghanistan. See Operation Enduring Freedom Age, and PTSD, 88 Agent Orange, 115, 117â119, 127, 201, 214, 216, 218, 318 Air Force cohorts, 136, 147, 149, 161, 251â253 Alcohol abuse or dependence, 8, 55, 57, 83, 86, 89, 144â145, 150, 158â163, 224, 238, 243, 250â 251, 289, 291, 319 Alcohol Use Disorder Identification Test (AUDIT), 158, 161â162 Allostasis, 54â55 Allostatic load and overload, 49â50, 54â56 Alternate Family Violence Measure, 289 American College of Rheumatology (ACR), 222, 226â227, 255 American Indian veterans. See Race and ethnicity American Psychiatric Association (APA), 76, 85 Amygdala, importance in stress response, 51â53, 57â58, 60â61, 65, 98â100 Animal studies, 18â19, 58â59, 96â97 Anticipation of deployment to a war zone, a deploymentârelated stressor, 36 Antisocial personality disorder, 145, 161, 284, 289, 300, 306 Anxiety disorders, 2, 7, 12, 30, 35, 51, 53, 84, 86, 88â89, 91, 100, 144â157, 193, 253, 257, 308â 309, 319. See also Generalized anxiety disorder Anxiety Sensitivity Index (ASI), 149 APA. See American Psychiatric Association Army cohorts, 34, 79, 118, 125â126, 142â144, 147, 158, 167, 229, 237, 241, 253, 287 female, 38 ASI. See Anxiety Sensitivity Index Assault. See Sexual assault and harassment Assessment of the strength of evidence, 25â26 biologic plausibility, 26 consistency of association, 26 doseâresponse relationship, 25 specificity of association, 26 strength of an association, 25 temporal relationship, 25 323
324 GULF WAR AND HEALTH AUDIT. See Alcohol Use Disorder Identification Test Auditory-Verbal Learning Test, 169 Australian troops, 79â80, 88â89, 91â92, 123â124, 134, 146, 150, 152, 163, 180, 185, 199, 216, 231â233, 248â249, 253, 256, 287, 318 Autoimmune diseases, 63, 137, 217â218 B Barsky Amplification Scale, 149 Bed nucleus of the stria terminalis (BNST), 51â53, 61 Bias, in identifying and evaluating the literature, 24 Biologic plausibility, in assessing the strength of evidence, 26 Birth defects, 12 and miscarriage, 229â231 primary studies, 229â231 secondary studies, 231 Birth Defects Monitoring Programs, 229 Black veterans. See Race and ethnicity Blood lipids, 193 concentrations of, 188 BMI. See Body-mass index BNST. See Bed nucleus of the stria terminalis Body-mass index (BMI), 61â62, 138, 188â189 Brain function, 60â61 and anxiety and fear, 61 and memory and cognition, 60â61 in stress response, 60â61 Brain-gut axis and IBS, 64â65, 204 in stress response, 64â66 Brain-imaging techniques, 60 Brainâs role in stress response, 50â56, 60â61 allostatic load and overload, 54â56 gastrointestinal (GI) and brain-gut axis, 64â66 hypothalamus-pituitary-adrenal axis, 53â54 importance of the amygdala, 51â53 reticular activating system, 51 Brief Life Stress Questionnaire, 224 Brief Symptom Inventory, 151 British troops. See United Kingdom troops C C-reactive protein, 58, 64 CAGE scale, 158 California Verbal Learning Test (CVLT), 168â169 Canadian troops, 36, 79, 123, 136, 148, 162, 176, 225, 248, 250, 318
