Skip to main content
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2000 Nov;54(11):834–838. doi: 10.1136/jech.54.11.834

Occupational risk factors for ill health in Gulf veterans of the United Kingdom

K Ismail 1, N Blatchley 1, M Hotopf 1, L Hull 1, I Palmer 1, C Unwin 1, A David 1, S Wessely 1
PMCID: PMC1731581  PMID: 11027197

Abstract

OBJECTIVES—To study the association between occupational factors specific to the Armed Forces (rank, functional roles, Service, regular or reservist status and deployment factors) and symptomatic health problems in Gulf veterans, after sociodemographic and lifestyle factors have been accounted for.
DESIGN—A postal cross sectional survey of randomly selected UK Gulf veterans was conducted six to seven years after the Gulf conflict. Physical ill health was measured using the Fatigue Questionnaire and a measure of the Centers for Disease Control and Prevention (CDC) multi-symptom syndrome. Psychological ill health was measured using the General Health Questionnaire and a post-traumatic stress measure.
SETTING—Population of servicemen who were serving in the UK Armed Forces during the Gulf conflict between 1 September 1990 and 30 June 1991.
PARTICIPANTS—3297 Gulf veterans.
MAIN RESULTS—In multivariate logistic regression, there was an inverse relation between higher rank and psychological and physical ill health (test of trend: General Health Questionnaire, p=0.004 ; post-traumatic stress, p=0.002; fatigue, p=0.015; CDC case, p=0.002). Having left the Armed Forces was associated with a two to three times increase in reporting ill health. Of the deployment factors, there was a weak association between being deployed as an individual reinforcement in a combat role and post-traumatic stress but there was no association between receiving pre-deployment training or post-deployment leave and ill health. Marital status and smoking were associated with psychological and physical ill health.
CONCLUSIONS—Rank was the main occupational factor associated with both psychological and physical ill health in Gulf veterans. This may parallel the associations between socioeconomic status and morbidity in civilian populations. Ill health seems to be greater in those who return to civilian life. Sociodemographic factors also seem to be important in ill health in Gulf veterans.


