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Release: June 16, 2000

UI study finds evidence of multiple symptoms, but no 'Gulf War syndrome'

IOWA CITY, Iowa -- In a study involving nearly 3,700 Gulf War-era veterans from Iowa, University of Iowa Health Care researchers did not find evidence of a unique "Gulf War syndrome" attributed to military service in the Persian Gulf from 1990-1991.

While the findings should alleviate concerns about an unexplained "mystery illness" among Gulf War veterans, the study results make clear the need to recognize the number of unexplained symptoms among veterans who served in the Persian Gulf and develop strategies for preventing similar health problems following future military operations. The study is published in the June 15 issue of the American Journal of Medicine.

"Since the end of the Gulf War, there have been concerns about whether Gulf War veterans have a medical illness of unknown origin," said Bradley N. Doebbeling, M.D., UI associate professor of internal medicine and epidemiology, and senior investigator and lead author of the study. "Although a number of studies had been conducted, there has been no definitive explanation as to whether such a syndrome exists or not. Our goal was to look for evidence of an illness that was unique to those deployed in the Persian Gulf and was not seen in a comparable control group of military personnel from that period who did not serve in the Persian Gulf."

Doebbeling and his colleagues surveyed approximately 1,900 Iowa veterans from 889 military units who were deployed to the Persian Gulf. They also surveyed a control group of nearly 1,800 Iowa veterans from 893 military units who did not serve in the Persian Gulf. The subjects answered questions about commonly reported and potentially important health symptoms.

Half of the deployed veterans and 14 percent of the nondeployed controls reported health problems that they attributed to military service during 1990-1991. Compared with the nondeployed controls, the deployed veterans had significantly greater frequency of 123 of 137 symptoms. The greatest differences in reported symptoms between the deployed veterans and nondeployed controls included multiple joint pain, joint stiffness, fatigue, headaches and memory problems.

The researchers then used factor analysis, a statistical technique that can identify patterns of related responses, on a random subset of the group of deployed veterans to find underlying patterns of symptoms. The results were compared with those from a separate, random subset of deployed Gulf War veterans, as well as a large group of nondeployed controls.

"We assumed that if there indeed was a unique Gulf War syndrome, the patterns of reported symptoms would be similar among the two subsets of deployed veterans, and those symptom patterns would be different from the nondeployed controls," Doebbeling said.

Factor analysis identified three symptom patterns that were repeated among the two subsets of deployed veterans. These were somatic distress (joint stiffness, myalgia, numbness or tingling, headaches and nausea), psychological distress (feeling nervous, worrying, feeling distant or cut off, and depression), and panic (anxiety attacks, a racing or skipping heart, attacks of chest pain, and attacks of sweating).

However, these three patterns of symptoms were nearly identical to the patterns of symptoms identified among the nondeployed controls. This suggests that the health complaints of Gulf War veterans are similar to those of the general military population and therefore make the existence of a Gulf War syndrome unlikely.

The UI study is unique among other investigations, Doebbeling noted, in that it evaluated a large, representative sample of nearly 2,000 soldiers from hundreds of units deployed to the Persian Gulf, and an equally large control group of military personnel from hundreds of units not deployed to the Persian Gulf. The soldiers in the study represented all U.S. military service branches, both active duty National Guard and reserve units, regardless of whether they had been discharged from military service.

The study had one of the highest participation rates of medical research studies related to the Gulf War so far, Doebbeling added. The study results confirm previous findings from two separate studies that also used factor analysis, one involving U.S. Air Force units from Pennsylvania and one involving British military personnel.

Doebbeling noted that although the study did not identify a unique disorder, the Gulf War veterans did report many symptoms, which could reflect medical conditions that occur more commonly in deployed veterans.

"This study further emphasizes the need to accept and treat the health problems of these veterans and find ways to prevent these health problems from occurring to future military personnel," he said.

UI researchers have a follow-up study under way that examines the veterans' medical problems by conducting in-person evaluations, physical exams and neurological testing, and assessing for risk factors. This work is being done at the UI Hospitals and Clinics.

The UI study, directed by Doebbeling and David Schwartz, M.D., UI professor of internal medicine and environmental and occupational health, was funded by the U.S. Centers for Disease Control and Prevention (CDC). The U.S. Department of Defense is funding the follow-up study.

The study co-authors included Schwartz, UI researchers William Clarke, Ph.D., James Torner, Ph.D., David Watson, Ph.D., Robert Woolson, Ph.D., and Margaret Voelker, Ph.D., and Drue Barrett, Ph.D., from the CDC.

In addition to their UI faculty appointments, Doebbeling and Schwartz are staff physicians and researchers at the Veterans Affairs Medical Center in Iowa City.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.