Gulf War and Health Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress (2008) / Chapter Skim
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has had a program to examine health risks posed by specific agents and hazards to which Gulf War veterans might have been exposed during their deployment. Four reports have examined health effects related to depleted uranium, pyridostigmine bromide, sarin, and vaccines; insecticides and solvents; fuels, combustion products, and propellants; and infectious diseases.
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In response to VA's request, IOM appointed the Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of DeploymentRelated Stress to conduct the review. COMMITTEE'S INTERPRETATION OF ITS CHARGE Given the committee's charge from VA -- to assess the long-term health effects of deployment-related stress -- the committee began by defining the deployment in question as "deployment to a war zone." Combat is one of the most potent stressors that a person can experience, but as military conflicts have evolved to include more guerilla warfare and insurgent activities, restricting the definition of deployment-related stressors to combat may fail to acknowledge other potent stressors experienced by military personnel in a war zone or in the aftermath of combat.
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To consider a study as primary, the committee insisted that the health effect be diagnosed or confirmed by a clinical evaluation, specific laboratory test, hospital records, or other medical record or, for a psychiatric outcome, by standardized interviews. Primary studies included comparisons of veterans deployed to a war zone with their nondeployed counterparts and studies that evaluated health effects in veterans with deployment-related or combat-related PTSD.
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From page 4... ...
Limited but Suggestive Evidence of an Association Evidence is suggestive of an association between deployment to a war zone and a specific health effect in human studies, but the body of evidence is limited by the inability to rule out chance and bias, including confounding, with confidence. At least one high-quality study reports a positive association that is sufficiently free of bias and includes adequate control for confounding, and other corroborating studies provide support for the association but are not sufficiently free of bias, including confounding.
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LIMITATIONS OF VETERAN STUDIES Few of the studies reviewed by the committee measured combat exposure or the level of stress experienced by military personnel during deployment to a war zone. Even in the studies that did assess combat exposure, using questionnaires or scales, researchers asked whether an exposure occurred (for example, had a soldier fired on the enemy)
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Acute stress responses are usually adaptive, preparing the body for "fight or flight." After exposure to the stressor has ended, the acute stress response subsides, and the body returns to its normal state. However, if the body's reactions persist after the stressor has ended, a chronic stress response can develop, which can be maladaptive and result in feelings of anxiety and lack of control and chronic health effects.
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No health effects were found for two categories of association, sufficient evidence of a causal relationship and limited/suggestive evidence of no association. Of all the long-term health effects reviewed, the strongest findings were on psychiatric disorders, including PTSD, anxiety, and depression.
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From page 8... ...
That is, a consistent positive association has been observed between deployment to a war zone and a specific health effect in human studies in which chance and bias, including confounding, could be ruled out with reasonable confidence. For example, several high-quality studies report consistent positive associations, and the studies are sufficiently free of bias and include adequate control for confounding.
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From page 9... ...
• Adverse employment outcomes. Limited/Suggestive Evidence of No Association Evidence is consistent in not showing a positive association between deployment to a war zone and a specific health effect after exposure of any magnitude.
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