Chronic Multisymptom Illness in Gulf War Veterans Case Definitions Reexamined (2014) / Chapter Skim
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Numerous researchers have described the pattern of signs and symptoms found in deployed Gulf War veterans and noted that they report unexplained symptoms at higher rates than nondeployed veterans or veterans deployed elsewhere during the same period. Gulf War veterans have consistently shown a higher level of morbidity than the nondeployed, in some cases with severe and debilitating consequences.
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In addition, the vigorous discussions with the veterans and researchers were invaluable for increasing the committee members' understanding of the complexity of issues involved in its task. 2 The committee uses the term chronic multisymptom illness throughout the report, as defined in the statement of work, when referring to the symptom complex in Gulf War veterans.
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, when several symptoms are reported together in the absence of evidence of a physical cause, they are often termed medically unexplained syndromes. To add to the difficulty in defining CMI and finding a common etiology, the literature contains a number of discussions that refer to different postwar syndromes as possible explanations for the illnesses in Gulf War veterans (e.g., Engel, 2004; Hyams et al., 1996)
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. Case Definitions of Chronic Multisymptom Illness in Gulf War Veterans One of the tasks of the committee was to examine the peer-reviewed literature specific to deployed Gulf War veterans' symptomatology in an effort to develop or identify a case definition that will show adequate sensitivity and specificity for research and treatment purposes.
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General Limitations of Gulf War Studies The cohort studies of Gulf War veterans have contributed greatly to the understanding of veterans' health, but limitations are commonly encountered in observational epidemiologic studies. They include selection biases that limit the studies' control for potential confounding factors, self-reporting of health outcomes and exposures affected by recall bias, outcome misclassification, and reporting bias.3 Other limitations of the body of evidence are that studies might be too narrow in their assessment of health status, the measurement instruments might have been too insensitive to detect abnormalities that affect deployed veterans, and the period of investigation might have been too brief to detect health outcomes that have a long latency or require many years to progress to the point where disability, hospitalization, or death occurs.
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However, people do not have factors; everyone will have a score on each factor, but dichotomization of factor scores to define a "case" is a postprocessing decision made by the investigator and is not a direct result of the factor-analytic model. The studies that have used factor analysis to investigate symptoms in Gulf War veterans have used several strategies.
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. TABLE S.1 Case Definitions of Chronic Multisymptom Illness Used in Gulf War Veteran Studies Definition Symptoms -- must have signs, Duration Onset Exclusions Severity symptoms, or complaints that fit at least Haley -- 5 of 8 signs or symptoms: Must be denied a clinical 1)
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musculoskeletal symptoms, including back pain, persistent muscle aches or pains, painful joints, swollen joints, joint stiffness, and pain after exertion VA Might include things like fatigue, ≥6 Must not be (Kang et muscle or joint pain, headache, months adequately al., 2009) memory problems, digestive explained by problems, respiratory problems, conventional skin problems, or any other medical or unexplained symptoms that may psychiatric
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Furthermore symptoms were regularly reported with higher frequency in Gulf War veterans than in nondeployed era veterans or veterans who were deployed elsewhere; they include gastrointestinal, respiratory, and dermatologic symptoms (those were in addition to the fatigue, pain, and neurocognitive symptoms already identified)
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The CDC definition captures those three symptoms; the Kansas definition also captures them, but it also includes the symptoms reported most frequently by Gulf War veterans. Other case-definition studies report additional symptoms that are not seen with the same frequency or in all studies.
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Gulf War illness has been used by many researchers to identify the array of symptoms expressed by Gulf War veterans. Its consistent use in the literature might reduce confusion.
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arylesterase activity with neurologic symptom complexes in Gulf War veterans. Toxicology and Applied Pharmacology 157(3)
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1998. Health symptoms reported by Persian Gulf War veterans two years after return.
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