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 Research Topics    |    Major Focus Areas
Research Topics
ACCIDENTS & INJURIES
BONE, JOINT & MUSCLE
BRAIN & NERVOUS
CANCER
CARDIOVASCULAR
CHEMICAL WARFARE
DIGESTIVE HEALTH
ENVIRONMENTAL & OCCUPATIONAL HEALTH
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GENETIC STUDIES
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MORTALITY/DEATH
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VACCINES & PROTECTIVE MEDICATIONS
General Health & Physical Symptoms
General
Project Summary

Title: War Syndromes from 1900 to the Present: Symptom Patterns and Long-Term Health Outcomes
Synopsis: The study compares symptoms referred to as "War Syndromes," from 1900 to the present, to determine if "unexplained" symptoms experienced by soldiers after combat are similar.
Overall Project Objective: The primary hypothesis tested in this study, after corrections for societal influences and historical medical descriptors, is that symptom patterns and long-term health outcomes of war syndromes are consistent between the conflicts studied and over time.
Status/Results to Date: In essence, Part 1 investigated the following randomly-selected groups: Boer War (1899-1902) - 200 cases of Disordered Action of the Heart (DAH) and 200 cases of rheumatism; World War I - 200 cases of DAH, 200 cases of shell shock/neurasthenia, 167 cases of gassing and 73 nurses; World War II - 200 cases of psychoneurosis, 67 cases of effort syndrome and 100 cases on non-ulcer dyspepsia; and for the Persian Gulf conflict- 400 cases of Gulf-related illness. In addition, 28 cases were collected from Victorian campaigns and 21 cases from Korea/Malaya. A total of 1,865 veterans were included in the study. Cluster analysis has shown that there is no single war syndrome. There appear to be three sub-groups with the following characteristics, which bear an important temporal relationship to specific conflicts: Group one: a post-combat syndrome typified by chronic fatigue and prevalent during the late nineteenth century and World War I. Group two: a somatic disorder with a focus on the heart typical of World War I though with less common representatives during the Boer War and World War II. Group three: a post-combat syndrome with psychological characteristics and associated somatic symptoms more typical of World War II and the Gulf War. The form that these take is chiefly determined by an associated war and may, therefore, be related to the nature of combat, contemporary medical knowledge and important health beliefs and fears. The post-combat syndromes from Gulf War do not stand apart from the other conflicts. Just over half (54%) of the sample fell into group three characterized by psychological symptoms and associated with the post-1939 period. Yet group one, characterized by chronic fatigue, accounted for 36.5% of the sample, and this tends to be associated with Victorian campaigns, the Boer War and World War I. Only 9.5% were found in group two, the somatic post-combat syndrome with a focus on the heart. The results from Part 2, the mortality study, showed that there was no significant statistical difference between the 200 DAH veterans from the Boer War and their matched controls, or between the 126 neurasthenia/shell shock veterans of World War I and their controls. However, the 139 DAH veterans of World War I died significantly earlier than their controls. This is thought to be the result of the selective termination of DAH pensions in demonstrably healthy ex-servicemen during the interwar period.
Project:DoD-70
Agency:Department Of Defense
Location:Royal Defence Med. Coll
P.I. Name:Ian Palmer, LTC
Research Type:Epidemiology
Research Focus:Symptoms & General Health
Focus Category:General Health & Physical Symptoms
Status:Ongoing
Study Start Date:February 09,1998
Estimated Completion Date:March 08,2001
Specific Aims: The study is in two parts. Part 1 is a retrospective comparison of war syndromes in the British Army from 1900 to the present using hospital and pension records. Part 2 examines the long-term morbidity and mortality rates of servicemen with post-combat syndromes. Two primary questions are addressed: first, are medically-unexplained symptoms experienced by soldiers after combat similar, and secondly are morbidity and mortality rates of servicemen with post-combat syndromes greater than a control population of veterans with equivalent levels of disability?
Methodology: The status and interpretation of war syndromes have been influenced by changing popular health beliefs and advances in medical science. In the Boer War, for example, they were explained in terms of cardiac pathology and rheumatism following fever, while following the Persian Gulf conflict they have been attributed to a variety of toxic exposures. Part 1 of the study will try to determine whether the symptomatology of war syndromes is similar and whether different disorders can be reliably distinguished from each other by cluster analysis. Records for comparison were obtained from the Ministry of Defence's Medical Assessment Programme (MAP), the Public Record Office and the War Pension Agency of the Department of Social Security. In Part 2, the morbidity and mortality of randomly-selected groups of World War One veterans were compared. One randomly-selected group of DAH veterans from the Boer War and two groups of World War One veterans (diagnosed with DAH/effort syndromes and shell shock/neurasthenia) were contrasted with control populations of ex-servicemen awarded pensions for gunshot wounds and matched by level of disability.
Most Recent Publications:

Jones E, Palmer I. Army Psychiatry in the Korean War: the experience of one Commonwealth Division Military Medicine, 165:256-260, Apr 2000. Abstract

Jones E, Wessely S. Case of chronic fatigue syndrome after Crimean war and Indian mutiny. British Medical Journal, 18-25;319(7225):1645-7, Dec 1999. Abstract

Jones E, Vermaas RH, McCartney H, Beech C, Palmer I, Hyams KC, Wessely S. Flashbacks and post-traumatic stress disorder: the genesis of a 20th-century diagnosis. British Journal of Psychiatry, 182(2):158-163. Feb 2003. Abstract

Jones E, Everitt B, Palmer I, Hyams KC, McCartney H, Poynter D, Wessely S. From the Boer War to the Gulf: a statistical comparison of the symptomatology of postcombat syndromes. N/A, Submitted Research Report to DoD, Oct 2001. Report

Jones E, Vermaas RH, Beech C, Palmer I, Hyams KC, Wessely S. Mortality and postcombat disorders: U.K. veterans of the Boer War and World War I. Military Medicine, 168(5):414-418. May 2003. Abstract

Jones E, Hodgins-Vermaas R, McCartney H, Everitt B, Beech C, Poynter D, Palmer I, Hyams KC, Wessely S. Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution. British Medical Journal, 324(7333):321-324. Feb 2002. Abstract

Jones E, Wessely S. Psychiatric battle casualties: an intra and inter-war comparison British Journal of Psychiatry, 178:242-7, 2001. Abstract

Jones E, Hyams KC, Wessely S. Screening for vulnerability to psychological disorders in the military: an historical survey. Annals of Internal Medicine, Submitted, 2001. Article

Jones E, Wessely S. The Impact of total war on the practice of British psychiatry. The Shadows of Total War, Europe, East Asia and the United States 1919-1939, Cambridge University Press, In Press, 2001. Article

Jones E. The birth of military psychiatry: its pre-1914 history in the UK. The Royal College of Psychiatrists Annual Meeting, Jul 2001. Article

Jones E, Wessely S. The origins of British military psychiatry before the First World War. War and Society, 19:91-108, 2001. Article

Jones E. War Syndromes: the Psychological Impact of Modern Warfare, A Study of the changing nature of pressure groups and government responses. N/A, 1999. Report