INDEX 325 Cancer, 117â132 all cancers, 118â125 Gulf War, 120â123 PTSD and, 125â126 skin cancer, 124â125 testicular cancer, 123â124 Vietnam War, 118â120 CAPS. See Clinician-Administered PTSD Scale Cardiovascular diseases, 183â196 blood lipid concentrations, 188 cardiovascular symptoms, 183â184, 191â192 heart disease, 186â187 hypertension, 184â186, 189â190 PTSD and, 188â193 Cardiovascular reactivity, PTSD and, 190â191 Cardiovascular system, in stress response, 63â64 Career Development Study (CDS), 285â286 Case-control studies, 21â22 Casualty Information System, 239 Categories of association, 4â5, 26â28. See also Summary of findings regarding the association between deployment to a war zone and specific health and psychosocial effects in identifying and evaluating the literature, 26â28 inadequate/insufficient evidence to determine whether an association exists, 5, 27 limited but suggestive evidence of an association, 4, 27 limited/suggestive evidence of no association, 5, 28 sufficient evidence of a causal relationship, 4, 27 sufficient evidence of an association, 4, 27 CCEP. See Comprehensive Clinical Evaluation Program CDC. See Centers for Disease Control and Prevention CDS. See Career Development Study Centers for Disease Control and Prevention (CDC), 118, 124, 127, 133, 142â143, 158, 168, 174â 177, 185, 187, 193, 237, 248, 251â253 Central nervous system (CNS), 53, 59, 65â66, 207, 210, 225 CES. See Combat Exposure Scale CFS. See Chronic fatigue syndrome Chalder fatigue scale, 176 CHD. See Coronary heart disease Chemical stressors, deployment-related, 39 Child Behavior Checklist, 285, 293 Childhood Physical Punishment Scale, 293 Children, psychosocial effects of parentsâ deployment on, 285â286, 291â293 Childrenâs Depression Inventory, 292 Chronic fatigue syndrome (CFS), 86â87, 174â178, 253 case definition of, 174 primary studies, 175
326 GULF WAR AND HEALTH PTSD and, 176â177 secondary studies, 175â176 Chronic obstructive pulmonary disease (COPD), 197, 201 Chronic stress, 6, 13, 15, 52â57 brain function, 60â61 cardiovascular system, 63â64 endocrine system, 61â62 gastrointestinal system and brain-gut axis, 64â66 and health, 59â66 immune and inflammatory responses, 62â63 Chronic widespread pain (CWP), 222â228, 255â257. See also Fibromyalgia primary studies, 222â224 PTSD and, 226, 256â257 secondary studies, 224â226 Chronicity of stressors, 57 CIDI. See Composite International Diagnostic Interview Clinical features, of PTSD, 76â77 Clinician-Administered PTSD Scale (CAPS), 76, 138, 226, 291, 309 CNS. See Central nervous system Cognition, 60â61 Cohort studies, 20â21 Combat exposure, 28, 33â34, 42, 81 and PTSD risk, 88, 90, 92â93 Combat Exposure Index, 145 Combat Exposure Scale (CES), 117, 224, 253, 305, 317 Expanded, 146, 224 Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress, approach to its charge, 2â3, 14â15 interpretation of its charge, 2, 13â14 Comorbidity, and PTSD, 78, 84â85 Composite International Diagnostic Interview (CIDI), 23, 76, 142, 147 Comprehensive Clinical Evaluation Program (CCEP), 181, 223 Conclusions, 317â320 about cancer, 126â127 about cardiovascular diseases, 193â194 about chronic fatigue syndrome, 177 about chronic stress and health, 66 about deployment-related stressors, 43 about digestive system disorders, 209â210 about employment, 309â310 about endocrine diseases, 139â140 about fibromyalgia and chronic widespread pain, 226â227 about gastrointestinal (GI) effects, 209â210 about homelessness, 301â302 about incarceration, 306
