The following graph depicts the percentages of veterans who endorse symptoms as reported in studies cited in Chapter 3. The minimum, median, and maximum are indicated for each category of symptoms. Data are further characterized by whether the reports came from deployed Gulf War personnel and veterans (GWVs), nondeployed Gulf War–era personnel and veterans (NGVs), and Gulf War–era personnel and veterans deployed to other regions (Else). The percentages do not represent prevalence inasmuch as the results of all study types (including military-based and registry studies) cited are not representative of the population. Groups of symptoms are listed along the vertical axis, and the horizontal axis displays the percentage of veterans endorsing the symptoms.
Figure B.1 is followed by additional detail, including the number of times (N) that a symptom was reported in GWVs, and a description of the symptoms in each category as reported by studies. It should be noted that some studies report multiple symptoms in a group; for example, both vomiting and diarrhea are included in gastrointestinal (GI) symptoms and are reported separately by some studies and together in others. Also, the number of studies that reported symptoms in each group varies; for example, many studies reported on cognitive symptoms, fewer on chemical sensitivity. The numbers of symptoms reported by individual studies also vary. Each bar represents a different number of studies, and each bar represents a collection of symptoms.
For NGVs and Else, fewer studies reported percentages for a given symptom. For example, nine studies reported symptoms of allergies in GWVs, eight in NGVs, and one in Else.
Figure B.1 does not differentiate by type of study, number of participants, year, onset, duration, severity, exposure, or other aspects.
Studies that did not report percentages or reported on a study population previously described are not included. And symptoms or symptom groups with five or fewer percentages reported for GWVs are not included in Figure B.1; instead, those symptoms or symptom groups are listed in Table B.1.
FIGURE B.1 Range and median of percentages of veterans reporting symptoms in studies of Gulf War veterans and military personnel.
NOTE: GI = gastrointestinal; GWV = Gulf War veteran; NGV = nondeployed veteran; Else = veteran deployed elsewhere.
SOURCES: Doebbeling et al., 2000; Fukuda et al., 1998; Gray et al., 1999, 2002; Iowa Persian Gulf Study Group, 1997; Ishøy et al., 1999; Joseph et al., 1997; Kang et al., 2000; Kelsall et al., 2004; Kroenke et al., 1998; Nisenbaum et al., 2004; Proctor et al., 1998; Roy et al., 1998; Salamon et al., 2006; Simmons et al., 2004; Steele et al., 2012; Stretch et al., 1995; Unwin et al., 1999; Wolfe et al., 1998.
The terminology used by study authors to describe symptoms is listed below for each group of symptoms with the number of percentages in GWVs reported (N). There were several symptoms that fit easily into the symptom groups or symptom groups with five or fewer percentages reported in GWVs (see Table B.1).
Allergies (N = 9): hay fever or allergies (>6 months); hay fever or allergies; allergic edemas of face, eyes, or lips; allergic eye symptoms; itchy painful eyes; allergies (other than skin); allergies.
Cough/cold/flu/sinus/sore throat (N = 36): bothered by cough; cough; cough (>6 months); persistent cough; persistent cough when don't have cold; continual cough; common cold or flu; flu; head colds; congested/mucous or phlegm; sinus troubles; sinus congestion (>6 months); sinus congestion; runny nose; sore throat; symptoms of bronchitis.
Skin (N = 20): rash; rashes; rash or sores (>6 months); skin rashes; skin rash; rash or skin ulcer; skin irritation; rash or skin irritation; dryness or scaling of skin; skin rashes, eczema, skin allergies; skin allergies; Eczema; sensations of itching on skin; other forms of skin problems; moderate or multiple skin symptoms.
Anxiety (N = 20): nervous or tense; feeling anxious (>6 months); frequent periods of anxiety or nervousness; anxious; chronic anxiety; chronic worry/anxiety; panic or anxiety; feeling of nervousness, irritability, or agitation; feeling jumpy/easily startled; symptoms of anxiety disorder; symptoms of posttraumatic stress disorder (PTSD); PTSD and associated symptoms; anxiety/stress/sleep disturbance; taking medication to sleep or calm down; nightmares/flashbacks; nightmares; distressing dreams.
