Re: The Gulf War syndrome controversy

Mindfulness-based Stress Reduction in Addition to Usual Care Is Associated with Improvements in Pain, Fatigue, and Cognitive Failures Among Veterans with Gulf War Illness

BACKGROUND

Many Gulf War I veterans report ongoing negative health consequences. The constellation of pain, fatigue, and concentration/memory disturbances is referred to as "Gulf War illness." Prior research suggests that mindfulness-based stress reduction may be beneficial for these symptoms, but mindfulness-based stress reduction has not been studied for veterans with Gulf War illness. The objective of this trial was to conduct a pilot study of mindfulness-based stress reduction for veterans with Gulf War illness.

METHODS

Veterans (N = 55) with Gulf War illness were randomly assigned to treatment as usual plus mindfulness-based stress reduction or treatment as usual only. Mindfulness-based stress reduction was delivered in 8 weekly 2.5-hour sessions plus a single 7-hour weekend session. Pain, fatigue, and cognitive failures were the primary outcomes, assessed at baseline, after mindfulness-based stress reduction, and 6 months follow-up. Secondary outcomes included symptoms of posttraumatic stress disorder and depression.

RESULTS

In intention-to-treat analyses, at 6-month follow-up, veterans randomized to mindfulness-based stress reduction plus treatment as usual reported greater reductions in pain (f = 0.33; P = .049), fatigue (f = 0.32; P = .027), and cognitive failures (f = 0.40; P < .001). Depressive symptoms showed a greater decline after mindfulness-based stress reduction (f = 0.22; P = .050) and at 6 months (f = 0.27; P = .031) relative to treatment as usual only. Veterans with posttraumatic stress disorder at baseline randomized to mindfulness-based stress reduction plus treatment as usual experienced significantly greater reductions in symptoms of posttraumatic stress disorder after mindfulness-based stress reduction (f = 0.44; P = .005) but not at 6 months follow-up (f = 0.31; P = .082).

CONCLUSIONS

Mindfulness-based stress reduction in addition to treatment as usual is associated with significant improvements in self-reported symptoms of Gulf War illness, including pain, fatigue, cognitive failures, and depression.

Administration of an amino Acid-based regimen for the management of autonomic nervous system dysfunction related to combat-induced illness

The etiology and pathophysiology of posttraumatic stress disorder (PTSD) remains poorly understood. The nutritional deficiencies associated with the altered metabolic processes of PTSD have not previously been studied in detail. This pilot study measured the reduction in symptoms in 21 military veterans reporting moderate to severe symptoms associated with PTSD. Two amino acid–based medical foods specifically formulated with biogenic amines and other nutrients were administered to study subjects targeting specific neurotransmitter deficiencies resulting from altered metabolic activity associated with PTSD. This study included the Physician Checklist – Military (PCL-M), Short Form General Health Survey (SF-36), and Epworth Sleepiness Scale to measure the change in each subject’s score after 30 days of administration. An average decrease of 17 points was seen in the PCL-M, indicating a reduction in PTSD symptoms (P < 0.001). The mental health component of the SF-36 showed an average 57% increase in the subjects’ mental health rating (P < 0.001). The results of this initial study demonstrate that addressing the increased dietary requirements of PTSD can improve symptoms of the disease while eliminating significant side effects. A larger, double-blind, randomized, placebo-controlled trial is warranted.

On being a Gulf veteran: an anthropological perspective

There is no doubt that Gulf service has affected the well-being of some of the members of the UK armed forces who served in that conflict, yet the reason for this remain unclear. At present, the debate surrounding Gulf War Syndrome (GWS) has become stagnant and highly polarized. This paper argues that a new perspective is needed to further improve our understanding of the problem and suggests that the methods and theories of anthropology, with its focus on nuances and subtleties, can provide new insights. Data were generated from 14 months of ethnographic fieldwork in the UK including participant observation, semi-structured interviews and document analysis. Anthropology provides a unique way of approaching and understanding somatic symptoms and suggests that GWS symptom reporting can be seen as a form of communication. The work focuses on the sufferers' accounts, the symptoms themselves and the context within which we find them in order to better understand what was being expressed and commented upon. Although necessary to contextualize GWS through situating it among other emergent illnesses and widespread health beliefs, this paper shows there is a need to bring back the particular. This work seeks to make sense of the cultural circumstances, specific and general, which gave rise to the illness.

Gulf War Veterans’ Illnesses: A Pilot Study of the Relationship of Illness Beliefs to Symptom Severity and Functional Health Status

This investigation describes the illness beliefs of veterans regarding their Gulf War-related health concerns and investigates the relationship of these illness beliefs to physical and mental health functioning. Gulf War veterans (N = 583) presenting for evaluation at a Veteran's Affairs and Department of Defense facility completed self-report measures of symptom-related beliefs, psychosocial distress, and functional status. Hierarchical multiple regression analyses were performed to determine the extent that symptom-related beliefs impacted symptom-reporting and functional status independent of demographic factors and psychiatric illness. Several beliefs predicted physical symptom reporting and functional impairment in physical health and mental health domains after controlling for demographic variables and psychiatric illness. Gulf War veterans' illness beliefs may impact clinical outcomes. Discussing illness beliefs and providing accurate information is an important component of medical care for Gulf War veterans.

Posttraumatic stress symptomatology is associated with unexplained illness attributed to Persian Gulf War military service

OBJECTIVE

Controversy exists concerning unexplained illness in Persian Gulf War veterans, especially regarding the contribution of psychological trauma. We sought to determine if war zone trauma or posttraumatic stress symptomatology (PTSS) are associated with illnesses reported by Gulf War veterans that were documented by medical examination but not attributable to a medical diagnosis.

METHODS

A total of 1119 (55% response rate) of 2022 randomly sampled veterans of the United States Persian Gulf War were screened and 237 cases and 113 controls were identified by medical examination for a case-control study comparing Persian Gulf War military veterans with or without medically documented, but unexplained, symptoms. Multivariate logistic regression and cross-validation analyses examined self-report measures of demographics, subjective physical symptoms and functioning, psychiatric symptoms, stressors, war zone trauma, and PTSS, to identify correlates of case-control status.

RESULTS

Posttraumatic stress symptomatology and somatic complaints were independently associated with case status, as were (although less consistently) war zone trauma and depression. Age, education, and self-reported health, stress-related somatization, pain, energy/fatigue, illness-related functional impairment, recent stressors, and anxiety were univariate (but not multivariate) correlates of case status.

CONCLUSIONS

PTSS related to war zone trauma warrants additional prospective research study and attention in clinical screening and assessment as a potential contributor to the often debilitating physical health problems experienced by Persian Gulf War veterans.