title: Symptom attribution and symptom reporting in Australian Gulf War veterans.
abstract: OBJECTIVE
  To better understand the consistent elevated symptom reporting by Gulf War veterans; we compared Australian Gulf War veterans and military-comparison group on symptom attributional styles and the relationship with total number and grouping of somatic and psychological symptoms.
  
  
  METHODS
  Postal questionnaires were completed by Australian Gulf War veterans (n=697) and military-comparison group (n=659) in 2000-2002 and 2011-2012. Data were collected on deployments, military-psychological stressors, symptom reporting, symptom factors and attributional style (normalising, psychologising, somatising, mixed-attribution).
  
  
  RESULTS
  Gulf War veterans did not differ in attributional style from comparison group (p>0.05); normalising was the predominant style. Groups were combined for analyses. Psychologisers reported the highest overall symptoms (mean(M)=10.95, standard deviation(SD)=9.15), the most psychophysiological (M=1.71, SD=2.82), cognitive (M=5.79, SD=5.09) and arthro-neuromuscular symptoms (M=1.53, SD=1.73). Psychologisers and somatisers reported significantly more symptoms across overall symptoms, all three symptom factors and psychological distress than normalisers. Normalisers consistently reported fewest overall symptoms (M=2.85, SD=4.49), psychophysiological (M=0.40, SD=0.98), cognitive (M=1.14, SD=2.22), and arthro-neuromuscular symptoms (M=0.72, SD=1.31). Persistent symptoms, rather than remitted, between baseline and follow-up were associated with increased rates of psychologising and mixed-attribution compared with normalising. For incident symptoms a similar pattern was observed, some symptoms also showed increased rates of somatising.
  
  
  CONCLUSIONS
  In veterans, psychologising was associated with higher symptom reporting, whilst somatisers and mixed-attribution also demonstrated higher reporting than normalisers. Symptom persistence and incidence were associated with symptom attribution. The findings indicate that attributional style is associated with patterns of symptom reporting and highlights both past and present symptoms may influence attributional style.
authors.affiliation: Department of Epidemiology & Preventive Medicine, Monash University, Australia. Electronic address: breanna.wright@monash.edu.
authors.forename: Breanna K
authors.initials: BK
authors.lastname: Wright
authors.affiliation: Centre for Traumatic Stress, University of Adelaide, Australia.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: McFarlane
authors.affiliation: Department of Psychiatry, Monash University, Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Clarke
authors.affiliation: Department of Epidemiology & Preventive Medicine, Monash University, Australia.
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Sim
authors.affiliation: Department of Epidemiology & Preventive Medicine, Monash University, Australia. Electronic address: helen.kelsall@monash.edu.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Kelsall
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D059026:Diagnostic Self Evaluation; D005260:Female; D047830:Gulf War; D015438:Health Behavior; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D018923:Persian Gulf Syndrome; D011795:Surveys and Questionnaires; D063189:Symptom Assessment / Q000523:psychology*; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Attributional style; Gulf War; Symptom attribution; Symptom factors; Symptom reporting; Veterans