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Chronic fatigue syndrome and related disorders in UK veterans of the Gulf War 1990–1991: results from a two-phase cohort study

Published online by Cambridge University Press:  25 September 2007

K. Ismail ,
K. Kent ,
R. Sherwood ,
L. Hull ,
P. Seed ,
A. S. David  and
S. Wessely
K. Ismail*
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
K. Kent
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
R. Sherwood
Affiliation:
Clinical Biochemistry, King's College Hospital, London, UK
L. Hull
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
P. Seed
Affiliation:
Division of Reproduction and Endocrinology, King's College London, London, UK
A. S. David
Affiliation:
Section of Cognitive Neuropsychiatry, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
S. Wessely
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
*
*Address for correspondence: Dr K. Ismail, Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. (Email: [email protected])
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Abstract

Background

The aim was to determine the prevalence of chronic fatigue syndrome (CFS), chronic fatigue and fibromyalgia in UK military personnel after the Gulf War 1990–1991.

Method

A two-phase cohort study was used. Three randomly selected subsamples identified from a population-based cross-sectional postal survey of over 10 000 current and ex-service UK military personnel (Gulf veterans were those deployed to the Gulf War 1990–1991; non-Gulf veterans were Bosnia peacekeepers 1992–1997 and those on active duty during the Gulf War 1990–1991 but not deployed) were recruited. Their disability status was assessed using the Short Form 36 physical functioning scale; Gulf veterans who reported physical disability (n=111) were compared with non-Gulf (n=133) veterans who reported similar levels of physical disability. Screening for known medical and psychiatric conditions was conducted to exclude medical explanations for disability and symptomatic distress. Standardised criteria for CFS, chronic fatigue and fibromyalgia were used.

Results

Disabled Gulf veterans were more likely to be overweight, have elevated γ-glutamyl transferase levels and screen positive for hypertension. There were no other clinically significant differences in clinical markers for medically explainable conditions. Disabled Gulf veterans were more likely than similarly disabled Bosnia and Era veterans (adjusted odds ratio 7.8, 95% confidence interval 2.5–24.5) to meet the criteria for CFS. Rates for other medically unexplained conditions were not significantly increased.

Conclusions

Symptoms in keeping with CFS account for a significant part of the symptomatic distress in Gulf veterans.

Keywords

Chronic fatigue syndromefibromyalgiaGulf War syndromemedically unexplained syndromes
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 7 , July 2008 , pp. 953 - 961
Copyright
Copyright © 2007 Cambridge University Press