INDEX 327 about marital and family conflict, 293â294 about neurobehavioral and neurocognitive effects, 170 about neurobiology, 100 about psychiatric disorders, 152 about reproductive effects, 233 about respiratory system diseases, 200â201 about skin disorders, 218â219 about sleep disturbances, 182 about substance-use disorders, 162â163 about suicide and accidental death, 243â244 about symptom reporting, 257â258 quality of the studies, 317â318 summary of, 7â9, 318â320 Conflict Tactics Scale (CTS), 287â288 Confounding factors, 21 in identifying and evaluating the literature, 24 Consistency of association, in assessing the strength of evidence, 26 Continuous Performance Test, 169 Controllability, modifying the stress response, 59 COPD. See Chronic obstructive pulmonary disease Coping strategies, and PTSD, 89â90 Coronary heart disease (CHD). See Heart Disease Corticotropin, 52â53, 58, 64, 96 Corticotropin-releasing hormone (CRH), 52â53, 58, 64, 96â98, 208 Cortisol, 53â54, 58â61, 96â97, 100 Course, of PTSD, 81â84 CRH. See Corticotrophin-releasing hormone Cross-sectional studies, 22 CTS. See Conflict Tactics Scale CVLT. See California Verbal Learning Test CWP. See Chronic widespread pain Cytokines, 54, 62 D Da Costa syndrome, 183 Danish troops, 41, 167, 188, 198, 215, 232â233, 248â249, 318 Demographics of military populations, 12â13 Department of Defense (DoD) Mental Health Advisory Team, 241, 283 Solider and Marine Well-Being Survey, 34 Task Force on Domestic Violence, 287 Deployment-related stressors, 2, 5â6, 13, 31â47, 115 anticipation of deployment to a war zone, 36â37 conclusions, 43 environmental and chemical stressors, 39 impacts on families and children, 292â293
328 GULF WAR AND HEALTH living conditions, 38 military sexual assault and harassment, 37â38 noncombat stressors, 35 peacekeepers, 40â41 Reserve and National Guard troops, 39â40 stressors during combat, 32â35 women, 41â43 Depressive disorders, 51, 55â56, 91â92, 142â157, 193, 257, 319. See also Major depressive disorder; Psychiatric Disorders Developmental history, and PTSD, 88â89 Diabetes, 133â135 primary studies, 133 secondary studies, 134â135 Diagnosis, of PTSD, 76â77 Diagnostic and Statistical Manual of Mental Disorders (DSM), 7, 76â77, 81, 84â85, 142, 158, 256 diagnostic criteria for PTSD, 77 Diagnostic Interview Schedule (DIS), 142, 217, 242 Digestive system disorders, 204â213 primary studies, 205â206 PTSD and, 208â209 secondary studies, 207â208 DIS. See Diagnostic Interview Schedule Disability, and PTSD, 85â86 DoD. See Department of Defense Dose-response relationship, in assessing the strength of evidence, 4, 25 of cancer and PTSD, 125 of combat and PTSD, 92, 94 of early life stress and PTSD, 58 of exposure to war-zone stressors and PTSD, 144, 150 of sex and PTSD, 87 of skin disorders and PTSD, 216 Drug abuse or dependence, 8, 84, 86, 158â163, 238â239, 243, 251, 320 DSM. See Diagnostic and Statistical Manual of Mental Disorders E Early-life stress modifying the stress response, 58 and PTSD, 88â89 Employment, 308â311 Endocrine diseases, 133â141 diabetes, 133â135 obesity, 138â139 PTSD and, 137â138 thyroid disease, 135â137
INDEX 329 Endocrine system in stress response, 61â62 insulin resistance and glucose intolerance, 62 obesity, 61â62 Environmental stressors, 6, 39, 49, 197 Epidemiologic studies, 7, 17â22 case-control studies, 21â22 cohort studies, 20â21 cross-sectional studies, 22 Ethnicity. See Race and ethnicity Evaluation criteria, 3â4 primary studies, 3 secondary, or support, studies, 4 Evaluation of the literature, 17â29 Evidence, assessment of the strength of, 25â26 Evidence types, 18â22 animal studies, 18â19 epidemiologic studies, 19â22 F Fear conditioning, in the neurobiology of PTSD, 97â98 Fertility difficulties, 231â232 primary studies, 231â232 secondary studies, 232 Fibromyalgia and chronic widespread pain, 222â228 