Jillian Frances Ikin

Comorbidity of PTSD and depression in Korean War veterans: prevalence, predictors, and impairment.

BACKGROUND Rates of PTSD and depression are high in Korean War veterans. The prevalence and impact of the two disorders occurring comorbidly, however, has not been investigated. This paper aims to investigate the extent to which PTSD and depression co-occur in Australian veterans of the Korean War, the symptom severity characteristics of comorbidity, the impact on life satisfaction and quality, and the association with war-related predictors. METHODS Veterans (N=5352) completed self-report questionnaires including the Posttraumatic Stress Disorder Checklist, the Hospital Anxiety and Depression Scale, the Life Satisfaction Scale, the brief World Health Organisation Quality of Life questionnaire and the Combat Exposure Scale. RESULTS Seventeen percent of veterans met criteria for comorbid PTSD and depression, 15% had PTSD without depression, and a further 6% had depression without PTSD. Compared with either disorder alone, comorbidity was associated with impaired life satisfaction, reduced quality of life, and greater symptom severity. Several war-related factors were associated with comorbidity and with PTSD alone, but not with depression alone. LIMITATIONS The reliance on self-reported measures and the necessity for retrospective assessment of some deployment-related factors renders some study data vulnerable to recall bias. CONCLUSIONS Comorbid PTSD and depression, and PTSD alone, are prevalent among Korean War veterans, are both associated with war-related factors 50 years after the Korean War, and may represent a single traumatic stress construct. The results have important implications for understanding complex psychopathology following trauma.

Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: relation to immunisations and other Gulf War exposures.

Aims: To investigate whether Australian Gulf War veterans have a higher than expected prevalence of recent symptoms and medical conditions that were first diagnosed in the period following the 1991 Gulf War; and if so, whether these effects were associated with exposures and experiences that occurred in the Gulf War. Methods: Cross-sectional study of 1456 Australian Gulf War veterans and a comparison group who were in operational units at the time of the Gulf War, but were not deployed to that conflict (n = 1588). A postal questionnaire was administered and the likelihood of the diagnosis of self-reported medical conditions was assessed and rated by a medical practitioner. Results: Gulf War veterans had a higher prevalence of all self-reported health symptoms than the comparison group, and more of the Gulf War veterans had severe symptoms. Increased symptom reporting was associated with several exposures, including having more than 10 immunisations, pyridostigmine bromide tablets, anti-biological warfare tablets, pesticides, insect repellents, reportedly being in a chemical weapons area, and stressful military service experiences in a strong dose-response relation. Gulf War veterans reported psychological (particularly post-traumatic stress disorder), skin, eye, and sinus conditions first diagnosed in 1991 or later more commonly than the comparison group. Over 90% of medical conditions reported by both study groups were rated by a medical practitioner as having a high likelihood of diagnosis. Conclusion: More than 10 years after the 1991 Gulf War, Australian veterans self-report all symptoms and some medical conditions more commonly than the comparison group. Further analysis of the severity of symptoms and likelihood of the diagnosis of medical conditions suggested that these findings are not due to over-reporting or to participation bias.

Respiratory health status of Australian veterans of the 1991 Gulf War and the effects of exposure to oil fire smoke and dust storms

Background: Since the 1991 Gulf War concerns have been raised about the effects on veterans’ health of exposures to Kuwaiti oil fire smoke and to dust storms. Methods: A cross sectional study compared 1456 Australian Gulf War veterans with a randomly sampled military comparison group (n = 1588). A postal questionnaire asked about respiratory conditions, exposures, medications, tobacco use, demographic characteristics, and military service details. During a medical assessment, spirometric tests and a physical examination were performed and a respiratory questionnaire was administered. Results: The response rate for the Gulf War veteran group was 80.5% and for the comparison group 56.8%. Australian Gulf War veterans had a higher than expected prevalence of respiratory symptoms and respiratory conditions suggesting asthma (OR 1.4; 95% CI 1.1 to 1.9) and bronchitis first diagnosed since the Gulf War (OR 1.9; 95% CI 1.2 to 3.1) but did not have poorer lung function or more ventilatory abnormalities than the comparison group. Veterans who reported exposure to oil fire smoke had slightly poorer forced vital capacity (difference between means –0.10 l; 95% CI –0.18 to –0.03) and those exposed to dust storms had a slightly better peak expiratory flow rate (difference between means 12.0 l/min; 95% CI 0.6 to 23.4) than veterans who did not report exposure. Veterans who were in the Gulf at or after the start of the oil fires had more respiratory conditions suggesting asthma (OR 1.7; 95% CI 1.0 to 2.9) than those who completed their deployment before this time. Conclusions: Increased self-reporting of respiratory symptoms, asthma, and bronchitis by veterans was not reflected in poorer lung function. The findings do not suggest major long term sequelae of exposure to oil fire smoke or dust storms.