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References

Aaron, L, Burke, M, Buchwald, D (2000). Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia and temperomandibular disorder. Archives of Internal Medicine 160, 221–227.CrossRefGoogle Scholar
Barsky, A, Borus, J (1999). Functional somatic syndromes. Annals of Internal Medicine 130, 910–921.CrossRefGoogle ScholarPubMed
Black, D, Carney, C, Peloso, P, Woolson, R, Schwartz, D, Voelker, M, Barrett, D, Doebbeling, B (2004). Gulf war veterans with anxiety – prevalence, comorbidity, and risk factors. Epidemiology 15, 135–142.CrossRefGoogle ScholarPubMed
Black, D, Doebbeling, B, Voelker, M, Clarke, W, Woolson, R, Barrett, D, Schwartz, D (2000). Multiple chemical sensitivity syndrome: symptom prevalence and risk factors in a military population. Archives of Internal Medicine 160, 1169–1176.CrossRefGoogle Scholar
Bourdette, D, McCauley, LAB, Johnston, W, Wynn, M, Joos, S, Storzbach, D, Shuell, T, Sticker, D (2001). Symptom factor analysis, clinical findings, and functional status in a population-based case control study of Gulf War unexplained illness. Journal of Occupational and Environmental Medicine 43, 1026–1040.CrossRefGoogle Scholar
Branth, S, Ronquist, G, Stridsberg, M, Hambraeus, L, Kindgren, E, Olsson, R, Carlander, D, Arnetz, B (2007). Development of abdominal fat and incipient metabolic syndrome in young healthy men exposed to long-term stress. Nutrition, Metabolism and Cardiovascular Diseases 17, 427–435.CrossRefGoogle ScholarPubMed
Buchwald, D, Garrity, D (1994). Comparison of patients with chronic fatigue syndrome. Fibromyalgia, and multiple chemical sensitivities. Archives of Internal Medicine 154, 2049–2053.CrossRefGoogle ScholarPubMed
Dandeker, C, Iversen, A, Ross, J, Wessely, S (2006). What is a veteran? Armed Forces and Society 32, 161–177.CrossRefGoogle Scholar
Donta, S, Clauw, D, Engel, C, Guarino, P, Peduzzi, P, Williams, D, Skinner, J, Barkhuizen, A, Taylor, T, Kazis, L, Sogg, S, Hunt, S, Dougherty, C, Richardson, R, Kunkel, C, Rodriguez, W, Alicea, E, Chiliade, P, Ryan, M, Gray, G, Lutwick, L, Norwoo, D, Smith, S, Everson, M, Blackburn, W, Martin, W, Griffiss, J, Cooper, R, Renner, E, Schmitt, J, McMurtry, C, Thakore, M, Mori, D, Kerns, R, Park, M, Pullman-Mooar, S, Bernstein, J, Hershberger, P, Salisbury, D, Feussner, J (2003). Cognitive behavioral therapy and aerobic exercise for Gulf War veterans' illnesses: a randomized controlled trial. Journal of the American Medical Association 289, 1396–1404.CrossRefGoogle ScholarPubMed
Eisen, S, Kang, H, Murphy, F, Blanchard, M, Reda, D, Henderson, W, Toomey, R, Jackson, L, Alpern, R, Parks, B, Klimas, N, Hall, C, Pak, H, Hunter, J, Karlinsky, J, Battistone, M, Lyons, M, the Gulf War Study Participating Investigators (2005). Gulf War veterans' health: medical evaluation of a US cohort. Annals of Internal Medicine 142, 881–890.CrossRefGoogle Scholar
Fiedler, N, Ozakinci, G, Hallman, W, Wartenberg, D, Brewer, N, Barrett, D, Kipen, H (2006). Military deployment to the Gulf War as a risk factor for psychiatric illness among US troops. British Journal of Psychiatry 188, 453–459.CrossRefGoogle Scholar
Folstein, S, Jensen, B, Leigh, R, Folstein, M (1983). The measurement of abnormal movement: methods developed for Huntington's disease. Neurobehavioral Toxicology and Teratology 5, 605–609.Google ScholarPubMed
Fukuda, K, Nisenbaum, R, Stewart, G, Thompson, WW, Robin, L, Washko, RM, Noah, DL, Barrett, DH, Randall, B, Herwaldt, BL, Mawle, AC, Reeves, WC (1998). Chronic multi-symptom illness affecting Air Force veterans of the Gulf War. Journal of the American Medical Association 280, 981–988.Google Scholar
Fukuda, K, Straus, S, Hickie, I, Sharpe, M, Dobbins, J, Komareff, A (1994). The chronic fatigue syndrome: a comprehensive approach to its definition and study. Annals of Internal Medicine 121, 953–959.Google Scholar