primary studies, 222â224 PTSD and, 226 secondary studies, 224â226 âFight or flightâ stress response, 6, 14, 49, 51â52, 54 G GAD. See Generalized anxiety disorder Gastrointestinal (GI) effects, 204â213, 251 primary studies, 205â206 PTSD and, 208â209 secondary studies, 207â208 in stress response, 64â66 General symptoms and signs, 248â250, 259 PTSD and reporting of, 250â251 Generalized anxiety disorder (GAD), 144â152, 169, 180 Genes, modifying the stress response, 56â58 GI. See Gastrointestinal (GI) effects Glucocorticoids, 60 receptors of, 53â54, 96 Glucose intolerance, 62 Graves disease, 137, 139. See also Endocrine diseases; Thyroid disease
330 GULF WAR AND HEALTH Graves registration, 13, 35 Grooved Pegboard Test, 169 Gulf War, 1, 5, 32, 35, 38â43, 79, 82â83, 88â89, 92, 115, 120â121, 125â127, 318 demographics, 12â13 living conditions, 37â38 prevalence of PTSD in, 79, 82â83, 87â88 Gulf War Health Registry, 253 Gulf War illness, 122, 179, 205, 224. See also Unexplained illness H Harassment. See Sexual assault and harassment Hardiness, and PTSD, 89â90 Hawaiian Vietnam Veterans Project (HVVP), 87 Health effects, 115â260 assessment of as an inclusion criterion, 23 cancer, 117â132 cardiovascular diseases, 183â196 chronic fatigue syndrome, 174â178 digestive system disorders, 204â213 endocrine diseases, 133â141 fibromyalgia and chronic widespread pain, 222â228 gastrointestinal effects, 204â213 neurobehavioral and neurocognitive effects, 167â173 organization of chapter, 115â117 psychiatric disorders, 142â157 reproductive effects, 229â236 respiratory system diseases, 197â203 skin disorders, 214â221 sleep disturbances, 179â182 substance-use disorders, 158â166 suicide and accidental death, 237â247 symptom reporting, 248â260 Heart disease, 183â184, 186â187, 189, 192â194 primary studies, 186â187 secondary studies, 187 Heart rate, PTSD and, 63, 188â191 Hispanic veterans. See Race and ethnicity Hodgkinâs lymphoma, 118â119 Homeless Chronically Mentally Ill Veterans Program, 300 Homelessness, 299â303 primary studies, 299â300 secondary studies, 300â301 Homeostasis, 54 HPA. See Hypothalamus-pituitary-adrenal axis HVVP. See Hawaiian Vietnam Veterans Project Hypertension, 183â186
INDEX 331 primary studies, 184â185 PTSD and, 189â190 secondary studies, 185â186 Hypothalamus-pituitary-adrenal (HPA) axis, 50, 53â54, 58, 65, 96â97, 218 alterations in the neurobiology of PTSD, 96â97 in stress response, 53â54 I IBS. See Irritable bowel syndrome ICD. See International Statistical Classification of Diseases and Related Health Problems Immune responses, in stress response, 62â63 Inadequate/insufficient evidence to determine whether an association exists, 5, 9, 27, 320 Incarceration, 304â307 Inclusion criteria, 23 health-effect assessment, 23 in identifying and evaluating the literature, 23 methodologic rigor, 23 primary studies, 23 secondary studies, 23 Inflammatory responses, in stress response, 62â63 Insulin resistance, 62 International Statistical Classification of Diseases and Related Health Problems (ICD), 115, 122, 136, 149, 186, 193, 238, 243â244, 248, 251, 254 Intimate partner violence, 287â291 primary studies, 288â290 secondary studies, 290â291 Iowa Persian Gulf Study Group cohort, 42, 122, 125, 148â149, 159, 200, 217, 223â225, 248, 254, 304 Iraq. See Operation Iraqi Freedom Irritable bowel syndrome (IBS), 64â65, 204â213 K Korean War, 3, 7, 14, 17, 31, 84, 91, 100, 117, 126, 137, 139, 181, 192, 194, 208, 210, 218â219, 249â250, 300, 318 prevalence of PTSD in, 80â81 L Limitations of veteran studies, 5, 217â218 in identifying and evaluating the literature, 28 Limited but suggestive evidence of an association, 4, 8, 27, 319â320 Limited/suggestive evidence of no association, 5, 9, 28, 320 Liver cancer, primary, 118â119 Living conditions, as deployment-related stressors, 38
