title: Self-reported ill health in male UK Gulf War veterans: a retrospective cohort study.
abstract: BACKGROUND
  Forces deployed to the first Gulf War report more ill health than veterans who did not serve there. Many studies of post-Gulf morbidity are based on relatively small sample sizes and selection bias is often a concern. In a setting where selection bias relating to the ill health of veterans may be reduced, we: i) examined self-reported adult ill health in a large sample of male UK Gulf War veterans and a demographically similar non-deployed comparison group; and ii) explored self-reported ill health among veterans who believed that they had Gulf War syndrome.
  
  
  METHODS
  This study uses data from a retrospective cohort study of reproduction and child health in which a validated postal questionnaire was sent to all UK Gulf War veterans (GWV) and a comparison cohort of Armed Service personnel who were not deployed to the Gulf (NGWV). The cohort for analysis comprises 42,818 males who responded to the questionnaire.
  
  
  RESULTS
  We confirmed that GWV report higher rates of general ill health. GWV were significantly more likely to have reported at least one new medical symptom or disease since 1990 than NGWV (61% versus 37%, OR 2.7, 95% CI 2.5-2.8). They were also more likely to report higher numbers of symptoms. The strongest associations were for mood swings (OR 20.9, 95%CI 16.2-27.0), memory loss/lack of concentration (OR 19.6, 95% CI 15.5-24.8), night sweats (OR 9.9, 95% CI 6.5-15.2), general fatigue (OR 9.6, 95% CI 8.3-11.1) and sexual dysfunction (OR 4.6, 95%CI 3.2-6.6). 6% of GWV believed they had Gulf War syndrome (GWS), and this was associated with the highest symptom reporting.
  
  
  CONCLUSIONS
  Increased levels of reported ill health among GWV were confirmed. This study was the first to use a questionnaire which did not focus specifically on the veterans' symptoms themselves. Nevertheless, the results are consistent with those of other studies of post-Gulf war illness and thus strengthen overall findings in this area of research. Further examination of the mechanisms underlying the reporting of ill health is required.
authors.affiliation: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. rebecca.simmons@lshtm.ac.uk
authors.forename: Rebecca
authors.initials: R
authors.lastname: Simmons
authors.forename: Noreen
authors.initials: N
authors.lastname: Maconochie
authors.forename: Pat
authors.initials: P
authors.lastname: Doyle
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004781:Environmental Exposure; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D018923:Persian Gulf Syndrome / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D015995:Prevalence; D012189:Retrospective Studies; D015983:Selection Bias; D012650:Self Disclosure; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*