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Health and Human Services Department of Defense Veterans Affairs Health and Human Services Gulf War Information Department of Defense Gulf War Information Veterans Affairs Gulf War Information Home Home Advanced Search Glossary FAQs Site Map Contact Us
 Research Topics    |    Major Focus Areas
Research Topics
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General
Project Summary

Title: Post-deployment Morbid Stress, Behavior and Health: Developing a Model for Predicting Morbidity, Mortality, and other Adverse Outcomes
Synopsis: The study aims to see if utilizing health and administrative information datasets of illnesses and death, and behavioral and stress related factors of Gulf War Veterans can be utilized to develop models to predict differences in who will or will not develop GWI.
Overall Project Objective: To identify important demographic, behavioral, and stress-related factors associated with excess morbidity as determinants of whether or not a soldier will develop a "war syndrome" condition subsequent to deployment or combat. The overall hypothesis is that much of the variation in which soldiers experience Gulf War Illnesses (GWI) can be explained by four main factors and interactions among these factors. The four factors are: 1) predeployment stressors, distress, functional status or health status; 2) predeployment health behaviors; 3) deployment-related stressors and distress; and 4) postdeployment behaviors and experiences.
Status/Results to Date: Key findings from this study include the following: (1) Selection bias (prewar differences in demographics, behaviors and stressors between deployed and nondeployed soldiers) does not appear to explain postwar excess risk for GWI. (2) Differences in risk-taking habits or exposures that were present prior to deployment may persist during and after the war and may explain differences in postwar injury morbidity between deployed and nondeployed veterans. (3) There is a need for further study of injury-related risk factors and outcomes among deployed veterans after they return to the U.S. (4) Data available for the study of Gulf War Era (GWE) veterans are limited. Hospitalization data may provide the most comprehensive information but are limited by at least four types of biases that must be considered when using these data. These include 1. Temporal changes in diagnosis, health care delivery, and coding practices; 2. Healthy worker effect bias (greater attrition among war veterans and VA care-seeking for previously unreported war-related health concerns); 3. Instrumentation bias (variable sensitivity of hospitalization for different diagnoses); and 4. Historical bias (associations between hospitalizations and media coverage of Gulf War Illnesses, and military downsizing). (5) Temporal trends in illnesses common among GW veterans suggest that these conditions were also common after the Vietnam redeployment period. In addition, hospitalization rates for these conditions increased with the initiation of the Army's CCEP program and with increased media focus on deployment related illnesses. There may also be temporal association between illnesses and stressful events such as military downsizing and base closures. (6) Analyses are underway for a fourth manuscript that documents associations between nonwar related stressors and risk for Gulf War-prevalent conditions among deployed and nondeployed GWE veterans. Thus far our results indicate that deployed soldiers are at greater risk for postwar psychiatric-related hospitalizations even after controlling for differences in demographics and prewar stressors between deployed and nondeployed soldiers. This is particularly true for unmarried deployed soldiers. On the other hand, married soldiers whose spouse was also on active duty, were at a 10-fold increased risk for a post-war hospitalization for any cause especially if his or her spouse also deployed to the gulf. Thus it seems that marital status, deployment, and the interaction between these factors influence health in complex ways that deserve further study. (7) Soldiers who scored lower on the Armed Services Vocational Aptitude Battery test (ASVAB) or soldiers who were not advancing in their rank as quickly as their peers, tended to be at increased risk for all adverse outcomes, and in particular psychiatric-related hospitalizations. This information may be useful in making selections for deployment or in developing targeted interventions during redeployment.
Project:DoD-73
Agency:Department Of Defense
Location:Soc. Sectors Develop. Strategies Inc
P.I. Name:Nicole S Bell, ScD, MPH
Research Type:Epidemiology
Research Focus:Symptoms & General Health
Focus Category:General Health & Physical Symptoms
Status:Ongoing
Study Start Date:June 25,1998
Estimated Completion Date:July 24,2001
Specific Aims: To describe and compare the health status of deployed and nondeployed Gulf War Era (GWE) veterans; to identify key demographic, behavioral, and stress-related factors associated with excess morbidity or mortality among these veterans; and to evaluate the quality of available data used to study the health of GWE veterans. There were seven specific products included in the approved Statement of Work (SOW) that pertained to the following hypotheses: 1. There is a baseline prevalence of the conditions most commonly included in definitions of GWI always present among active duty Army soldiers. 2. Selection for deployment to the Gulf is nonrandom and occurs in such a way that those at greatest risk for GWI or postwar injury may also be most likely to be deployed. 3. Individual characteristics and experiences of stress explain some variation in presentation of GWI in the general population independent of deployment to the Gulf. The combination of information including prewar measures of health and stress, individual characteristics, deployment to the Gulf, and stressors occurring concurrent with the time spent in the Gulf, can be used to predict much of the variation in GWI. 4. Effect modifiers of stress, distress, functional status, and health behaviors will improve the model's fit and facilitate understanding of factors key to predicting variation among those who do and do not develop GWI and postwar injury.
Methodology: Data from the Total Army Injury and Health Outcomes Database (TAIHOD) will be used. This database includes all hospitalizations, deaths, disabilities, and accidents reported for the years 1980-1998, and, for some analyses, data extending back as far as 1970 will be used. The TAIHOD personnel records include detailed demographic, occupation, deployment, and discharge information. Army Health Risk Appraisal (HRA) surveys are also linked to the TAIHOD and include measures of self-reported stress, distress, and risk-taking behaviors. Construction of variables used in testing each hypothesis will occur after careful consideration of the availability and quality of the data. Another important aspect to this work is the careful and rigorous review and evaluation of health and demographic data present in the TAIHOD; this work benefits not only our own research but has the potential to assist other researchers as well, as many of the administrative data sources contained in the TAIHOD are also used by other federally funded Gulf War Veterans' health researchers.
Most Recent Publications:

Bell NS, Amoroso PL, Williams JO, Yore MM, Engel CC, Senier L, DeMattos AC, Wegman DH. "Demographic, physical, and mental health factors associated with deployment of US Army soldiers to the Persian Gulf." Military Medicine, 165(10):762-72 , Oct 2000. Abstract

Bell NS, Amoroso PL, Wegman DH, Senier L. "Proposed Explanations for Excess Injury Among Veterans of the Persian Gulf War" Conference on Illnesses among Gulf War Veterans. A Decade of Scientific Research, January 23-26, 2001. Poster

Bell NS, Senier L, Yore MM, Engel CC, Wegman DH, DeMattos AC, Williams JO, Amoroso PL. A three-decade view of hospitalization rates for conditions common among soldiers deployed to the Gulf War: interpretation and bias. N/A, Submitted for publication. Article

Bell NS, Amoroso PL, Wegman DH, Senier L. Proposed explanations for excess injury among veterans of the Persian Gulf War and a call for greater attention from policymakers and researchers. Injury Prevention, 7(1):4-9, Mar 2001. Abstract

Bell NS, Amoroso PL, Senier L, Williams JO. The Total Army Injury and Health Outcomes Database (TAIHOD): Uses and Limitations as a Research Tool for Force Health Protection Research. Natick, MA: U.S. Army Research Institute of Environmental Medicine, In Preparation. Technical Note

Bell NS, Williams JO, Senier L, Amoroso PL. The U.S. Army's Health Risk Appraisal (HRA) Survey, Part II: Generalizability, Sample Selection, and Respondent Profile. Natick, MA: U.S. Army Research Institute of Environmental Medicine, In Preparation. Technical Report

Senier L, Bell NS, Strowman SR, Schemmp C, Amoroso PL. The U.S. Army's Health Risk Appraisal Survey Part I: History, Reliability, and Validity. Natick, MA: U.S. Army Research Institute of Environmental Medicine, In Preparation. Technical Note

Bell NS, Amoroso PL, Wegman DH, Senier L. Why are people who return from war at incresed risk for injury? Western Journal of Medicine, 175:115-118, 2001. Article