332 GULF WAR AND HEALTH M Magnetic resonance imaging (MRI), 99 Major depressive disorder (MDD), 7, 76, 84â86, 91â92, 96, 142â157, 189, 226, 243, 253, 309 Marine cohorts, 34, 79, 119, 253 Marital and family conflict, 283â298 deployment impacts on families and children, 291â293 intimate partner violence, 287â291 primary studies, 284â286 secondary studies, 286â287 MDD. See Major depressive disorder Memory, 53, 60â61, 167â169, 248â249 Mental Health Advisory Team (MHAT), DoD, 31, 34â35, 92, 241, 283 Meta-analysis, 18, 91, 98, 190, 193, 255, 258 Methodologic rigor, as an inclusion criterion, 23 MHAT. See Mental Health Advisory Team MI. See Myocardial infarction Military sexual assault and harassment, 37â38 Military status, and PTSD, 91 Minnesota Multiphasic Personality Inventory (MMPI), 137, 189, 256 Miscarriage primary studies, 229â231 secondary studies, 231 Mississippi Scale for Combat-Related PTSD, 81, 180, 189, 191â192, 309 MMPI. See Minnesota Multiphasic Personality Inventory Modifiers of the stress response, 56â59 controllability, 59 early-life stress, 58 genes, 56â58 Motor-vehicle accidents, 238â241 MRI. See Magnetic resonance imaging Multisymptom-based medical conditions, 2, 12, 251â254 Myocardial infarction (MI), 58, 189, 193 N NART. See National Adult Reading Test Nasal cancer, 118â119 Nasopharyngeal cancer, 118â119 National Adult Reading Test (NART), 167 National Child Abuse and Neglect Data System, 293 National Comorbidity Survey (NCS), 78, 83â84, 158â161, 189, 290, 309 National Crime Victimization Survey, 287 National Death Index, 123, 237â238, 240 National Family Violence Re-Survey, 287
INDEX 333 National Guard troops, 13, 32, 35, 39â40, 79, 83, 122, 124, 146, 148, 159â160, 176â177, 224â 225, 251â252. See also Reservists deployment-related stressors for, 39â40 National Health Interview Surveys, 242 National Health Survey of Gulf War Era Veterans and Their Families, 38, 133, 147, 175, 185, 198, 206, 215, 222 National Law Center on Homelessness and Poverty, 299 National Survey of Homeless Assistance Providers, 300 National Survey of the Vietnam Generation (NSVG), 143, 284â285, 288â290, 308 National Vietnam Veterans Readjustment Study (NVVRS), 33, 78, 80, 84â85, 87â88, 92, 117, 143â144, 158â159, 162, 180, 182, 251, 284â285, 288, 291, 293â294, 299, 305, 308â309, 318 Naval Mobile Construction Battalions (Seabees), 134, 136, 148, 175, 179, 184â185, 198â200, 205, 209 Navy cohorts, 43, 91, 147, 179, 253 NCS. See National Comorbidity Survey Neurobehavioral and neurocognitive effects, 167â173 primary studies, 167â168 PTSD and, 168â170 secondary studies, 168 Neurobiology of PTSD, 94â100 fear conditioning, 97â98 HPA-axis alterations, 96â97 neuroimaging studies, 99â100 sleep disturbances, 98â99 startle reflex, 98 sympathetic nervous system alterations, 94â96 Neurocognition Deployment Health Study, 167 Neuroimaging studies, in the neurobiology of PTSD, 99â100 NHL. See Non-Hodgkinâs lymphoma Non-Hodgkinâs lymphoma (NHL), 118â119, 126â127 Noncombat stressors, deployment-related, 2, 13, 31, 35 Normative Aging Study, 80, 90, 189, 192, 250, 318 NSVG. See National Survey of the Vietnam Generation NVVRS. See National Vietnam Veterans Readjustment Study O Obesity, 61â62, 138â139 Obsessive-compulsive disorder, 145â147 OEF. See Operation Enduring Freedom OIF. See Operation Iraqi Freedom Operation Desert Shield, 11, 13, 32 Operation Desert Storm, 1, 11, 13, 32 Operation Enduring Freedom (OEF), 1â3, 6â7, 11â14, 28, 31, 33, 39, 40, 43, 88, 93, 100, 150â 151, 248, 255, 258, 283 prevalence of PTSD in, 79