Life satisfaction and quality in Korean War veterans five decades after the war.

Background: Military service is considered to be a hidden variable underlying current knowledge about well-being in the elderly. This study aimed to examine life satisfaction and quality of life in Australia’s surviving male Korean War veterans and a community comparison group, and to investigate any association with war deployment-related factors. Methods: Participants completed a postal questionnaire which included the Life Satisfaction Scale, the brief World Health Organization Quality of Life (WHOQOL-Bref) questionnaire and the Combat Exposure Scale. Results: Korean War veterans reported significantly lower Percentage Life Satisfaction (PLS) and quality of life scores on four WHOQOL-Bref domains, compared with similarly aged Australian men (each p value <0.001). These outcomes were most strongly associated with severity of combat exposure and low rank. Mean PLS was approximately 15% lower in veterans who reported heavy combat compared with those reporting no combat, and approximately 12% lower in enlisted ranked veterans compared with officers. Conclusions: Fifty years after the Korean War, life satisfaction and quality in Australian veterans is poor relative to other Australian men, and is associated with deployment-related factors including combat severity and low rank. In order to respond effectively to current and projected population health needs, nations with large veteran populations may need to consider the impact of military service on well-being in later life.

The health of Australian veterans of the 1991 Gulf War: factor analysis of self-reported symptoms

Background: A recent report showed that Australian veterans of the 1991 Gulf War displayed a greater prevalence of a multitude of self-reported symptoms than a randomly sampled comparison group of military personnel who were eligible for deployment but were not deployed to the Gulf. Aims: To investigate whether the pattern, rather than frequency, of symptom reporting in these Australian Gulf War veterans differed from that of the comparison group personnel. Methods: Factor analysis was used to determine whether the co-occurrence of 62 symptoms in 1322 male Gulf War veterans can be explained by a number of underlying dimensions, called factors. The methodology was also applied to 1459 male comparison group subjects and the factor solutions of the two groups were compared. Results: For the Gulf War veterans, a three factor solution displayed replicability and construct validity. The three factors were labelled as psycho-physiological distress, somatic distress, and arthro-neuromuscular distress, and were broadly similar to those described in previous studies of Gulf War veterans. A concordant three factor solution was also found for the comparison group subjects, with strong convergence of the factor loadings and factor scores across the two groups being displayed. Conclusion: Results did not display evidence of a unique pattern of self-reported symptoms among Gulf War veterans. Results also indicated that the differences between the groups lie in the degrees of expression of the three underlying factors, consistent with the well documented evidence of increased self-reported symptom prevalence in Gulf War veterans.

Developing a brief depression screen and identifying associations with comorbid physical and psychological illness in Australian Gulf War veterans

OBJECTIVE Major depression occurs frequently in veterans, and is associated with comorbid psychological and physical disorders and poorer quality of life. Depression can be difficult to detect in primary care, while lengthy assessment instruments can deter use. Our study aimed to develop a brief depression screen that could be used by veterans and caregivers, and then to compare the association between the brief screen and comorbidities and quality of life with that of a longer instrument. METHODS Our dataset comprised 1204 male Royal Australian Navy veterans of the 1990/91 Gulf War. Depressive symptoms were assessed using the General Health Questionnaire (GHQ-12), health-related quality of life by the Short-Form Health Survey (SF-12), major depression and comorbid psychiatric diagnoses such as posttraumatic disorder (PTSD) using Diagnostic and Statistical Manual (DSM-IV) criteria. Comorbid physical illnesses including musculoskeletal disorders, chronic fatigue and diabetes were examined. RESULTS A brief depression screen of three key self-reported symptoms was identified. Veterans with major depression present according to the screen were over four times more likely to have multisymptom illness or PTSD, and almost twice as likely to have musculoskeletal disorders. Having depression according to the brief screen and having at least one other physical or psychological condition was associated with poorer quality of life. Similar results were obtained for a longer screen based on all GHQ-12 items. CONCLUSION A 3 item depression screen performed as well as a 12 item one in identifying major depression, comorbid physical and psychological illness and poorer quality of life in veterans.

What Was Different about Exposures Reported by Male Australian Gulf War Veterans for the 1991 Persian Gulf War, Compared with Exposures Reported for Other Deployments?

This study identified chemical and environmental exposures specifically associated with the 1991 Persian Gulf War. Exposures were self-reported in a postal questionnaire, in the period of 2000-2002, by 1,424 Australian male Persian Gulf War veterans in relation to their 1991 Persian Gulf War deployment and by 625 Persian Gulf War veterans and 514 members of a military comparison group in relation to other active deployments. Six of 28 investigated exposures were experienced more frequently during the Persian Gulf War than during other deployments; these were exposure to smoke (odds ratio [OR], 4.4; 95% confidence interval, 3.0-6.6), exposure to dust (OR, 3.7; 95% confidence interval, 2.6-5.3), exposure to chemical warfare agents (OR, 3.9; 95% confidence interval, 2.1-7.9), use of respiratory protective equipment (OR, 13.6; 95% confidence interval, 7.6-26.8), use of nuclear, chemical, and biological protective suits (OR, 8.9; 95% confidence interval, 5.4-15.4), and entering/inspecting enemy equipment (OR, 3.1; 95% confidence interval, 2.1-4.8). Other chemical and environmental exposures were not specific to the Persian Gulf War deployment but were also reported in relation to other deployments. The number of exposures reported was related to service type and number of deployments but not to age or rank.

