title: The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study.
abstract: OBJECTIVE
  To examine the prevalence of psychiatric disorders in veterans of the Gulf war with or without unexplained physical disability (a proxy measure of ill health) and in similarly disabled veterans who had not been deployed to the Gulf war (non-Gulf veterans).
  
  
  METHODS
  Two phase cohort study.
  
  
  METHODS
  Current and ex-service UK military personnel.
  
  
  METHODS
  Phase 1 consisted of three randomly selected samples of Gulf veterans, veterans of the 1992-7 Bosnia peacekeeping mission, and UK military personnel not deployed to the Gulf war (Era veterans) who had completed a postal health questionnaire. Phase 2 consisted of randomly selected subsamples from phase 1 of Gulf veterans who reported physical disability (n=111) or who did not report disability (n=98) and of Bosnia (n=54) and Era (n=79) veterans who reported physical disability.
  
  
  METHODS
  Psychiatric disorders assessed by the schedule for clinical assessment in neuropsychiatry and classified by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.
  
  
  RESULTS
  Only 24% (n=27) of the disabled Gulf veterans had a formal psychiatric disorder (depression, anxiety, or alcohol related disorder). The prevalence of psychiatric disorders in non-disabled Gulf veterans was 12%. Disability and psychiatric disorders were weakly associated in the Gulf group when confounding was adjusted for (adjusted odds ratio 2.4, 99% confidence interval 0.8 to 7.2, P=0.04). The prevalence of psychiatric disorders was similar in disabled non-Gulf veterans and disabled Gulf veterans ( 19% v 24%; 1.3, 0.5 to 3.4). All groups had rates for post-traumatic stress disorder of between 1% and 3%.
  
  
  CONCLUSIONS
  Most disabled Gulf veterans do not have a formal psychiatric disorder. Post-traumatic stress disorder is not higher in Gulf veterans than in other veterans. Psychiatric disorders do not fully explain self reported ill health in Gulf veterans; alternative explanations for persistent ill health in Gulf veterans are needed.
authors.affiliation: Gulf War Illnesses Research Unit, Guy's, King's, and St Thomas's School of Medicine, London SE5 8AZ. khalida.ismail@iop.kcl.ac.uk
authors.forename: Khalida
authors.initials: K
authors.lastname: Ismail
authors.forename: Kate
authors.initials: K
authors.lastname: Kent
authors.forename: Traolach
authors.initials: T
authors.lastname: Brugha
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.forename: Lisa
authors.initials: L
authors.lastname: Hull
authors.forename: Paul
authors.initials: P
authors.lastname: Seed
authors.forename: Ian
authors.initials: I
authors.lastname: Palmer
authors.forename: Steve
authors.initials: S
authors.lastname: Reid
authors.forename: Catherine
authors.initials: C
authors.lastname: Unwin
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
mesh_terms: D015331:Cohort Studies; D006233:Persons with Disabilities / Q000523:psychology; D006801:Humans; D007493:Iraq; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D008603:Mental Health; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*; D014857:Warfare