334 GULF WAR AND HEALTH Operation Iraqi Freedom (OIF), 1â3, 6â7, 11â14, 28, 31â35, 38â40, 43, 79, 88, 94, 100, 150â 151, 167, 191, 208, 241, 243, 248, 255, 257â258, 283 prevalence of PTSD in, 79 P Panic disorder, 84, 95, 97, 145â149 Parental Problems Index (PPI), 285 PB. See Pyridostigmine bromide PDHA. See Postdeployment health assessment Peacekeepers, deployment-related stressors for, 35, 40â41 and health effects, 162, 167, 170, 180, 188, 215, 232â233, 249â250 and psychosocial effects, 287, 290 Persian Gulf War Veterans Act, 1, 12 Phobias, 146â148, 150 Physical injury, and PTSD, 93â94 Postdeployment health assessment (PDHA), 150â151 Posttraumatic stress disorder (PTSD), 2â3, 5â8, 12, 15, 18, 23, 28, 31, 35, 43, 51, 59â60, 75â 113, 116, 118, 137â140, 142â152, 159, 162, 168â170, 176â183, 188â194, 205, 208â210, 249â250, 283â294, 299, 304â305, 308â309, 317â319 and cancer, 125â126, 132 and cardiovascular disease, 192â193 and cardiovascular reactivity, 190â191 and cardiovascular symptoms, 191â192 and chronic fatigue syndrome, 176â177 and chronic pain, 256â257 and comorbidity, 84â85 conclusions, 100 course of, 81â84 diagnosis and clinical features, 76â77 and digestive system disorders, 208â209 and disability, 85â86 and endocrine diseases, 137â139 and fibromyalgia and chronic widespread pain, 226 and gastrointestinal effects, 208â209 and general symptom reporting, 250â251 and heart rate, 188â189 and hypertension, 189â190 and neurobehavioral and neurocognitive effects, 168â170 and neurobiology, 94â100 and prevalence, 78â81 and reproductive effects, 233 and respiratory system diseases, 200 risk and protective factors for, 86â94 and skin disorders, 216â218 and sleep disturbances, 180â182 and substance-use disorders, 162
INDEX 335 and suicide and accidental death, 242â243 and unexplained illness, 254â255 PPI. See Parental Problems Index Prevalence of PTSD, 78â83 in the Gulf War, 79 in the Korean War, 80â81 in Operation Enduring Freedom and Operation Iraqi Freedom, 79 in U.S. military populations, estimated, 82â83 in the Vietnam War, 80 in World War II, 80â81 Proinflammatory cytokines, 54, 62 Propranolol, 95â96 Protective factors for PTSD. See Risk and protective factors Psychiatric disorders, 142â157. See also Posttraumatic stress disorder; Substance-use disorders primary studies, 142â147 secondary studies, 148â151 Psychiatric history, and PTSD, 89 Psychosocial effects, 8, 283â319 employment, 308â311 families and children, 291â293 homelessness, 299â303 incarceration, 304â307 intimate partner violence, 287â291 marital and family conflict, 283â298 PTSD. See Posttraumatic stress disorder Pyridostigmine bromide (PB), 39 R Race and ethnicity, and PTSD, 87â88, 305 Random error, in identifying and evaluating the literature, 24â25 Rapid-eye-movement (REM) sleep, 51, 98â99, 181 RAS. See Reticular activating system rCBF. See Regional cerebral blood flow Recommendations, 321 Regional cerebral blood flow (rCBF), 99 REM. See Rapid-eye-movement sleep Reproductive effects, 229â236 birth defects and miscarriage, 229â231 fertility difficulties, 231â232 PTSD and, 233 sexual dysfunction, 232â233 Reservists, 11, 31, 39â40. See also National Guard troops deployment-related stressors for, 39â40 Respiratory system diseases, 197â203 primary studies, 197â199