Keywords: military; Gulf veterans; rank

Full Text

The Full Text of this article is available as a PDF (137.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bray R. M., Marsden M. E., Peterson M. R. Standardized comparisons of the use of alcohol, drugs, and cigarettes among military personnel and civilians. Am J Public Health. 1991 Jul;81(7):865–869. doi: 10.2105/ajph.81.7.865. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Breslau N., Kilbey M. M., Andreski P. Nicotine dependence and major depression. New evidence from a prospective investigation. Arch Gen Psychiatry. 1993 Jan;50(1):31–35. doi: 10.1001/archpsyc.1993.01820130033006. [DOI] [PubMed] [Google Scholar]
  3. Chalder T., Berelowitz G., Pawlikowska T., Watts L., Wessely S., Wright D., Wallace E. P. Development of a fatigue scale. J Psychosom Res. 1993;37(2):147–153. doi: 10.1016/0022-3999(93)90081-p. [DOI] [PubMed] [Google Scholar]
  4. Coker W. J., Bhatt B. M., Blatchley N. F., Graham J. T. Clinical findings for the first 1000 Gulf war veterans in the Ministry of Defence's medical assessment programme. BMJ. 1999 Jan 30;318(7179):290–294. doi: 10.1136/bmj.318.7179.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Derogatis L. R., Lipman R. S., Rickels K., Uhlenhuth E. H., Covi L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974 Jan;19(1):1–15. doi: 10.1002/bs.3830190102. [DOI] [PubMed] [Google Scholar]
  6. Dlugosz L. J., Hocter W. J., Kaiser K. S., Knoke J. D., Heller J. M., Hamid N. A., Reed R. J., Kendler K. S., Gray G. C. Risk factors for mental disorder hospitalization after the Persian Gulf War: U.S. Armed Forces, June 1, 1991-September 30, 1993. J Clin Epidemiol. 1999 Dec;52(12):1267–1278. doi: 10.1016/s0895-4356(99)00131-6. [DOI] [PubMed] [Google Scholar]
  7. Fukuda K., Nisenbaum R., Stewart G., Thompson W. W., Robin L., Washko R. M., Noah D. L., Barrett D. H., Randall B., Herwaldt B. L. Chronic multisymptom illness affecting Air Force veterans of the Gulf War. JAMA. 1998 Sep 16;280(11):981–988. doi: 10.1001/jama.280.11.981. [DOI] [PubMed] [Google Scholar]
  8. Glass R. M. Blue mood, blackened lungs. Depression and smoking. JAMA. 1990 Sep 26;264(12):1583–1584. [PubMed] [Google Scholar]
  9. Goldberg J., True W. R., Eisen S. A., Henderson W. G. A twin study of the effects of the Vietnam War on posttraumatic stress disorder. JAMA. 1990 Mar 2;263(9):1227–1232. [PubMed] [Google Scholar]
  10. Gray G. C., Hawksworth A. W., Smith T. C., Kang H. K., Knoke J. D., Gackstetter G. D. Gulf War Veterans' Health Registries. Who is most likely to seek evaluation? Am J Epidemiol. 1998 Aug 15;148(4):343–349. doi: 10.1093/oxfordjournals.aje.a009651. [DOI] [PubMed] [Google Scholar]
  11. Gray G. C., Kaiser K. S., Hawksworth A. W., Hall F. W., Barrett-Connor E. Increased postwar symptoms and psychological morbidity among U.S. Navy Gulf War veterans. Am J Trop Med Hyg. 1999 May;60(5):758–766. doi: 10.4269/ajtmh.1999.60.758. [DOI] [PubMed] [Google Scholar]
  12. Marmot M. G., Bosma H., Hemingway H., Brunner E., Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997 Jul 26;350(9073):235–239. doi: 10.1016/s0140-6736(97)04244-x. [DOI] [PubMed] [Google Scholar]
  13. McCauley L. A., Joos S. K., Spencer P. S., Lasarev M., Shuell T. Strategies to assess validity of self-reported exposures during the Persian Gulf War. Portland Environmental Hazards Research Center. Environ Res. 1999 Oct;81(3):195–205. doi: 10.1006/enrs.1999.3977. [DOI] [PubMed] [Google Scholar]
  14. O'Toole B. I., Marshall R. P., Schureck R. J., Dobson M. Risk factors for posttraumatic stress disorder in Australian Vietnam veterans. Aust N Z J Psychiatry. 1998 Feb;32(1):21–31. doi: 10.3109/00048679809062702. [DOI] [PubMed] [Google Scholar]
  15. Peto R., Lopez A. D., Boreham J., Thun M., Heath C., Jr Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet. 1992 May 23;339(8804):1268–1278. doi: 10.1016/0140-6736(92)91600-d. [DOI] [PubMed] [Google Scholar]
  16. Richards M., Hardy R., Wadsworth M. The effects of divorce and separation on mental health in a national UK birth cohort. Psychol Med. 1997 Sep;27(5):1121–1128. doi: 10.1017/s003329179700559x. [DOI] [PubMed] [Google Scholar]
  17. Seltzer C. C., Jablon S. Army rank and subsequent mortality by cause: 23-year follow-up. Am J Epidemiol. 1977 Jun;105(6):559–566. doi: 10.1093/oxfordjournals.aje.a112420. [DOI] [PubMed] [Google Scholar]
  18. Sloggett A., Joshi H. Deprivation indicators as predictors of life events 1981-1992 based on the UK ONS Longitudinal Study. J Epidemiol Community Health. 1998 Apr;52(4):228–233. doi: 10.1136/jech.52.4.228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Sloggett A., Joshi H. Higher mortality in deprived areas: community or personal disadvantage? BMJ. 1994 Dec 3;309(6967):1470–1474. doi: 10.1136/bmj.309.6967.1470. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Stansfeld S. A., Fuhrer R., Shipley M. J. Types of social support as predictors of psychiatric morbidity in a cohort of British Civil Servants (Whitehall II Study). Psychol Med. 1998 Jul;28(4):881–892. doi: 10.1017/s0033291798006746. [DOI] [PubMed] [Google Scholar]
  21. Suadicani P., Ishøy T., Guldager B., Appleyard M., Gyntelberg F. Determinants of long-term neuropsychological symptoms. The Danish Gulf War Study. Dan Med Bull. 1999 Nov;46(5):423–427. [PubMed] [Google Scholar]
  22. Unwin C., Blatchley N., Coker W., Ferry S., Hotopf M., Hull L., Ismail K., Palmer I., David A., Wessely S. Health of UK servicemen who served in Persian Gulf War. Lancet. 1999 Jan 16;353(9148):169–178. doi: 10.1016/S0140-6736(98)11338-7. [DOI] [PubMed] [Google Scholar]
  23. Weich S., Lewis G. Poverty, unemployment, and common mental disorders: population based cohort study. BMJ. 1998 Jul 11;317(7151):115–119. doi: 10.1136/bmj.317.7151.115. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES