Empirical Research Concerning Stress and Both PTSD and Other (Non-PTSD) Health Problems
Table A.1
Persian Gulf War PTSD Literature Review
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Adler et al., 1994 | Examined the prevalence of PTSD symptoms following deployment. Examined the relationship between rank and type of trauma exposure and subsequent PTSD symptoms. | German-based U.S. Army combat units exposed to front line combat. Three categories based on exposure: 1=no exposure to dead or wounded; 2=exposed to civilian or Iraqi casualties; and 3=exposed to U.S., Iraqi and civilian casualties. N=4199; No exposure (27%); civilian or Iraqi casualties (37%); U.S. casualties (35%) No gender specified |
No | 9-10 months post-PGW | Exposure to dead and wounded enemies and allies; Unit related stress assessed by reports of stress related to peer and hierarchical support. | Correlational study examining the relationship between rank, degree of exposure, and PTSD symptoms. | IES; PTSD Symptoms Measure (derived from the BSI/IES/DSM-III-R); Exposure Measure assessing unit-related stress | Exposure corr. with IES scores; Those exposed to U.S. casualties had highest IES scores. Main effect for rank, exposure, and current unit related stress for both intrusion and avoidance (IES). Higher rank associated with less severe PTSD symptoms. |
| Baker et al., 1992 [1] | To evaluate clinical needs of PGW vets in an Ohio VA outreach program. | Personnel in 19 Reserve units within the Central Midwest; Branch not specified. N=325 |
No | 2-5 months post-PGW | Questionnaire assessing war-time stressors. | Correlational study examining the relationship of demographic variables, childhood experiences, and combat exposure to subsequent psychological sequelae. | IES; BSI; MISS (cut off=107); Coping Strategies Inventory; Childhood variables: childhood trauma. | Sig. corr. between child and combat stressors and MISS scores. Ethnicity and child stressors were corr. w/ BSI scores, combat stress. Blacks had higher BSI, IES scores; Childhood stress associated with higher BSI, IES, MISS. No gender differences. 5.9% PTSD. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Brandt et al., 1997 | Examined the relationship between physical injury during PGW and psychiatric symptoms. | Service members admitted to Army Medical Center from the PGW/68% traumatic injury; 3 categories created based on presence of psychiatric symptoms: a) full psychiatric diagnosis (disorder); b) symptoms of a psychiatric disorder; c) no psychiatric disorder or symptoms. M=139 |
Yes 51 of 161 who experienced non-trauma procedures |
During PGW | Admitted to Medical Center for traumatic incident during PGW. (68% traumatic injury, no definition specified) | Correlational study examining the relationship between physical and psychiatric symptoms. | Medical records used to establish chart diagnosis and psychiatric symptoms. | 36% had psychiatric symptoms; 21% had Axis I disorder; 5% adjustment disorder; 4% PTSD; Patients who experienced greater traumatic exposure were more likely to have psychiatric symptoms. |
| Deahl et al., 1994 | Examined the effects of psychological debriefing following a trauma (PGW) on subsequent morbidity. | British soldiers serving AWGS (Army War Grave Service) in the PGW. N=42 trauma subjects |
Yes N=20 |
9 months post-PGW | Recovering and identifying dead bodies of allies and enemies | Between group study comparing debriefed and non-debriefed subjects on morbidity 9 months following return from PGW. | IES; GHQ | 50% reported debriefing as helpful. No difference between debriefed and nondebriefed on GHQ or IES scores; Difference in "caseness" (GHQ>5, IES>12), and change in close relationships. Positive corr. between "caseness" and perception of life threat. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Engel et al., 1993 | Examined the relationship between precombat sexual/physical abuse and postcombat PTSD symptoms. | U.S. Army's First Cavalry Division; Active duty. M=269 |
No | 4-10 months post-PGW | Precombat exposure as assessed by interview; CES | Correlational study examining relationship between precombat abuse and post-combat PTSD symptoms. | MISS-ODS; CES; DIS Interview | M reported sig. more combat exposure and F reported sig. more precombat abuse. F, but not M, with precombat abuse reported sig. greater PTSD symptoms than those with less precombat abuse. F reported sig. higher MISS-ODS scores. Sig. corr. between CES and MISS-ODS. |
