PREFACE

Deployment to a war zone has a profound impact on the lives of many of the troops who are deployed to foreign soil and on their family members. Needless to say, numerous stressors are associated with deployment, from terrifying concerns about surviving, being taken prisoner, and being tortured to the horrific possibility of seeing friends die, being maimed, and handling dead bodies. Less traumatic but more pervasive stressors include anxiety about home life, such as loss of a job and income, impacts on relationships, and absence from family.

The effects of deployment-related stressors on a veteran’s health during and after deployment are numerous. When sudden and life-threatening stressors are encountered, the body will typically react with an acute “flight or fight” response that subsides when the stressor goes away. If the stressor or the acute response persists, the body may react with a more prolonged stress response that can lead to harmful long-term effects on health. The focus of this report, by the Institute of Medicine (IOM) Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress, is the long-term effects of deployment-related stress. What happens to military personnel when they are subjected to the many stressors that occur in a war zone?

The U.S. Department of Veterans Affairs and Congress have secured the assistance of IOM in evaluating the scientific literature regarding an association between deployment-related stressors and health effects. Congress’s request regarding the possible association between illness and exposure to stressors in the Gulf War is similar to its approach after the Vietnam War to exposure to Agent Orange and after the 1991 Persian Gulf War to exposure to numerous biologic and chemical agents. Although seemingly straightforward conceptually, this task has proved to be much more difficult than previous studies. The committee discussed how to define deployment-related stress, the types of stressors encountered, and how they might be assessed or measured.

In this report, the committee equated deployment-related stress with being deployed to a war zone, although it recognized that not everyone deployed to a war zone would respond to stressors in the same way and that not everyone would necessarily find a particular event stressful. The reaction to deployment-related stressors would depend on numerous factors that were present before, during, and after deployment. Stressors that people experienced in childhood, their interactions with friends and family, and whether they were wounded during deployment would all play a role in the nature of the response. The committee also understood that some military personnel would have minor reactions and transient health effects, some would have severe reactions and more chronic health effects, and some would go on to develop posttraumatic stress disorder (PTSD), which could be associated with additional health effects. That approach is detailed in the committee’s report.

The committee deliberated for many months and met 14 times. It reviewed all the studies of health effects in veterans deployed to a war zone and found that most studies did not measure the stressors of war (although that was not required for inclusion in the committee’s analysis), and that the ones that did measure deployment-related stress were most often related to PTSD. The committee noted that although experimental data from studies in animals indicated



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