Mood (N = 40): depression; depressed; depressed mood; depression or sadness; feeling depressed (>6 months); feeling down or depressed; frequent periods feeling depressed; symptoms of major depression; symptoms of minor depression; any symptoms of depression; symptoms of chronic dysphoria; crying easily; feeling distant or cut off; avoiding doing things or situations; feeling life is pointless, meaningless; loss of interest; loss of interest in TV, movies, news, friends; mood swings, aggression, irritability; irritability; unusual irritability; unusual anger; irritability or outbursts of anger; feeling irritable/angry outbursts; moody, irritable (>6 months); frequent rage.
Cognitive (N = 43): loss of concentration; difficulty concentrating; difficulty remembering or concentrating (>6 months); concentration or memory difficulties; memory difficulties; memory loss; memory loss/lack of concentration; memory problems; problems with memory; short-term memory problems; problems remembering recent information; difficulties leaning new information; problems with forgetfulness; forgetfulness; difficulty finding the right word; difficulty to find words; difficulty with speech; disturbances of speech, trouble finding and pronouncing words correctly; trouble finding words (>6 months); trouble finding words when speaking; confusion; episodes of disorientation (>6 months); feeling disoriented; symptoms of cognitive dysfunction.
Neurological (N = 42): dizziness or trouble maintaining balance (>6 months); dizziness; dizziness or feeling lightheaded; feeling dizzy, lightheaded, or faint; balance disturbances or fits of dizziness; blurred or double vision; blurred vision; blurred vision not improved by the use of glasses; double vision; eyes very sensitive to light; increased sensitivity to light; increased sensitivity to noise; numbness; numbness in arms or legs; numbness or tingling; numbness or
tingling (>6 months); numbness or tingling in extremities; numbness or tingling in fingers or toes; numbness or tingling in hands or feet; numbness or tingling in parts of body; numbness/tingling/dizziness; tingling in fingers and arms; tingling in legs and arms; tingling or shivering of arms, legs, or other parts of the body; shaking; tremors or shaking; tremors/shaking; muscle twitches or trembling; moderate or multiple neurologic symptoms; other neurological or neuromuscular not otherwise specified (NOS).
Pain (N = 45): body pain-hurt all over; general aches and pains; general muscle aches and pains; muscle aches/cramps; muscle pain; muscle pain (>6 months); muscle tension, aches, soreness, or stiffness; muscular pain/weakness; pain in muscles; unusual muscle pain; joint pain; joint pain (>6 months); joint pains; pain in joints; roving joint pain; pain without swelling or redness in several joints; aching joints/bones; pain or ache in more than one joint; back ache, low back pain, neckaches or stiffness; back problems; moderate or multiple pain symptoms; symptoms of fibromyalgia.
Fatigue (N = 33): fatigue; all fatigue; fatigue (>6 months); unusual fatigue; unusual feeling of fatigue during the day; fatigue lasting 24h after exertion (>6 months); fatigue lasting 24 hr; problems with fatigue lasting more than 24 hours after having made a physical effort; abnormal feeling of fatigue (not caused by physical activity); extreme fatigue every day, or almost every day; moderate or multiple fatigue symptoms; excessive sleepiness; sleepiness; sleepy all the time; needed more rest; feeling unrefreshed after sleep; feeling unusually sleepy/drowsy; feeling unwell after exercise/exertion; awakening with a feeling of fatigue and exhaustion after a hole night's sleep; problems with feeling tired; symptoms of chronic fatigue.
Sleep disturbances (N = 19): sleep disturbance; sleeping difficulties; difficulty sleeping (>6 months); difficulty sleeping; trouble sleeping; inability to fall asleep; problems falling asleep; problems falling or staying asleep; trouble falling or staying asleep; problems sleeping all night; not feeling rested after sleep; unrefreshing sleep.