336 GULF WAR AND HEALTH PTSD and, 200 secondary studies, 199â200 Reticular activating system (RAS), in stress response, 51â52 Rey-Osterrieth Complex Figure Drawing Test, 168â169 Risk and protective factors for PTSD, 86â94 age, 88 combat exposure, 92â93 developmental history and early-life stress, 88â89 hardiness, coping strategies, and sense of control, 89â90 physical injury, 93â94 psychiatric history, 89 race and ethnicity, 87â88 sex, 86â87 social support, 91â92 socioeconomic status and military status, 91 Rome Criteria, for functional GI disorders, 204 S Schedule for Affective Disorders and Schizophrenia-Lifetime Version, 243 SCID. See Structured Clinical Interview for DSM Seabee Health Study, 186 Seabees. See Naval Mobile Construction Battalions Self-reports, 4, 23, 28, 33, 41, 79, 116, 120, 122, 124â126, 133â138, 146â150, 167, 175â176, 183â187, 197â201, 205â207, 214â217, 222, 224â226, 229, 231â232, 242, 250â258, 288, 292, 305, 317â318 of sleep disturbance, 179â180 Sense of control, and PTSD, 89â90 Serotonin, 56â59, 94 Sex, and PTSD, 86â87 Sexual assault and harassment, military, 37â38 Sexual dysfunction, 232â233 Shell shock, 75 Skin cancer, 124â125, 131 Skin disorders, 214â221 primary studies, 214â215 PTSD and, 216â218 secondary studies, 215â216 Sleep disturbances, 98â99, 179â182 in the neurobiology of PTSD, 98â99 PTSD and, 180â182 self-reports of, 179â180 Social Isolation Index, 285 Social support, and PTSD, 91â92 Socioeconomic status, and PTSD, 91 Soft-tissue sarcoma, 118â119 Soldier and Marine Well-Being Survey, DoD, 34. See also Mental Health Advisory Team
INDEX 337 Somatoform pain disorder, 150, 256 Specificity of association, in assessing the strength of evidence, 26 Spouse/Partner Interview, of the National Vietnam Veterans Readjustment Study, 284â285 Standard Family Violence Measure, 289 Startle reflex, in the neurobiology of PTSD, 98 Strength of association, in assessing the strength of evidence, 25 Strength of evidence, assessment of, 25â26 Stress response, 6, 13â14, 49â74 central role of the brain, 50â56 chronic stress and health, 59â66 conclusions, 66 modifiers of the stress response, 56â59 pathways of, 52 physiologic changes during, 50 Stressors experienced by U.S. forces anticipation of deployment to a war zone, 36â37 chronicity of, 56â57 deployment-related, 5â7, 11, 13â15, 31â47 during combat, 32â35 environmental and chemical, 39 living conditions, 38 military sexual assault and harassment, 37â38 noncombat, 35 Structured Clinical Interview for DSM (SCID), 23, 76, 80, 92, 142, 144, 146, 149â150, 181, 189, 191, 284â285, 291, 305 Substance-use disorders, 60, 84, 89, 149, 158â166. See also Alcohol abuse or dependence; Drug abuse or dependence; Psychiatric disorders primary studies, 158â160, 164â166 PTSD and, 162 secondary studies, 160â162 Sufficient evidence of a causal relationship, 4, 8, 27, 319 Sufficient evidence of an association, 4, 8, 27, 319 Suicide, 237â247 ideation, 148, 151 primary studies, 237â241 PTSD and, 242â243 secondary studies, 241â242 Summary of findings regarding the association between deployment to a war zone and specific health and psychosocial effects, 8â9, 319â320 inadequate/insufficient evidence to determine whether an association exists, 9, 320 limited but suggestive evidence of an association, 8, 319â320 limited/suggestive evidence of no association, 9, 320 schematic depiction of, 15 sufficient evidence of a causal relationship, 8, 319 sufficient evidence of an association, 8, 319 Sympathetic nervous system alterations, in the neurobiology of PTSD, 94â96
