Prospective Study of Veteran Health in Previously Deployed Soldiers
Condition: Combat Disorders
MeSH terms: Combat Disorders
Study type: Observational

Summary: 
      Background: Previous deployments like that to the Persian Gulf in 1991 produced veterans with
      post-deployment symptom-based health problems with no medical explanation. This was termed
      Gulf War illness or medically unexplained illness (MUI). If previous wars are any indication,
      some soldiers currently deployed to hostile areas also will return home with unexplained
      symptom-based illnesses. However, when this study began there was virtually no pre-war,
      prospective data on risk and resilience factors associated with MUI. This study is attempting
      to fill that gap.

      Objectives: Our goals are to: (a) determine pre- and immediate post-deployment factors
      predicting later MUI and poor functional status, (b) improve previous methodological problems
      (e.g., selection bias, recall bias and lack of baseline controls) in studies of MUI, and (c)
      relate pre-deployment risk factors (e.g., personality, stressor reactivity) and resilience
      factors (e.g., coping style, social support) to post-deployment functional status.
    

Detailed description: 
      Background: Previous deployments like that to the Persian Gulf in 1991 produced veterans with
      post-deployment symptom-based health problems with no medical explanation. This was termed
      Gulf War illness or medically unexplained illness (MUI). If previous wars are any indication,
      some soldiers currently deployed to hostile areas also will return home with unexplained
      symptom-based illnesses. However, was virtually no pre-war, prospective data on risk and
      resilience factors associated with MUI before 2001. This study will attempt to fill that gap.
      Objectives: Our goals are to: (a) determine pre- and immediate post-deployment factors
      predicting later MUI and poor functional status, (b) improve previous methodological problems
      (e.g., selection bias, recall bias and lack of baseline controls) in studies of MUI, and (c)
      relate pre-deployment risk factors (e.g., personality, stressor reactivity) and resilience
      factors (e.g., coping style, social support) to post-deployment functional status. Methods:
      This study uses a prospective, longitudinal observational design to assess risk and
      resilience factors for post-war MUI in Reserve and National Guard enlisted personnel. A
      stratified random sample of more than 700 subjects will be drawn from those undergoing pre-
      and post-mobilization readiness processing at Fort Dix, NJ and Camp Shelby, MS. Personnel
      will be tested pre-mobilization (Phase 1), immediately after mobilization (Phase 2) and at 3
      months and 1 year post-deployment (Phases 3 & 4). Predictor variables include personality,
      social support, coping style, non-specific symptoms, sympathetic cardiac stress reactivity,
      and cortisol stress reactivity. Control variables include prior traumatic events, current
      distress, PTSD symptoms, socially desirable responding, body mass index, deployment
      experiences, environmental exposures and demographics (e.g., age, gender). Outcome variables
      include functional status, healthcare utilization, and MUI status (using CDC criteria for
      chronic multisymptom illness developed after the first Gulf War). Status: Publications and
      presentations are being prepared. Impact: The larger, prospective study with soldiers will
      help us to identify pre- and early post-deployment risk and resilience factors important in
      MUI, functional status, and healthcare utilization. There is an urgent need for both pre- and
      post-deployment predictors of later MUI uncontaminated by recall bias, and the selection bias
      of studying only treatment-seekers. If we are to understand how to best treat veterans
      presenting with unexplained symptoms, then we need to know which pre-war factors are most
      useful in predicting who is most likely to be resilient and who is most likely to be at risk
      for later unexplained illness.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Army National Guard & Reserves Soldiers deploying to either Iraq or Afghanistan. Outcome
        measures assessed at all 4 time points (pre-deployment, immediately post-deployment, 3
        months post-return, 1 year post-return)
      
Biospecimen description: 
      Saliva
    
Keywords: combat disorders; stress, psychological; somatoform disorders; life change events; utilization