| Ford et al., 1992 [1] | Compared debriefed versus nondebriefed PGW vets on psychological sequelae following PGW. | Eight Reserve units and National Guard units returning from ODS to V.A. services in Oregon. Branch not reported. N=55 |
No | 4-9 months post-PGW | Interview assessing war-time stressors. Variables included: family separation, direct exposure, indirect exposure, and emotional stress. | Correlational study examining vets on post-PGW physical and psychological symptoms. Examined change in symptoms after debriefing. | IES; GHQ; Marital Satisfaction Global Rating | 75% of entire group reported post-PGW stress and personal and family adjustment difficulties. Post-debriefing reported sig. decrease in PTSD symptoms, anxiety, depression, and social dysfunction and a sig. increase in family functioning. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Haley & Kurt, 1997 | Examined the psychological and physical symptoms reported by vets following the PGW. | Members of the 24th Reserve Naval Mobile Construction Battalion. 58% retired from service; 42% still active. N=249 |
No | 3 yrs/7 months post-PGW | Booklet measuring war-time exposure | Descriptive study examining the prevalence of health problems in PGW vets. Factor analyzed reported symptoms. | Standard survey measuring anatomical distribution or characteristics of each symptom, war time exposure, and psychological personality inventory. PAI (scales included Anxiety, PTSD, Somatic symptoms, Health concerns). | 70% reported serious health problems attributed to war; six medical syndromes surfaced explaining 70% of variance. Traumatic stress subscale in the Anxiety-Related Disorder Scale was not elevated in any group of vets with the reported medical syndromes. |
| Iowa Persian Gulf Study Group, 1997 | Compared deployed and nondeployed vets self-report of symptoms and illness 5 yrs following PGW. | Stratified sample drawn from 4 study domains (PGW regular military, National Guard/Reserve, nonPGW regular military, and nonPGW National Guard/reserve). Sample stratified for age, race, sex, rank, and branch. W=3695 |
Yes N=1799 |
5 yrs post-PGW | Military Exposure Questionnaire; deployment as proxy | Between group study comparing deployed versus not deployed military personnel on post-PG psychological symptoms. Not deployed to PGW as a control group. Stratified random sample with proportional allocations. | PCL-MIL (cut off 50); BSI; PRIME-MD; CAGE | PGW military personnel sig. more PTSD, depression, chronic fatigue, cognitive dysfunction, bronchitis, asthma, fibromyalgia, alcohol abuse, sex discomfort than nondeployed PGW military personnel. National Guard/reserve reported more chronic fatigue and general health problems than regular military. No reported link between stress and PTSD. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| McCarroll et al., 1993aTOP [2] | Examined the prevalence of PTSD symptoms in PGW vets who handled human remains versus PGW vets who did not. | 116 vets who handled remains were from Army Mortuary Affairs Co. The 118 vets who did not handle remains were from army units handling logistic functions. N=234 |
Yes M=110 F=8 |
3-5 months post-return to U.S. | Recovering and identifying dead allies and enemies. | Between-group study examining and psychological symptoms in PGW vets who handled remains and PGW vets who did not handle remains. | IES; SCL-90-R | Subjects who handled human remains reported sig. more intrusive and avoidance symptoms. Inexperienced workers reported sig. more symptoms than experienced workers. Positive corr. between number of remains handled and PTSD symptoms. |
| McCarroll et al., 1995a[2] | Examined the relationship between handling human remains and subsequent PTSD symptoms. | 55 vets who handled remains were from Army Mortuary Affairs Co. The 56 vets who did not handle remains were from army units handling logistic functions. N=55 Male=84% |
Yes M=52 F=4 |
13-15 months post-return from PGW (follow-up) | Recovering and identifying dead allies and enemies. | Between-group design comparing PGW vets who handled remains with PGW vets who did not handle remains on psychological symptoms post-PGW. | IES; SCL-90-R | Sig. differences between groups on IES scores at 13-15 months; Sig. decrease in IES scores at 13-15 mo. Sig. higher IES scores for PGW vets who handled remains. Sig. pos. corr. between age and intrusion symptoms for exposure group. |
| Perconte et al., 1993a | Examined stress level in survivors of a missile attack before and after treatment intervention. Compared stress levels with a group of survivors who did not receive treatment intervention. | Quartermaster unit hit by missile. N=25 |