Goss Gilroy Inc. (1998). Health study of Canadian Forces personnel involved in the 1991 conflict in the Persian Gulf. Goss Gilory Inc.: Ottawa, Ontario.Google Scholar
Gray, G, Gackstetter, G, Kang, H, Graham, J, Scott, K (2004). After more than ten years of Gulf War veteran medical evaluations, what have we learned? American Journal of Preventative Medicine 26, 443–452.CrossRefGoogle Scholar
Gray, G, Kaiser, K, Hawksworth, A, Hall, F, Barrett-Connor, E (1999). Increased postwar symptoms and psychological morbidity among US Navy Gulf War veterans. American Journal of Tropical Medicine and Hygiene 60, 758–766.CrossRefGoogle ScholarPubMed
Gray, G, Reed, R, Kaiser, K, Smith, T, Gastanaga, V (2002). Self reported symptoms and medical conditions among 11,868 Gulf War-Era veterans. The Seabee Health Study. American Journal of Epidemiology 155, 1033–1044.Google Scholar
Hemingway, H, Stafford, M, Stansfeld, S, Shipley, M, Marmot, M (1997). Is the SF-36 a valid measure of change in population health? Results from the Whitehall II study. British Medical Journal 315, 1273–1279.CrossRefGoogle ScholarPubMed
International Diabetes Federation (2005). The IDF consensus worldwide definition of the metabolic syndrome. International Diabetes Federation: Brussels (http://www.idf.org/webdata/docs/Metabolic_syndrome_definition.pdf). Accessed 15 July 2006.Google Scholar
Ishoy, T, Suadicani, P, Guldager, B, Appleyard, M, Hein, H, Gyntelberg, F (1999). State of health after deployment in the Persian Gulf. Danish Medical Bulletin 46, 416–427.Google ScholarPubMed
Ismail, K, Kent, K, Brugha, T, Hotopf, M, Hull, L, Seed, P, Palmer, I, Reid, S, Unwin, C, David, A, Wessely, S (2002). The mental health of UK Gulf war veterans: phase 2 of a two-phase cohort study. British Medical Journal 325, 576–579.Google Scholar
Ismail, K, Lewis, G (2006). Multi-symptom illnesses, unexplained illness and Gulf War Syndrome. Philosophical Transactions of the Royal Society of London, Series B 361, 543–551.CrossRefGoogle ScholarPubMed
Jason, L, Helgerson, J, Torres-Harding, S, Carrico, A, Taylor, R (2003). Variability in diagnostic criteria for chronic fatigue syndrome may result in substantial differences in patterns of symptoms and disability. Evaluation and the Health Professions 26, 3–22.Google Scholar
Kang, H, Natelson, B, Mahan, C, Lee, K, Murphy, F (2003). Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. American Journal of Epidemiology 157, 141–148.CrossRefGoogle ScholarPubMed
Kelsall, H, Sim, M, Forbes, A, Glass, D, McKenzie, D, Ikin, J, Abramson, M, Blizzard, L, Ittak, P (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, 1006–1013.CrossRefGoogle ScholarPubMed
Kelsall, H, Sim, M, McKenzie, D, Forbes, A, Leder, K, Glass, D, Ikin, J, McFarlane, A (2006). Medically evaluated psychological and physical health of Australian Gulf War veterans with chronic fatigue. Journal of Psychosomatic Research 60, 575–584.Google Scholar
Klein, S, Burke, L, Bray, G, Blair, S, Allison, D, Pi-Sunyer, X, Hong, Y, Eckel, R (2004). Clinical implications of obesity with specific focus on cardiovascular disease. Circulation 110, 2952–2967.CrossRefGoogle ScholarPubMed
Merikangas, K, Zhang, H, Avenevoli, S, Acharyya, S, Neuenschwander, M, Angst, J (2003). Longitudinal trajectories of depression and anxiety in a prospective community study: The Zurich Cohort Study. Archives of General Psychiatry 60, 993–1000.CrossRefGoogle Scholar
Proctor, S, Heaton, K, White, R, Wolfe, J (2001). Chemical sensitivity and chronic fatigue in Gulf War veterans: a brief report. Journal of Occupational and Environmental Medicine 43, 259–264.CrossRefGoogle ScholarPubMed
Ramsay, L, Williams, B, Johnston, G, MacGregor, A, Poston, L, Potter, J, Poulter, N, Russell, G (1999). Guidelines for management of hypertension: report of the third working party of the British Hypertension Society. Journal of Human Hypertension 13, 569–592.CrossRefGoogle ScholarPubMed
