title: Major depression and depressive symptoms in Australian Gulf War veterans 20 years after the Gulf War.
abstract: BACKGROUND
  Risk of major depression (depression) was elevated in Australia's 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Monash University Department of Epidemiology and Preventive Medicine, Australia. Electronic address: Jill.Blackman@monash.edu.
authors.forename: J F
authors.initials: JF
authors.lastname: Ikin
authors.affiliation: Monash University Department of Epidemiology and Preventive Medicine, Australia.
authors.forename: D P
authors.initials: DP
authors.lastname: McKenzie
authors.affiliation: Monash University Department of Epidemiology and Preventive Medicine, Australia.
authors.forename: S M
authors.initials: SM
authors.lastname: Gwini
authors.affiliation: Monash University Department of Epidemiology and Preventive Medicine, Australia.
authors.forename: H L
authors.initials: HL
authors.lastname: Kelsall
authors.affiliation: University of Melbourne Department of Psychiatry, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Creamer
authors.affiliation: University of Adelaide Centre for Traumatic Stress Studies, Australia.
authors.forename: A C
authors.initials: AC
authors.lastname: McFarlane
authors.affiliation: Monash University Department of Psychiatry, Australia.
authors.forename: D M
authors.initials: DM
authors.lastname: Clarke
authors.affiliation: Monash University Department of Epidemiology and Preventive Medicine, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Wright
authors.affiliation: Monash University Department of Epidemiology and Preventive Medicine, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Sim
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003130:Combat Disorders / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D047830:Gulf War; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Epidemiology; Gulf War; Major depression; Veterans’ health