certificates matched with military records (Araneta et al., 1999). Another ongoing study in the United Kingdom probes the prevalence of birth defects, problems in reproduction and fertility, exposure history and cancer in children. This study covers all Gulf War veterans and Gulf War era controls, a total of 106,000 veterans (Doyle et al., 1999).
Two population-based epidemiologic studies described earlier (Iowa Persian Gulf Study Group, 1997; Goss Gilroy, 1998) detected a significant elevation in the self-reported prevalence of symptoms that may indicate posttraumatic stress disorder (an anxiety disorder) and depression.19 In the Iowa study, 17 percent of Gulf War veterans reported symptoms of depression and 1.9 percent reported symptoms of PTSD. These figures were significantly higher than those for controls, whose prevalences were 11 and 0.8 percent, respectively (Table 2.4 ). The third population-based study found that Gulf War veterans from the United Kingdom were about 2½ times more likely than controls to have symptoms of PTSD. In this study, there were no significant differences in the levels of depression between deployed veterans and controls (Unwin et al., 1999).
In a study of military personnel (n = 16,167) from Pennsylvania and Hawaii (described earlier), 8–9 percent of deployed veterans met criteria for PTSD symptoms, based on self-reported symptom checklists, in comparison with 1–2 percent of nondeployed veterans (Stretch et al., 1996). Similarly, a small study found higher PTSD scores in deployed versus nondeployed veterans (Perconte et al., 1993a).
Sutker and colleagues (1993) compared 215 National Guard and Army reserve veterans who were deployed to the Persian Gulf with 60 veterans from the same unit who were activated but not deployed overseas. None had sought mental health treatment. The investigators found 16 to 24 percent of war zone– exposed troops had symptoms of distress that suggested depression and/or PTSD. Those who reported higher levels of stress had greater severity of PTSD and more health complaints than veterans who had low self-reported stress or no war-zone stress. Similarly, PTSD symptoms or diagnoses were more likely in groups of Gulf War veterans with combat exposure or injury (Baker et al., 1997; Labbate et al., 1998; Wolfe et al., 1998), those of female gender (Wolfe et al., 1993), veterans who had been exposed to missile attack (Perconte et al., 1993b), and those that had grave registration duties (Sutker et al., 1994).
Most epidemiologic studies of veterans have assessed the prevalence of self-reported symptoms of PTSD by asking subjects to fill out one or more validated psychometric scales, such as the Mississippi Scale for Combat-Related PTSD or the PTSD Checklist—Military. Psychometric scales of PTSD, while useful as screening tools for approximating a PTSD diagnosis, are not deemed to be diagnostic by themselves (Keane et al., 1988; Kulka et al., 1991).