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From the Portland VA Medical Center (D.S., K.A.C.) and the Center for Research on Occupational and Environmental Toxicology (D.S., L.M., W.K.A., D.S.R., C.A.K.), Department of Psychiatry (K.A.C.), and Department of Neurology (L.M.B.), Oregon Health Sciences University, Portland, OR.
Address reprint requests to: Daniel Storzbach, PhD, Center for Research on Occupational and Environmental Toxicology, 3181 SW Sam Jackson Park Road, L606, Oregon Health Sciences University, Portland, OR 97201. Email: storzbach{at}home.com
OBJECTIVE: The objective of this study was to assess measures of psychological and neurobehavioral functioning to determine their association with unexplained symptoms in Gulf War veterans.
METHODS: An epidemiological survey focusing on exposures and symptoms was mailed to a random sample of Gulf War veterans from Oregon and southwestern Washington. Volunteers were recruited from survey respondents who agreed to undergo a thorough medical examination and psychological and neurobehavioral assessment. Persistent symptoms with no medical explanation associated with service in the Persian Gulf (eg, fatigue, muscle pain, and memory deficits) that began during or after the war qualified respondents as cases. The 241 veterans with unexplained symptoms were classified as case subjects, and the 113 veterans without symptoms were classified as control subjects. All veterans completed a battery of computerized assessment tests consisting of 12 psychosocial and 6 neurobehavioral tests. Differences between case and control subjects on neurobehavioral and psychological variables were assessed with univariate and multivariate statistical comparisons.
RESULTS: Case subjects differed substantially and consistently from control subjects on diverse psychological tests in the direction of increased distress and psychiatric symptoms. Case subjects had small but statistically significant deficits relative to control subjects on some neurobehavioral tests of memory, attention, and response speed. A logistic regression model consisting of four psychological variables but no neurobehavioral variables classified case and control subjects with 86% accuracy.
CONCLUSIONS: Our results revealed that Gulf War veterans who report symptoms associated with that conflict differed on multiple psychological measures in the direction of increased distress and performed more poorly on neurobehavioral measures when compared with control subjects who did not report symptoms. This suggests that psychological differences have a prominent role in investigation of possible explanations of Gulf War symptoms.
Key Words: psychological assessment • neurobehavioral assessment, • veterans • Persian Gulf War, • health symptoms • clinical evaluation.
Abbreviations: BAI = Beck Anxiety Inventory; BARS = Behavioral Assessment and Research System; BDI = Beck Depression Inventory; CES-R = Combat Exposure Scale, Operation Desert Storm Revision; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; GW = Gulf War; HSS = Health Screening System; LES = Life Experiences Scale; Mississippi PTSD scale = Mississippi Scale for Combat-Related Posttraumatic Stress Disorder; MMPI-2 = Minnesota Multiphasic Personality Inventory-2; ODTP = Oregon Dual Task Procedure; PANAS = Positive and Negative Affect Schedule; PCL-C = Posttraumatic Stress Disorder Checklist–Civilian Version; Penn inventory = Penn Inventory for Posttraumatic Stress Disorder; PTSD = posttraumatic stress disorder; SASSI-2 = Substance Abuse Subtle Screening Inventory-2; SCIS = Subjective Cognitive Impairment Scale; SCL-90-R = Symptom Checklist-90-Revised; SF-36 = Health Status Questionnaire, short form.
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