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Are Veterans Seeking Veterans Affairs’ Primary Care as Healthy as Those Seeking Department of Defense Primary Care? A Look at Gulf War Veterans’ Symptoms and Functional Status

From Veterans Affairs Puget Sound Health Care System (R.D.R., S.C.H., M.M.), Seattle, WA; University of Washington School of Medicine (R.D.R., M.M), Seattle, WA; Department of Psychiatry (C.C.E.), Uniformed Services University, Bethesda, MD; Deployment Health Clinical Center (C.C.E.), Walter Reed Army Medical Center, Washington, DC; University of Arizona (K.M.), Department of Psychology, Tuscon, AZ; CESATE, VA Puget Sound Health Care System (K.M.), Seattle, WA.

Address reprint requests to: Ralph D. Richardson, 116 MHC, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108. Email: doc4reud{at}aol.com

OBJECTIVE: This study compared Gulf War veterans seeking VA primary care with Gulf War veterans seeking treatment from a Department of Defense primary care clinic on measures of physical symptoms, psychiatric complaints, and functional status. Additionally, the association between employment status and health was examined.

METHODS: Analysis was based on the responses of consecutive patients attending the Gulf War Primary Care clinics at either the VA Puget Sound Health Care System in Seattle, WA (N= 223), or the Walter Reed Army Medical Center in Washington, DC (N= 153), between March 1998 and September 1999.

RESULTS: After controlling for demographic variables, Gulf War veterans who sought VA care reported significantly more anxiety and PTSD symptoms than active duty military personnel. The groups did not differ on somatic complaints or summary scores from the SF-36. Employment status was significantly, independently, and consistently associated with greater psychiatric symptoms, physical symptoms, and decreased functional status.

CONCLUSIONS: Our findings reveal important differences in health status between veterans seeking primary care at a VA and a Department of Defense facility, differences that are in part related to employment status. Both groups report symptoms of psychiatric distress and decreased functional status, though VA patients are more impaired. Research findings based on clinical samples of veterans at VA sites may not generalize to Gulf War veterans still on active duty (and vice versa).

Key Words: Persian Gulf • healthy worker effect • health • functional status • PTSD • employment

Abbreviations: VA = Veterans Affairs;; WR = Walter Reed Army Medical Center;; BSI = Brief Symptom Inventory;; PHQ = Patient Health Questionnaire;; SSC = Somatic Symptom Checklist;; PCL-M = Post Traumatic Stress Disorder Checklist, Military version;; SF-36 = Medical Outcomes Study Short Form 36;; PTSD = postraumatic stress disorder;; GSI = global severity index;; DSM-IV = Diagnostic and Statistical Manual for Mental Disorders;; MHC = Mental Component Summary;; PCS = Physical Component Summary.