Yes N=8 |
During PGW (2 months post-missile attack 4/91) | Missile attack (on site; guard duty; nondeployed) | Pretest and posttest between-group design comparing PGW vets receiving debriefing with PGW vets not receiving debriefing in a unit-based program. | MISS (cut off 107); BDI; SCL-90-R | On-site group sig. higher MISS and SCL-90-R scores; F sig. higher BDI, MISS, SCL-90-R GSI at pre-treatment than M. Sig. reduction in symptoms post-treatment. No change in symptoms for nondeployed post-treatment. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Perconte et al., 1993b | Examined war-related psychological distress among PGW vets following PGW. | Community sample of Army, Navy, and Marine Reservists. 126 activated but not deployed; 26 deployed to Europe; 439 deployed to Southwest Asia combat theater. N=581 |
Yes N=152 |
11 months post-PGW | Deployed versus not deployed; Military History Q: not deployed; Europe deployed; Combat Deployed. | Between group design comparing deployed PGW vets with nondeployed PGW vets on psychological symptoms following trauma exposure. Examined variables of gender, race, and prior combat exposure. | MISS (cut off 107); BDI; SCL-90-R; Military History Questionnaire | Sig. effect of deployment. No sig. effect of race; Sig. interaction effect of race x deployment for MISS. Gender effect sig. for MISS & BDI. Sig. interaction effect for gender X deployment. F sig. higher scores on MISS. No sig. effect of prior combat. |
| Sloan et al., 1995a[2] | Examined the effectiveness of the Rorschach in detecting acute PTSD symptoms in PGW vets. | Volunteer Marine reservists all identified as having PTSD symptoms during a general postwar debriefing. Troops provided security and protected Iraqi prisoners. No vets had prior psychiatric history. N=30 |
No | 3-5.5 months post-war | No direct combat; Some report seeing dead and wounded people. | Correlational study examining the relationship between Rorschach and MMPI-2 scales measures of PTSD. | MMPI-2 (various scales); Rorschach | Neg. corr. between PTSD (MMPI-2) & Rorschach PTSD symptoms and indices of coping ability, personal resources, and psych adjustment. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Sloan et al., 1995b[2] | Examined the effectiveness of the MISS-ODS in assessing war-related PTSD symptoms in noncombat PGW vets. | Same as Above | No | 3-5.5 months post-war | No direct combat; Some report seeing dead and wounded people. | Correlational study examining the relationship between MISS-ODS scores for PTSD and DSM-III-R criteria for PTSD. | MMPI-2 (various scales); MISS-ODS (cut-off 89) | Of the 17 DSM-III-R PTSD symptoms vets reported an avg of 3.33 symptoms. 4 PTSD pos. according to DSM. 3 of these 4 met MISS-ODS cut-off for PTSD. Pos. corr. between MISS-ODS and PTSD symptoms. |
| Sloan et al., 1996[2] | Examined the effectiveness of MMPI-2 scales, and the IES in detecting PTSD symptoms in noncombat PGW vets. | Same as Above N=66 |
No | 3-5.5 months post-war | No direct combat; Some report seeing dead and wounded people. | Correlational study examining the relationship between MMPI-2 scale elevation and elevation on IES. | MMPI-2 (various scales); IES; WSI-ODS (War Stress Interview-ODS) | 71% experienced 1 or more symptoms of acute PTSD for at least 1 mo. post-PGW. MMPI-2 scale scores and IES scores were sig. corr. with PTSD symptoms. |
| Sohler et al., 1992[1] | Interim report of ongoing study examining the psychological sequelae on PGW vets following the PGW. Examined variables of gender, deployment, and pre-PGW combat exposure. | National Guard/Reserve units in North Central Florida. Branch not specified. M=397 |
Yes | 6 months post-PGW | Deployed versus nondeployed; CES. | Between-group design comparing PGW vets deployed and not deployed on psychological sequelae post-PGW. Gender, unit, and combat exposure were also assessed. | IES; Prior war experience; SCL-90-R (GSI scores) | Deployed had higher IES scores than non-deployed; F higher IES scores; Sig. interaction effect for gender by deployment (i.e. higher IES scores for deployed F than M); Experienced vets reported sig. fewer intrusive thoughts; F reported higher symptoms. CES sig. corr. with IES. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Southwick et al., 1993[2] | Examined the development of trauma symptoms over time in two reserve units. | New England National Guards randomly selected from medical unit and military police unit.
M=65 |
No | Two Assessments: Time 1=1 month post-PGW; Time 2=6 months post-PGW | CES | Longitudinal study examining symptom severity over time in two reserve units. Examined effects of gender and unit status. | MISS (cut off 89); 17-item PTSD Symptoms Scale; DSTQ (Desert Storm Trauma Quest.) | MISS=3 PTSD pos. at 1 mo/4 PTSD pos. at 6 mo.; PTSD Scale criteria= 8 PTSD pos. at 1 mo/7 at 6 mo. Pos. corr. between scores on MISS, CES, & DSTQ. No unit or gender differences. Increase in MISS scores over time. No sig. change in PTSD symptoms over time. |
| Southwick et al., 1995[2] | Same as Above | Same as Above M=49 |
No | 2 year follow-up (2 yr 1/month post-PGW) | CES | Longitudinal study examining symptom severity over time in two reserve units. Examined gender and unit effects. Compared medical and police units. | MISS (cut off 89); 17-item PTSD Symptoms Scale (DSM-III-R); DSTQ (Desert Storm Trauma Quest.) | At 2 yrs MISS=6 PTSD pos/DSM=8 PTSD pos. Medical unit had higher symptoms. Hyperarousal higher at all 3 time points. Increase in intrusive memories and reactivity between 1 mo. and 2 yrs. Decrease in irritability between 6 mo. and 2 yrs. No gender differences. CES sig. corr. with PTSD symptoms. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Stretch et al., 1996 (also Marlowe et al., 1994) | Examined the prevalence of PTSD symptoms in active and reserve deployed PGW vets and active and reserve nondeployed PGW vets following PGW. | Active duty and reservists from PA and Hawaii who were assigned to Army, Navy, Air Force & Marines. Subjects were either deployed (1524; active 715; reserve 766) or not deployed (2512; active 1576; reserve 948) to ODS. Gender not specified. |
Yes N=2512 |
Mail survey; 2 years post-PGW | Deployed versus nondeployed. Self-report of stressors | Between-group design examining prevalence rates of PTSD symptoms in active versus reservists, and deployed versus nondeployed to PGW. | IES; BSI; 17-item PTSD algorithm derived from IES and BSI | Active duty=57 deployed subjects PTSD pos. (8%) /21 of nondeployed PTSD pos. (1.3%); Reservists=70 deployed PTSD pos. (9.2%)/20 nondeployed PTSD pos. (2.1%). Sig. corr. between stressors and PTSD symptoms. |
| Sutker et al., 1993 | Examined the relationship between war stress and physical and psychological symptoms following PGW in activated deployed and nondeployed troops. | Army National Guard and Army Reserve. Troops were distributed across air reserve, medical, and infantry support specialist, air ambulance, tactical fighters, maintenance, and quartermaster. N=215 |
Yes N=60 |
4-10 months post-ODS | ODS-SES (divided groups into high and low exposure). | Between-group design comparing deployed (high and low exposure) with nondeployed (no exposure) on variables of post-ODS psychological sequelae. Compared PTSD pos. with PTSD neg. on personal characteristics. | BDI; STAI: ODS-SES; HSC; MISS (cutoff 97); PCL-MIL (PTSD checklist-military version) | High exposure group reported sig. higher MISS, PTSD Scale, BDI , anxiety and anger scores than did low and no exposure groups. High-exposed group sig. more difficulties sleeping, concentrating, nervousness. Gender and race sig. corr. with PTSD. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Sutker et al., 1994a | Examined the psychological, physical, and psychiatric disorders in Army reservists who served war-zone grave registry duty in support of ODS. | Army reservists of the 35th Member Army Reserve Quartermaster. M=21 |
No | 8 months post-return from PGW | ODS-SES; Open-ended assessment of most-severe trauma experienced at ODS. | Descriptive study examining the prevalence of psychological, psychiatric, physical symptoms in army troops who dealt with remains 8 months after return from war. | Questionnaire assessing physical, psychological, psychiatric variables; BDI; SCID; Physical Symptoms Checklist; Anxiety-State; State-Anger (STAS). PTSD diagnosis based on DSM-III-R (SCID). | 46% PTSD pos.; 91% of PTSD pos. were clinically depressed (BDI>10), 85% of nonPTSD were not clinically depressed. All PTSD pos. had elevated physical symptoms; 77% of nonPTSD had minimal concern about physical symptoms. |
| Sutker et al., 1994b | Examined and compared psychological and physical symptoms post-PGW in PGW vets who were deployed to graves registry with PGW vets who remained stateside. | Army Reservists assigned to 3 quartermaster co. that provided supplies and logistic support; 40 were deployed to graves registry. N=60 |
Yes N=20 M=95% |
12 months post-ODS | Graves Registry Duty Scale; deployed versus nondeployed. | Between group design comparing PGW vets deployed to graves registry with PGW vets remaining stateside on post-PGW psychological sequelae. | BDI; STAS; STAI; SCID; Physical Symptoms Checklist; Graves Registry Duty Scale; MISS-ODS (cutoff 97). | Exposure group reported more current and lifetime psychiatric disorder than nonexposure group. Exposure group greater PTSD symptoms, higher BDI, STAS, STAI, & physical symptoms checklist scores. 53% of PTSD cases had concurrent psychological disorder. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Sutker et al., 1995a[2] | Examined and compared the prevalence of psychological symptoms among military participants in war-zone exposed and stateside duty. Examined gender and ethnicity between exposed and nonexposed. | PG war-zone exposed (n=653) and stateside duty troops (n=259). Included Army, Air Force, Marine, National Guard, and reserve units who underwent psychological debriefing post-PGW. N=912 |
Yes N=259 M=83% F=17% |
within 12 months post-PGW | ODS-SES | Between-group study comparing war-zone exposed and stateside duty on psychological symptoms post-PGW. Examined gender and ethnicity. | BDI; STAI; STAS; BSI; HSC; MISS-ODS (cutoff 97) | Sig. more depression, anxiety, and somatic complaints for deployed; Minority sig. more symptoms of depression; F sig. more somatic complaints. No main effect for gender and PTSD; Interaction effect gender by ethnicity for PTSD. 10�12% deployed PTSD pos. |
| Sutker et al., 1995b[2] | Examined and compared PTSD pos. and PTSD neg. subjects on the availability of personal and environmental resources. | Troops assigned to Marine, Air Force, Navy, Army Reserve, and National Guard units deployed to combat in PGW. Sample derived from 1432 troops deployed as part of ODS who underwent psychological debriefing within 1 year of return. N=484 |
Yes N=97 M=87% F=13% |
within 12 months of return from PGW | ODS-SES | Correlational study examining PTSD pos. vets with PTSD neg. vets on personal and environ-mental resources available. | BDI; SCL-90-R; MISS-ODS(cutoff 97); SSQR; WOC | PTSD pos. vets reported sig. less satisfaction w/ social support, less family cohesion and expressiveness, more avoidant coping, self-blame, and wishful thinking than PTSD neg. vets. No gender info specified. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Unger et al., 1992 [1] | Examined and compared PG vets with National Guard vets who remained in U.S. on variables of post-PGW psychological symptoms. | PGW vets attending the Providence VA mtg. following return to Rhode Island from deployment to Persian Gulf. (PGV); and National Guard Servicemen (NGS) remained in U.S. N=85 |
Yes N=51 |
Upon return to Rhode Island from Persian Gulf; time not specified | CES; deployment as proxy | Between-group design comparing deployed and nondeployed reserve personnel on post-PGW psychological sequelae. | CES; SCL-90; MISS-ODS(cut off 89); SSI. | Differences between NGS and PGV's on CES, MISS, SCL-90-R (7 of 9 scales). Of the PGW vets, 50% under enemy fire saw someone killed; 75% felt in danger of being killed. Of PGW vets, 50% moderate-severe intrusive thoughts and avoidance & 35% nightmares. |
| Wolfe et al., 1993 [2] | Examined the relationship between gender and psychological outcome following exposure to war-zone stress. | PGW vets. N=2344 |
No | 5 days following return from PGW | Survey (traditional wartime activities; nontraditional wartime activities; nonwar-zone deployment experiences); Laufer combat & ODS exposure scales; self-generated categories. | Correlational design examining the relationship between exposure, gender, demographics and subsequent psychological symptoms post-PGW. | Ft. Devens ODS Reunion Survey (exposure; psych. and physical symptoms); MISS (cut off 89); BSI; Demo; DSM criteria. | F 9%, M 4% PTSD (MISS>89); F reported higher MISS, GSI PTSD check list. No gender differences for exposure. Gender, demo. (educ, marital status), Laufer exposure scores, ODS factor scores explain 12�17% of variance on (BSI, GSI, PTSD, MISS) outcome measures. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Wolfe et al., 1996 [2] | Examined vets response to deployment during ODS. | PGW vets Time 1: |
No | Two Assessments: Time 1= within 5 days of return; Time 2= 18-20 months postdeployment. |
Same as above | Longitudinal study examining the prevalence of PTSD symptoms over time in PGW vets. | Same as above | No gender differences for exposure; F. higher MISS; 30% in clinical sig. range on BSI. Increase in report of exposure and PTSD symptoms from Time 1 to Time 2. Exposure, gender, avoidance, social support, and family cohesion explain 15% of variance in PTSD symptoms. |
[2] Data presented on the same sample.
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Baker et al.[1] (1992) VA Report, Chap 7 | To evaluate clinical needs of PGW vets in an Ohio VA outreach program. | Convenience sample; N=325; Reserve and Guard troops; All services: male=74% |
No | 2-5 months post-PGW | Self-report survey of military and PGW experiences. | Cross-sectional survey; Needs assessment. | IES; BSI; MISS | Combat-exposed troops experienced higher levels of distress on BSI, MISS and intrusion subscale of IES. |
| Brandt et al. (1997) | To examine psychiatric problems of PGW surgical patients evacuated from theatre for combat- and noncombat-related problems. | N=161; All services: male=88% |
Yes N=51 of 161 who experienced nontrauma-related procedures. |
During and after PGW | Admitted to medical center for traumatic incident during PGW. | Medical records used to establish diagnosis. | Frequency of Axis I Psychiatric Disorders | Trauma associated w/greater likelihood of Axis I disorder. |
| Ford et al.[1] (1992) VA Report, Chap 10 | Evaluation of psychosocial debriefing program for PGW vets and families. | N=55 help-seekers; Guard and Reservists: male=70% |
No | 4-9 months post-PGW | War Stress Interview; Self-report. | Cross-sectional survey; Self-report before and after debriefing. | IES; GHQ; Marital satisfaction and family relations. | Symptoms appear to abate after debriefing; No differences in GHQ or IES between troops deployed to ODS or Europe. Slightly higher IES due to readjustment stressors rather than ODS stress. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Deahl et al. (1994) | Examined the effects of psychological debriefing following a trauma (PGW) on subsequent morbidity. | British soldiers serving Army war grave service; N=62 | Yes 20 of 62 |
9 months post-PGW | Recovering and identifying dead bodies of allies and enemies. | Between-group study comparing debriefed and nondebriefed on morbidity. | GHQ | No difference on GHQ scores between debriefed and nondebriefed; Health problems more likely in those who perceived a life threat. |
| Haley and Kurt (1997) | To determine whether symptoms can be explained due to multiple chemical exposures. | Convenience sample; N=249; Reserve construction battalion: male=100% response rate= unknown |
No | 11/94 3 years/7 months post-PGW | Self-reported exposure to various risks and self-reported symptoms of cognitive impairment. | Self-reported survey of exposure and symptoms; Factor-analyzed reported symptoms. | Self-reported symptoms | Combat stress not related to 3 syndromes; Symptoms linked to other exposures. |
| Iowa Persian Gulf Study Group (1997) | To compare prevalence of self-reported problems in deployed and nondeployed vets. | Stratified random sample of 3695 active, reserve, and Guard troops: male=91% white=91% age <25=91% response rate=76% all from Iowa |
Yes N=1799 M=91% F=9% |
5 years post-PGW |
Deployment; military exposure quest. | Epidemiologic study; self-reported. | Prime-MD; CAGE; BSI; PTSD-Checklist; SF-36 |
Deployed had higher prevalence of selected mental and physical health symptoms and syndromes; Reservists more chronic fatigue and alcohol abuse than regular military; Most PGW exposures related to medical and psychiatric conditions. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Kizer et al. (1995) | To assess nature of symptoms reported by a National Guard unit that included personnel w/unexplained symptoms. | Unit w/high rate of unexplained symptoms; N=59; male=90% age=23-59 (mean 39) response rate= 36%-78% |
Yes; N=3927 Some from same unit, others from similar units. |
12/94�3/95 | All served in PGW; self-report measure of various exposures. | Comparison of those experiencing symptoms w/vets from same and other units. | Standardized interview and physical exam; 13 chronic symptoms. | Target group reported symptoms of non-specific origin; No organic cause detected; 5 of 13 symptoms were significantly greater in target group: chronic diarrhea, other GI complaints, concentration problems, trouble finding words, fatigue. Exposure data not presented. |
| Labatte and Snow (1992) | To assess psychological impact of exposure to intense �friendly fire� incident during PGW. | Targeted sample; N=56; Active-duty Army troops involved in ground war | No | 9/91 4 months post-PGW | Self-reported combat exposure. | Self-report survey | 17-item checklist of symptoms; primary focus on sleep disturbance, alcohol use. | 29% still had nightmares and 38% reported increased alcohol use; Personal injury more important than exposure to dead soldiers in contributing to adjustment problems. |
| McCarroll et al. (1993a) | To see if exposure to human remains related to elevated PTSD scores. | N=234 males=84% |
Yes (118 of 234) Deployed but did not handle human remains. |
3�5 mos. post-PGW | Handled remains in Gulf War. | Comparison of two groups , all volunteers. | SCL-90-R | No differences in SCL-90-R between groups. Significant differences on IES. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings | McCarroll, et al. (1995a) | To see if soldiers who handled war dead had later symptoms of PTSD | N=55 male=84% |
Yes N=56 |
13-15 months post-PGW | Handled remains in Gulf War | Comparison of two groups. | SCL-90-R | No differences between groups in SCL-90-R. Significant differences on IES. |
| Perconte (1993a) | To evaluate treatment of intervention for survivors of missile attack. | Quartermaster unit hit by missile; N=25; reserve troops: male=84% |
Yes N=8 of 20 |
3/91-4/91 2 months post-missile attack |
On-site during missile attack; War stress survey | Treatment w/control group and pre-post between-group design. | BDI; SCL-90-R | On-site group had greater SCL scores pre-treatment, but not depression. Exposure severity linked to greater distress. |
| Perconte (1993b) | To examine level of psych. distress among PGW veterans. | Convenience sample; N=581; Army, Navy, Marine Reservists: male=88% |
Yes | 11 months post-PGW | Military History Quest; units rank ordered by war-stress exposure | Comparison of deployed and nondeployed troops. | BDI; SCL-90-R (GSI) | Distress higher among deployed. Among deployed, distress higher among females; No race effects; GSI and MISS but not BDI scores increased w/war stress rank order (units with more combat stress). |
| Sohler (1992)[1] | To assess the psychological sequelae of PGW service; Examined gender, deployment, and pre-PGW exposure. | N=507; Reserve and Guard troops: female=21% N=288 PGW deployed |
Yes | 7/91-9/91 6 months post-PGW |
Deployed versus nondeployed; CES | Between-group design comparing deployed and nondeployed vets on health and self-reported psych./physical health symptoms. | SCL; IES |
Deployed report higher IES than not deployed; No differences on SCL-90-R. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Stretch et al. (1995)
[2] (also Marlowe et al. 1994) |
Examined self-assessed physical health of PGW veterans. | Active duty and reservists from PA and HI; included all services: deployed=1524 |
