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BACKGROUND/RATIONALE:
Previous deployments like that to the Persian Gulf in 1991 produced veterans with post-deployment symptom-based health problems with no medical explanation. This was termed Gulf War illness or medically unexplained illness (MUI). If previous wars are any indication, some soldiers currently deployed to hostile areas also will return home with unexplained symptom-based illnesses. However, there is virtually no pre-war, prospective data on risk and resilience factors associated with MUI. This study will attempt to fill that gap.
OBJECTIVE(S):
Our goals are to: (a) determine pre- and immediate post-deployment factors predicting later MUI and poor functional status, (b) improve previous methodological problems (e.g., selection bias, recall bias and lack of baseline controls) in studies of MUI, and (c) relate pre-deployment risk factors (e.g., personality, stressor reactivity) and resilience factors (e.g., coping style, social support) to post-deployment functional status.
METHODS:
This study uses a prospective, longitudinal observational design to assess risk and resilience factors for post-war MUI in Reserve and National Guard enlisted personnel. A stratified random sample of 700 subjects will be drawn from those undergoing pre- and post-mobilization readiness processing at Fort Dix, New Jersey. Personnel will be tested pre-mobilization (Phase 1), immediately after mobilization (Phase 2) and at 3 months and 1 year post-deployment (Phases 3 & 4). Predictor variables include personality, social support, coping style, non-specific symptoms, sympathetic cardiac stress reactivity, and cortisol stress reactivity. Control variables include prior traumatic events, current distress, PTSD symptoms, socially desirable responding, body mass index, deployment experiences, environmental exposures and demographics (e.g., age, gender). Outcome variables include functional status, healthcare utilization, and MUI status (using CDC criteria for chronic multisymptom illness developed after the first Gulf War).
FINDINGS/RESULTS:
We have completed Phase 1 testing for 428 soldiers. We report here preliminary data for demographic and psychosocial measures from Phase I for the first 187 (172 male) participants enrolled. Of this initial sample of 187 soldiers, 78.1% are members of the Army National Guard and 21.9% are members of the Army Reserves. Participants range in age from 18-57 (Mean=29.3 SD=9.2) and have completed an average of 13.1 (SD=1.6) years of formal education. Approximately half (54.5%) of the Soldiers were preparing for their first deployment, with the remaining having had at least one prior deployment (range=1-6). The number of previous deployments was positively correlated (ps <= .01) with age, increased exposure to traumatic events, and higher Mental Component Summary (MCS) scores on the SF-36V (a self-reported health measure) and lower (p <= .05) SF-36V Physical Component Summary scores (PCS). Simple correlations were significant (ps <= .01) between higher perceived distress (Perceived Stress Scale scores) and lower MCS scores, fewer social supports, greater physical symptom severity, higher trait negative emotionality and greater reliance on avoidance coping (not controlling for other factors). Those with higher perceived distress also were younger, reported more alcohol use, and reported more pre-deployment trauma (ps <= .05). Recent stressors included family or work issues (including death or illness of a friend or relative), deployment-related issues, and financial concerns.
IMPACT:
The larger, prospective study with soldiers will help us to identify pre- and early post-deployment risk and resilience factors important in MUI, functional status, and healthcare utilization. There is an urgent need for both pre- and post-deployment predictors of later MUI uncontaminated by recall bias, and the selection bias of studying only treatment-seekers. If we are to understand how to best treat veterans presenting with unexplained symptoms, then we need to know which factors, occurring at what time in the illness process (including pre-illness factors) are most important. Understanding these could help us to develop appropriate pre-deployment inoculation strategies, and focus resources on particular “at risk” individuals soon after symptom onset when dysfunction and disability can be mitigated more effectively.
PUBLICATIONS:
None at this time.
DRA:
Military and Environmental Exposures
DRE:
Prevention, Treatment
Keywords:
PTSD, Risk factors, Deployment Related
MeSH Terms:
none
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