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Robert W. Haley, M.D.
Epidemiology Division, Department of Internal Medicine,
University of Texas Southwestern Medical Center, Dallas, Texas
Medical policy-makers have concluded that psychological
stress from wartime trauma and deployment was an important contributing
cause of chronic physical symptoms in Gulf War veterans. To evaluate the
basis for the conclusion, I reviewed the scientific articles from peer-reviewed
journals referenced in the final report of the Presidential Advisory Committee
on Gulf War Veterans' Illnesses and conducted a MEDLINE literature search.
All reported prevalence rates of posttraumatic stress disorder (PTSD)
in Gulf War veterans were defined by critical cutpoints on psychometric
scales constructed by summing veterans' responses on standardized symptom
questionnaires rather than by clinical psychiatric interviews. Observed
PTSD rates varied from 0% to 36% (mean, 9%). Correcting for measurement
errors with previously determined values of the sensitivity (range .77
to .96) and specificity (range .62 to .89) of the psychometric tests yielded
estimated true PTSD rates of 0% for 18 of the 20 reported rates. Mean
scores on the Mississippi PTSD scale in all subgroups of Gulf War veterans
were within the range of values for well-adjusted Vietnam veterans (50-89)
and far below that of Vietnam veterans with psychiatrically confirmed
PTSD (120-140). Most PTSD and "stress-related symptoms" reported
in studies of Gulf War veterans appear to represent false-positive errors
of measurement reflecting nonspecific symptoms of other conditions. These
findings invalidate the original basis for the stress theory of Gulf War
syndrome and raise questions about the need for large government expenditures
for further research on stress in Gulf War veterans.
"Keywords": Meta-Analysis; Stress Disorders,
Post-Traumatic; Sensitivity and Specificity
No support but findings relevant to Federally supported
Gulf War veterans’ illnesses research |