Yes | 2/93-8/93 | Deployment; Self report of stressors | Cross-sectional survey; Self-report |
Checklist of physical symptoms | Deployed troops reported more physical health complaints even after adjusting for demographics. |
| Stretch, et al. (1996) [2] (also Marlowe, et al. 1994) | Examined self-assessed psychological health of PGW veterans. | Active duty and reservists from PA and HI: deployed=1524 |
Yes | 2/93�8/93 | Deployment; Self report of stressors | Cross-sectional self-administered survey of psychological symptoms | BSI; IES | Weak increase in BSI among deployers (4% higher); Relationship is weak with control for demographics. |
| Sutker et al. (1993) | Examined relationship between war stress and physical/ psych. symptoms following PGW in activated deployed and nondeployed troops | Convenience sample; N=215; Army National Guard/reserve troops | Yes N=60 of 215 |
4-10 months post-PGW | ODS-SES | Between-group design comparing deployed (high and low) w/nondeployed on psych. and physical health measures | BDI; STAI; Trait Anger Scale; HSC |
Deployed w/high exposure had higher depression, anxiety, and physical health complaints than nondeployed; Deployed w/low exposure report symptom levels more comparable to nondeployed. |
| Sutker et al. (1994a) | Examined psychological, physical, and psychiatric disorders in Army Reservists who served grave registry duty in PGW . | N=24; Army Reservists assigned to Quartermaster unit: male=21 female=3 | No | 8 mos. post-PGW | ODS-SES | Descriptive study examining prevalence of self-reported health problems and diagnosed psychiatric disorders. | BDI; STAI; Trait Anger Scale; HSC; SCID |
Body handlers had elevated physical and psych. symptoms relative to civilian norms; 55% diagnosed w/current Axis I disorder. |
| Study | Objectives | Sample | Control | Time of Assessment | Exposure Assessment | Methodology | Outcome Assessment | Relevant Findings |
| Sutker et al. (1994b) | Examined impact of graves registration duty on psych. and physical symptoms. | N=60; Army Reservists assigned to Quartermaster unit: female=8% |
Yes N=20 of 60 non-deployed |
12 mos. post-PGW |
Graves Registry Duty Scale | Between-group design comparing deployed and nondeployed. | SCID; STAI; Trait Anger Scale; BDI; HSC |
Deployed body handlers had higher incidence of PTSD and somatic complaints. |
| Sutker et al. (1995a) | Examined prevalence of psychological and physical symptoms in PGW vets; examined gender and ethnicity in deployed/non-deployed. |
N=912; Reserve and Guard vets; All services: female=13% |
Yes N=259 non-deployed |
Within 12 mos. post-PGW | ODS-SES | Between-group study comparing war-zone exposed and stateside vets. | BDI; STAI; STAS; HSC |
Somatic and psych. symptoms higher among deployed troops; Females significantly more health complaints than males. |
| Sutker et al. (1995b) | Compared PTSD pos. and PTSD neg. subjects on the availability of personal and environmental resources. | National guard units deployed to combat in PGW. Sample derived from 1432 troops who underwent psychological debriefing within 1 year of return. N=484 |
Yes N=97 M=87% F=13% |
Within 12 months of return from PGW | ODS-SES | Correlational study examining PTSD-pos. subjects with PTSD-neg. subjects on personal and environmental resources available. | BDI; SCL-90-R; MISS-ODS (cut off 97); SSQR; WOC |
PTSD-pos. subjects reported sig. less satisfaction w/social support, less family cohesion and expressiveness, more avoidant coping, self-blame, and wishful thinking than PTSD-neg. subjects. |
| Unger et al. (1992)
[1] VA Report, Chap 8 |
Examined physical and psych. symptoms in deployed and non-deployed troops. | N=85; Reserve and Guard vets; No demographics provided. | Yes N=51 of 85 |
Upon return to Rhode Island; time not specified | CES; Deployment as proxy for stress exposure. |
Between-group design comparing deployed and nondeployed troops. | SCL-90 | Deployed troops had significantly higher physical and psych. symptoms except for depression (somatization not clear). |
[2] Data presented on the same sample.