Weakness/energy (N = 8): feeling weak in parts of your body; generalized muscle weakness; general muscle weakness; loss of strength; suddenly diminished muscular power; lacking energy; overly tired/lack of energy.
Chest pain (N = 11): chest pain (>6 months); chest pain; chest pain/tightness; tightness in chest.
Cardiac (N = 12): rapid heartbeat; rapid heart rate; rapid heart rate (not exercising); racing heart; irregular heartbeats or “hear flutters”; irregular heartbeat; blood pressure; heart problems.
Genitourinary (N = 10): passing urine more often; frequent urination; frequent or painful urination; frequent, painful urination; pain on passing urine; urinary infections; kidney disease/symptoms; genital system and bladder problems.
GI (Gastrointestinal) (N = 54): diarrhea; diarrhea (>6 months); frequent diarrhea; recurrent diarrhea; loose or aquaeous stools; diarrhea or constipation; constipation; alternating loose and hard stools; flatulence or burping; gas, bloating, cramps, abdominal pain (>6 months); rumbling In the stomach more than a couple of times a week; nausea; nauseous; nausea or vomiting (>6 months); nausea, vomiting; vomiting, nausea, or upset stomach; nausea, upset stomach; stomach upset; upset stomach; stomach ache; stomach cramp; abdominal pain; abdominal pain or cramping; stomach cramps or excessive gas; stomach pain/ulcer; dyspepsia or esophageal disease; heartburn; gastralgia; irritated bowel syndrome; moderate or multiple GI symptoms; digestive symptoms.
Headache (N = 21): any headaches; headache; headache (>6 months); headaches; recurrent headaches; repeated fits of headache; severe headache.
Hearing (N = 7): loss of hearing or ringing in ears; ringing in ears; tinnitus; audition disorders; hearing loss.
Hot/cold (N = 17): chills; chills/fever; feeling feverish; fever; fever (>6 months); fever or chills; hot or cold spells, fever, sweats, chills; low tolerance for heat or cold; night sweats; night sweats that soak bed sheets (>6 months); night sweats that soak the bed sheets; night sweats/excessive; sweating/fevers; sweating.
Joints (N = 11): joint stiffness; joint stiffness (>6 months); joint swelling; swelling in joint; joint swelling/redness.
Mouth, teeth, gums (N = 8): problems with mouth gums or teeth; mouth/gum problems; problems with teeth or gums; bleeding gums; teeth loss; mouth sores.
Respiratory (N = 25): difficulty breathing or catching breath; difficulty breathing or shortness of breath; unable to breathe deeply enough; shortness of breath; shortness of breath (>6 months); shortness of breath (not exercising); feeling short of breath at rest; dyspnea; dyspnea or cough; wheezing; wheezing (>6 months); wheezing in chest; rapid breathing; faster breathing than normal; moderate or multiple respiratory symptoms; symptoms of asthma.
Weight change (N = 13): weight gain/loss; sudden weight gain; unintended weight gain ≥10 lbs; appetite loss/weight loss; sudden weight loss; weight loss; unintended weight loss ≥10 lbs; unintended weight loss ≥10 lbs (>6 months).
Hair loss (N = 7): hair loss; unusual hair loss; sudden hair loss; any hair loss or hair disease.
Reproductive and sexual dysfunction (N = 13): painful intercourse; pain during intercourse; problems during sexual intercourse; decreased interest in sex (>6 months); sexual dysfunction/lack of sex drive; impotence; burning semen; burning in sex organs; Veteran or partner feels a burning sensation after sex; menstrual difficulties.
