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War-related psychological stressors and risk of psychological disorders in Australian veterans of the 1991 Gulf War

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne

MALCOLM R. SIM, PhD

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne

MARK C. CREAMER, PhD

Australian Centre for Post-traumatic Mental Health, University of Melbourne, Melbourne

ANDREW B. FORBES, PhD, DEAN P. McKENZIE, BA(Hons), HELEN L. KELSALL, MPH and DEBORAH C. GLASS, PhD

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne

ALEXANDER C. McFARLANE, MD

Department of Psychiatry, University of Adelaide, Adelaide

MICHAEL J. ABRAMSON, PhD and PETER ITTAK, BSc

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne

TERRY DWYER, MD and LEIGH BLIZZARD, PhD

Menzies Centre for Population Health Research, University of Tasmania, Hobart

KERRY R. DELANEY, MBBS

Royal Australian Navy, retired, Canberra

KEITH W. A. HORSLEY, MPA and WARREN K. HARREX, MSc

Australian Government - Department of Veterans'Affairs, Canberra

HARRY SCHWARZ, MPH

Health Services Australia, Melbourne, Victoria, Australia

Correspondence: Jillian Ikin, Monash University, Department of Epidemiology and Preventive Medicine, Central and Eastern Clinical School, Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia. Tel: +61 3 9903 0555; Fax: +61 3 9903 0556; e-mail: jill.ikin{at}med.monash.edu.au

Declaration of interest Supported by the Australian Government - Department of Veterans'Affairs.

Background Questions remain about the long-term health impacts of the 1991 Gulf War on its veterans.

Aims To measure psychological disorders in Australian Gulf War veterans and a military comparison group and to explore any association with exposure to Gulf War-related psychological stressors.

Method Prevalences of DSM-IV psychological disorders were measured using the Composite International Diagnostic Interview. Gulf War-related psychological stressors were measured using a service experience questionnaire.

Results A total of 31% of male Gulf War veterans and 21% of the comparison group met criteria for a DSM-IV disorder first present in the post-Gulf War period. The veterans were at greater risk of developing post-Gulf War anxiety disorders including post-traumatic stress disorder, affective disorders and substance use disorders. The prevalence of such disorders remained elevated a decade after deployment. The findings can be explained partly as a ‘war-deployment effect’. There was a strong dose-response relationship between psychological disorders and number of reported Gulf War-related psychological stressors.

Conclusions Service in the 1991 Gulf War is associated with increased risk of psychological disorders and these are related to stressful experiences.

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