Contents

Preface
Figures
Tables
Summary
Acknowledgments
Glossary

Chapter One: Introduction

Background
Returning U.S. Troops Report Health Problems
Purpose of This Report
Sources of Evidence Drawn Upon to Accomplish Our Objective
Organization of the Report
Chapter Two: Stress and Health: Definitions and Concepts
Illness and Disease
Stress
Conceptual Models Linking Stress to Poor Health
A Conceptual Framework for Understanding War-Zone Stressors
Chapter Three: Stress Exposure in the Persian Gulf War
Overview of Stresses Experienced by Veterans of the Gulf War
Certain Individuals Were Postulated to Be at High Risk for Stress Reactions
Stress Exposure and Perceived Stress
Mental Health Evaluations In-Theater
Surveys Conducted In-Theater
Surveys Conducted in the Immediate Post-Gulf War Period
Surveys Conducted Several Years Following the Gulf War
Methodological Limitations
Summary and Conclusions
Chapter Four: Non-Gulf War Scientific Literature Linking Stress to Health Problems
Stress and Psychological Health Outcomes
Stress and Physical Health Outcomes
Cognitive and Social Factors in the Perception of Illness and Illness Behavior
Stress Vulnerability and Resistance
Summary and Conclusions
Chapter Five: Gulf War Scientific Literature Linking Stress to Health Problems
Overview
Study Selection Criteria
How Stress Exposure Was Measured
How Health Outcomes Were Measured
Stress Exposure and Mental Health Outcomes
Gulf War-Related Stress Exposure and Other Mental Health Outcomes
Gulf War-Related Stress Exposure and Bodily Symptoms
Findings Specific to Vulnerable Groups
Limitations of the Empirical Literature Examining the Stress-Health Link
Summary of the Stress-Health Link
Chapter Six: Findings and Conclusions
What Does the General Scientific Literature Say About the Nature of Stress?
Does Evidence Indicate That Deployed Troops Were Exposed to Stress in the Gulf?
Does the General Scientific Literature Unrelated to the Gulf War Suggest That Stress Can Contribute to Poor Health?
Are the Problems Reported by CCEP and VA Registry Participants Consistent with the Scientific Literature Linking Stress to Health Problems?
What Can Be Concluded from the Scientific Literature Bearing Directly on the Link Between Gulf War Stress Exposure and Subsequent Health Problems?
Concluding Observation
Appendix: EMPIRICAL RESEARCH CONCERNING STRESS AND BOTH PTSD AND OTHER (NON-PTSD) HEALTH PROBLEMS

References