338 GULF WAR AND HEALTH Symptom reporting, 248â260 chronic pain, 255â256 general symptoms and signs, 248â250 PTSD and chronic pain, 256â257 PTSD and general symptom reporting, 250â251 PTSD and unexplained illness, 254â255 unexplained illness, 251â254 T T3. See Triiodothyronine T4. See Thyroxine Task Force on Domestic Violence, DoD, 287 Temporal relationship, in assessing the strength of evidence, 25 Test of Memory Malingering (TOMM), 168 Testicular cancer, 123â124, 131 Thyroid disease, 135â137 primary studies, 135â136 secondary studies, 136â137 Thyroid-stimulating hormone (TSH), 133, 135â136, 138â139 Thyrotropin. See Thyroid-stimulating hormone Thyroxine (T4), 135â136, 138 TOMM. See Test of Memory Malingering Trauma. See Posttraumatic stress disorder Triiodothyronine (T3), 135â136, 138 TSH. See Thyroid-stimulating hormone Types of evidence, in identifying and evaluating the literature, 18â22 U UK. See United Kingdom troops UN. See United Nations Unexplained illness, 90, 251â254, 257â260 PTSD and, 254â255 United Kingdom (UK) troops, 36, 75, 79, 121, 123, 135, 167, 175, 180, 184, 214â216, 222, 225â 226, 232â233, 241, 248, 318 United Nations (UN), 40â41, 188, 250 University of Pennsylvania Smell Identification Test, 169â170 V VES. See Vietnam Experience Study VET. See Vietnam-Era Twin Registry Veteran studies, limitations of, 5, 28, 317â318 Veterans Health Study, 137, 192, 217, 251 Veterans Programs Enhancement Act, 1, 12 Vietnam-Era Twin Registry (VET), 134, 145, 159, 163, 191, 207
INDEX 339 Vietnam Experience Study (VES), 80, 87, 118, 133, 135, 137, 142, 158, 161â162, 168â169, 185, 187, 193, 197, 215â218, 229, 231â233, 237â238, 243, 248, 284, 318 Vietnam War, 6, 13, 31, 33, 35, 40â41, 81, 86, 88, 91â95, 97, 100, 115, 117â120, 127, 139, 162, 194, 201, 210, 214, 216, 218â219, 231, 237â239, 248â250, 256â257, 284, 289â291, 293, 300, 308â309, 318 demographics, 13 prevalence of PTSD in, 80 Violent Behavior Index, 293 W WAIS-R. See Wechsler Adult Intelligence Scale-revised âWar neurosis,â 75 WCST. See Wisconsin Card Sorting Test Wechsler Adult Intelligence Scale-revised (WAIS-R), 168â169 Wisconsin Card Sorting Test (WCST), 168â169 Women, 13, 33, 38, 41â43, 137â140, 222, 248 cancer, 117, 120, 123 cardiovascular disease, 186 comorbidity and disability, 84â86 deployment-related stressors for, 41â43 employment, 308 fibromyalgia and chronic pain, PTSD and, 226, 256 gastrointestinal effects, PTSD and, 209 homelessness, 299, 301 marital and family conflict, 284â285, 287â288 prevalence of PTSD in, 78 psychiatric disorders, 144â146, 149 PTSD risk and protective factors, 86â87, 91 reproductive effects, 230â231 respiratory diseases, PTSD and, 200 substance abuse, 158â159, 161â162 suicide and accidental death, 139â140 symptom reporting, PTSD and, 250â251 in the Vietnam war, 80â82 World Health Organization, 78, 158 World Mental Health Survey, 78 World War I, 75, 183 World War II, 7, 13, 31, 33, 41, 75, 83â85, 90â91, 93â94, 137â138, 181, 189, 192, 208, 218â 219, 249â250 prevalence of PTSD in, 80â81 Y Yohimbine, 95