Increased symptom reporting persists in 1990–1991 Gulf War veterans 20 years post deployment

BACKGROUND Following the 1990-1991 Gulf War, Gulf War veterans (veterans) reported health symptoms more commonly than non-deployed groups. This article examines symptom persistence, incidence and prevalence 20 years on. METHODS In 2000-2003 and 2011-2012, a 63-item symptom checklist was administered to 697 veterans and 659 comparison group. Symptomatology was compared using log-binomial regression. RESULTS Both veterans and comparison group reported significantly increased prevalence (3-52%) over time in more than half the symptoms, with a similar overall rate of increase. Half the symptoms had higher incidence (risk-ratios ranged 1.43-1.50) and a quarter were more persistent (risk-ratios ranged 1.12-1.20) in veterans than the comparison group. CONCLUSIONS Symptomatology increased in both groups over time, but persisted to a similar extent and had higher incidence among veterans than the comparison group. The gap in symptom prevalence between the two groups remained unchanged. These findings suggest enduring health consequences of Gulf War service.

Major depression and depressive symptoms in Australian Gulf War veterans 20 years after the Gulf War.

BACKGROUND Risk of major depression (depression) was elevated in Australias Gulf War veterans in a 2000-2002 (baseline) study. A follow up study has measured the Gulf War-related risk factors for depression, also the current prevalence and severity of depression, use of anti-depressant medication, and persistence, remittance or incidence of depression since baseline in Gulf War veterans and a military comparison group. METHODS Participants completed the Composite International Diagnostic Interview v.2.1, the 9-item Patient Health Questionnaire and the Military Service Experience Questionnaire, and consented to Repatriation Pharmaceutical Benefits Scheme (RPBS) and PBS linkage. RESULTS Prevalence of depression (9.7% Gulf War veterans and 7.7% comparison group; adj RR=1.2, 95% CI 0.8-1.7), and pattern of persistence, remittance and incidence of depression since baseline, were similar in the two groups, however veterans reported slightly more severe symptoms (adj median difference 1, 95% CI 0.26-1.74) and were more likely to have been dispensed anti-depressant medication (adj RR=1.56, 95% CI 1.05-2.32). Depression amongst veterans was associated with self-reported Gulf War-related stressors in a dose-response relationship (adj RR 1.06, 95% CI 1.02-1.09). LIMITATIONS Lower participation rates at follow up resulted in reduced statistical power compared with baseline, Gulf War related stressor data collected at baseline was at risk of recall bias, and RPBS and PBS databases do not capture all dispensed Nervous System medications. CONCLUSIONS More than 20 years after the Gulf War, veterans are experiencing slightly more severe depressive symptoms than a military comparison group, and depression continues to be associated with Gulf War-related stressors.

Stability of symptom patterns in Australian Gulf War veterans: 10-year longitudinal study

Objectives Previously we established that symptoms reported by 1990–1991 Gulf War veterans were correlated and exhibited a pattern with 3 factors (psychophysiological distress, somatic distress and arthroneuromuscular distress), and this pattern was similar to that observed in a military comparison group. In this follow-up study, we examined whether the patterns of symptomatology have changed over time. Methods Using data on 56 symptoms that was collected in 2000–2003 (wave 1) and 2011–2012 (wave 2) from an Australian cohort of Gulf War veterans (veterans) and a military comparison group, exploratory factor analysis was conducted and Tuckers Congruence Coefficient (TCC) was used to determine factor structure similarity across study groups and waves. Results The results showed that the 3 factors observed at wave 1 were still present at wave 2, and factor structures across study groups and study waves were fairly similar, with TCC ranging 0.86–0.92. Veterans consistently reported more symptoms across all 3 factors. Veterans’ symptomatology specific to psychophysiological distress increased between waves 1 and 2 (ratio of means 1.15; 95% CI 1.07 to 1.25) but psychophysiological distress symptomatology was constant in the comparison group (ratio of means 0.97; 95% CI 0.89 to 1.06). Somatic and arthroneuromuscular distress symptomatology significantly increased over time for both study groups, although at a similar rate. Conclusions While the symptom groupings (measured by the 3 factors) remained unchanged at 10 years of follow-up, and remained comparable between Gulf War and comparison group, symptomatology continued to be elevated in Gulf War veterans than in the comparison group, and was most evident for psychophysiological distress.