Reid, S, Hotopf, M, Hull, L, Ismail, K, Unwin, C, Wessely, S (2001 a). Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans. American Journal of Epidemiology 153, 604–609.CrossRefGoogle ScholarPubMed
Reid, S, Wessely, S, Crayford, T, Hotopf, M (2001 b). Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study. British Medical Journal 322, 767.CrossRefGoogle ScholarPubMed
Salvaggio, A, Periti, M, Miano, L, Tavanelli, M, Marzorati, D (1991). Body mass index and liver enzyme activity in serum. Clinical Chemistry 37, 720–723.CrossRefGoogle ScholarPubMed
Steele, L (2000). Prevalence and patterns of Gulf War illness in Kansas veterans: association of symptoms with characteristics of person, place, and time of military service. American Journal of Epidemiology 152, 992–1002.Google Scholar
Stewart, D (1990). The changing face of somatisation. Psychosomatics 31, 153–158.CrossRefGoogle Scholar
Stimpson, N, Thomas, H, Weightman, A, Dunstan, F, Lewis, G (2003). Psychiatric disorder in veterans of the Persian Gulf War of 1991: systematic review. British Journal of Psychiatry 182, 391–403.CrossRefGoogle ScholarPubMed
The Iowa Persian Gulf Study Group (1997). Self-reported illnesses and health status among Gulf War veterans. A population based study. Journal of the American Medical Association 277, 238–245.Google Scholar
Thomas, H, Stimpson, N, Weightman, A, Dunstan, F, Lewis, G (2006). Systematic review of multi-symptom conditions in Gulf War veterans. Psychological Medicine 36, 735–747.CrossRefGoogle ScholarPubMed
Unwin, C, Blatchley, N, Coker, W, Ferry, S, Hotopf, M, Hull, L, Ismail, K, Palmer, I, David, A, Wessely, S (1999). Health of UK servicemen who served in the Persian Gulf War. Lancet 353, 169–178.CrossRefGoogle ScholarPubMed
Ustun, T, Sartorius, N (1995). Mental Illness in General Health Care: an International Study. John Wiley & Sons: Chichester.Google Scholar
Vazquez-Barquero, J, Diez-Manrique, J, Pena, C, Aldama, J, Rodgriguez, C, Arango, J, Mirapeix, C (1987). A community mental health survey in Cantabria: a general description of morbidity. Psychological Medicine 17, 227–241.CrossRefGoogle ScholarPubMed
Ware, JJ, Sherbourne, C (1992). The MOS 36-item short-form survey (SF-36): conceptual framework and item selection. Medical Care 30, 473–483.CrossRefGoogle ScholarPubMed
Wessely, S, Chalder, T, Hirsch, S, Wallace, P, Wright, D (1996). Psychological symptoms, somatic symptoms and psychiatric disorder in chronic fatigue syndrome: a prospective study in the primary care setting. American Journal of Psychiatry 153, 1050–1059.Google ScholarPubMed
Wessely, S, Hotopf, M, Sharpe, M (1998). Chronic Fatigue and its Syndromes. Oxford University Press: Oxford, UK.CrossRefGoogle Scholar
Wessely, S, Nimnuan, C, Sharpe, M (1999). Functional somatic syndromes: one or many? Lancet 354, 936–939.CrossRefGoogle ScholarPubMed
WHO (1999). Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. World Health Organization: Geneva.Google Scholar
WHO (2000). Obesity: Preventing and managing the global epidemic. WHO Obesity Technical Report Series 894. World Health Organization: Geneva.Google Scholar
Wolfe, F (1997). The relation between tender points and fibromyalgia symptom variables: evidence that fibromyalgia is not a discrete disorder in the clinic. Annals of the Rheumatic Diseases 56, 268–271.CrossRefGoogle Scholar
Wolfe, F, Ha, S, Yunus, M, Bennett, R, Bombardier, C, Goldenberg, D, Tugwell, P, Campbell, S, Abeles, M, Clark, P, Fam, A, Farber, S, Fiechtner, J, Franklin, C, Gatter, R, Hamaty, D, Lessard, J, Lichtbroun, A, Masi, A, McCain, G, Reynolds, W, Romano, T, Russell, I, Sheon, R (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis and Rheumatism 33, 160–172.CrossRefGoogle ScholarPubMed