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Gulf War and Health, Volume 8: Update of Health Effects of Serving in the Gulf War
interview, and psychiatric diagnostic instruments (the Clinician-Administered PTSD Scale [CAPS] or the Mississippi Scale for Combat-Related PTSD) (Proctor et al., 1998). Current PTSD (time 2) was diagnosed in 8.1% of the Fort Devens group, 7.6% of the New Orleans group, and none of the Germany group based on the CAPS. Health status and function were lower in the Gulf War deployed cohorts than the Germany deployed cohort (19.7-20.7% of deployed cohorts reported fair or poor health vs 6.4% of Germany deployed cohort). The three most prevalent symptoms in the Fort Devens group were “forgetfulness,” “fatigue,” and “unsatisfactory sleep” (Proctor et al., 1998).
Wolfe et al. (1999b) also recruited cases from the Fort Devens, New Orleans, and Germany cohorts with a stratified random-sampling strategy (148 from the Fort Devens group, 56 from the New Orleans group, and 56 from the Germany group). They used the Laufer Combat Scale to assess exposure to combat situations and the Mississippi Scale for Combat-Related PTSD to assess PTSD. The deployed Fort Devens group had significantly (p < 0.05) higher levels of current and lifetime PTSD (5.4% and 6.5%, respectively) and current and lifetime MDD (6.6% and 22.5%, respectively) than the Germany group (0% for both). Deployed personnel from New Orleans also had higher levels of current and lifetime PTSD (7.2% and 8.2%, respectively) and current and lifetime MDD (4.5% and 10.2%, respectively) than the Fort Devens or Germany deployed groups, although the difference was not significant. The prevalence of the other eight psychiatric disorders was similar between the three groups. Compared with the PTSD prevalence in the general population (7.8%) (Kessler et al., 1995), the Germany group (controls) had much lower rates of PTSD (0%). However, the low prevalence estimates in the controls increases from zero to 5-8% when the veterans are deployed to active war situations. A strength of this study is that it is characterized by direct interview.
In another analysis of these data (Wolfe et al., 1999a) looked at the course and predictors of PTSD and found that there was a higher rate of PTSD at time 2 (8%) than at time 1 (3%) (OR 3.2), indicating the development of new cases. Responders at time 2 were more likely to be younger, belong to racial minorities, and be deployed; however, the absence of differences in PTSD rates due to those characteristics indicates a lack of selection bias at time 2. Women were significantly more likely to have PTSD than men at either time (OR 3.2 at time 1, 95% CI 1.9-5.5; OR 2.3 at time 2, 95% CI 1.5-3.5), although their numbers were very low at each assessment. For men, 1% exceeded the cutpoint for PTSD at time 1 and time 2, 1% exceeded it at time 1 only, and 6% exceeded it at time 2 only.
Brailey et al. (1998) studied Gulf War veterans on their return from service (an average of 9 months after their return) with a face-to-face debriefing and psychological assessment with self-administered questionnaires, comparing Gulf War deployed (n = 876) with nondeployed veterans (n = 396 mobilized but not deployed), including National Guard and reserve troops. A subset of 349 received a followup assessment an average of 16 months later. Investigators used standard psychiatric rating scales for their assessments including: the Beck Depression Inventory (BDI), the State Anger, the State Anxiety, the Brief Symptom Inventory (BSI) Depression, BSI Anxiety, BSI Hostility, and the HSC. The deployed veterans had higher scores than the nondeployed on the BDI, the State Anger, the BSI Anxiety, and the HSC. When the Gulf War deployed veterans were reassessed on average of 16 months later, they showed increases on all scales, including the BDI, the State Anger, the BSI Anxiety, the BSI Hostility, HSC, and on both PTSD scales (the 17-item DSM-III R PTSD Checklist and the Mississippi Scale for Desert Storm War Zone Personnel). They showed increased rates of depression (6.9% to 13.8%), PTSD (2.3% to 10.6%), and hostility (4.9% to 13.8%). The authors correlated war stress with those symptoms