women deployed fewer than 120 days reported more depression as a general health measure (1.84 vs 2.22, p = 0.03) and more insomnia (1.92 vs 2.34, p = 0.04). There were more reports of unintentional weight loss in those deployed less than 120 days compared with those deployed elsewhere (p = 0.006) and a significant difference between those deployed less than 120 days and those deployed for more than 120 days (p = 0.006). Those who had left the military reported more frequent health problems. At time 2, skin rashes persisted in those who had served in theater less than 120 days, but differences in the other health conditions were no longer significant between the deployed and nondeployed women. Deployed women, however, regardless of the length of their service, reported more coughs, and those who were deployed for fewer than 120 days also reported more memory problems (p = 0.008). At time 2 only, women who had served in the gulf also were more likely to report lumps or cysts in the breast (p = 0.017), abnormal Pap test results (p = 0.036), and headaches (p = 0.0010), regardless of the length of their deployment. In a further study of female Air Force veterans 6 years after the war (Pierce, 2005), veterans who were deployed to the Persian Gulf area reported more frequently 29 of 48 symptoms compared with those deployed elsewhere, although the deployed women no longer reported more insomnia, unintentional weight loss, or memory problems than the nondeployed women. Women who had been deployed to the Gulf War were more likely (p < 0.001) to report the following symptoms than women who had not been deployed: skin rash; persistent cough; dizziness, faintness, or lightheadedness; forgetfulness, hoarseness, respiratory difficulties; tendency to bruise or bleed easily; itchy skin; and loss of energy. Reported health problems were not related to whether the woman was on active-duty, in the reserves, or a member of the National Guard.

In a similar study by Unwin et al. (2002), female UK veterans deployed to the Gulf War (n = 226) reported more frequently having 49 of the 50 medical conditions or symptoms assessed (the exception was asthma) than did female veterans deployed to Bosnia (n = 217) or era controls (n = 192). The most frequently reported symptoms in all three cohorts were headaches, fatigue, feeling unrefreshed after sleep, irritability and outbursts of anger, sleeping difficulties, and forgetfulness but the Gulf War veterans reported significantly more of each symptom compared with the other cohorts; ORs ranged from 1.5-3.7, all 95% CIs excluded 1.0 except for sleeping difficulties in deployed veterans versus nondeployed. The most frequently self-reported medical disorders for all three groups were premenstrual tension, back problems, and problems with periods, although the difference between the Gulf War veterans and the era veterans was not significant. The results for the symptom and medical condition reporting for female veterans were very similar to those for male UK Gulf War veterans (Unwin et al., 1999).

Frommelt et al. (2000) evaluated Pap smear results from a cohort of 6715 Air Force women who served on active duty between August 7, 1990, and March 1, 1991, and had routine Pap smears conducted in 1994. Pap smear test results were collected for 1446 female Gulf War veterans and 5269 female veterans who were not deployed to the Gulf. Overall, there were no observed differences in cervical pathology between the two groups. Among 26-30 years old veterans, a diagnosis of “other than within normal limits” occurred more frequently among Gulf War veterans (11.5%) compared with nondeployed veterans (6.6%, p = 0.013) in 1994, but no differences were detected among other age groups ranging from 20 and younger to over 50 years of age. The authors suggest there is no biologically plausible evidence to support an age-specific association between Gulf War service and abnormal cervical cytology.

Barth et al. (2009) assessed the long-term mortality for neurologic disorders in Gulf War veterans compared with nondeployed veterans between 1991 and the date of death or December



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