TABLE B.1 Symptoms Not Included in Graph B.1 (≤5 Reported Percentages per Symptom or Symptom Group)
|Symptom||Study||% GWVs Reporting Symptom||% NGVs Reporting Symptom||% Deployed Elsewhere Reporting Symptom|
|Chemical sensitivity: chemical sensitivity; chemical sensitivity (>6 months); multiple chemical sensitivity; sensitive to chemicals; symptomatic response to chemicals, odors||Fukuda et al., 1998; Gray et al., 2002; Kang et al., 2000; Salamon et al., 2006; Steele et al., 2000||4..3–17.0||0.7–8.0||0.7|
|Other: other; other symptoms; other symptoms NOS||Joseph et al., 1997; Roy et al., 1998; Simmons et al., 2004; Stretch et al., 1995||5.1–21.4||1.9–6.5|
|Swollen glands: sore or swollen glands in neck; swollen glands; swollen lymph nodes (>6 months)||Fukuda et al., 1998; Kang et al., 2000; Salamon et al., 2006; Steele et al., 2000||8.0–17.7||2.0–8.0|
|Difficulty in swallowing: problems swallowing; trouble with swallowing; difficulty swallowing||Kang et al., 2000; Salamon et al., 2006; Stretch et al., 1995||12.1–16.2||5.0–7.2|
|Eyes, ears, nose: eyes trouble; eyes, ears, nose trouble; nasal sores (>6 months)||Salamon et al., 2006; Stretch et al., 1995||17.0–26.0||5.5–5.6|
|Alcohol: symptoms of alcohol abuse; intolerance to alcohol||Nisenbaum et al., 2004; Schwartz et al., 1997||19.4–11.9||4–16.8||5.0|
|Appetite: appetite loss; loss or decrease in appetite||Gray et al., 2002; Nisenbaum et al., 2004||9.4–13.3||3.0–5.2||3.4–8.5|
|Hoarseness||Stretch et al., 1995||9.7–12.0||4.1–3.7|
|Injuries and healing: retarded wound healing; bruise easily; tendency to bruise or bleed easily; slowness of healing; slow healing||Ishoy et al., 1999; Kang et al., 2000; Salamon et al., 2006||3.5–13.0||1.7–7.0|
|Deterioration of general health||Simmons et al., 2004||3.7||2.9|
|Chronic/frequent infection||Simmons et al., 2004||5.8||1.6|
|Single episodes of acute infections||Simmons et al., 2004||2.7||2.0|
|Lump in throat||Nisenbaum et al., 2004||8.0||3.0||3.80|
|Milk intolerance (>6 months)||Fukuda et al., 1998||7.0||4.0|
|Nuisances after vaccination||Ishoy et al., 1999||2.8||0.0|
|Reporting ≥1 symptom||Simmons et al., 2004||60.7||36.7|
|Skeletal & other muscular symptoms||Simmons et al., 2004||15.1||13.2|
|Suicidal thoughts||Gray et al., 2002||6.4||2.7||2.6|
|Sweaty clammy or damp hands||Ishoy et al., 1999; Wolfe et al., 1998||7.0–7.9||3.9|
|Swelling of feet||Kang et al., 2000||11.0||6.0|
|Tendency to bruise or bleed easily||Salamon et al., 2006||3.5|
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Ishøy, T., P. Suadicani, B. Guldager, M. Appleyard, H. O. Hein, and F. Gyntelberg. 1999. State of health after deployment in the Persian Gulf. The Danish Gulf War study. Danish Medical Bulletin 46(5):416-419.
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Kelsall, H. L., M. R. Sim, A. B. Forbes, D. C. Glass, D. P. McKenzie, J. F. Ikin, M. J. Abramson, L. Blizzard, and P. Ittak. 2004. Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: Relation to immunisations and other Gulf War exposures. Occupational and Environmental Medicine 61(12):1006-1013.
Kroenke, K., P. Koslowe, and M. Roy. 1998. Symptoms in 18,495 Persian Gulf War veterans: Latency of onset and lack of association with self-reported exposures. Journal of Occupational and Environmental Medicine 40(6):520-528.
Nisenbaum, R., K. Ismail, S. Wessely, C. Unwin, L. Hull, and W. C. Reeves. 2004. Dichotomous factor analysis of symptoms reported by UK and US veterans of the 1991 Gulf War. Population Health Metrics 2.
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