15. Health of female Gulf War veterans
This chapter describes the contact and recruitment outcomes, exposure assessment and investigation of health outcomes for female Gulf War veteran and comparison group participants. The results for female participants have been presented separately from male participants because health patterns in men and women can be quite different. If the data for the female participants had been included with the men’s data, patterns specific to women would have been difficult to identify. Because the number of female Gulf War veterans is quite small, comparisons between the two groups are limited to primarily descriptive analyses. Tests to detect statistically significant differences between groups were not conducted because of these small numbers.
The study methods and definitions in relation to health outcomes for female participants in the study are generally the same as those described in the preceding chapters for the health of male Gulf War veterans and will not be repeated in this female health chapter. Where analyses and methods in relation to the investigation of women’s health do differ from those described in previous chapters, these differences are documented in the appropriate section of this chapter.
15.1 Aim
The aim of this analysis is to describe the health of female Gulf War veterans and the exposures and experiences which they report as being relevant to their deployment to the Gulf War. Further, the analysis aims to compare the health, exposures and experiences of female Gulf War veterans with that of female comparison group participants. Finally, the analysis aims to compare the health, exposures and experiences of female Gulf War veterans with that of male Gulf War veterans.
15.2 Research questions
1. Are female Gulf War veterans similar to female comparison group participants in relation to a range of psychological and physical health measures?
2. What exposures and experiences do female Gulf War veterans report for the Gulf War deployment?
3. Are female Gulf War veterans similar to female comparison group participants in relation to exposures and experiences reported for non-Gulf War military service or civilian occupations?
4. Are female Gulf War veterans similar to male Gulf War veterans in relation to a range of psychological and physical health measures and exposures and experiences reported for the Gulf War deployment?
15.3 Results
15.3.1 Recruitment
The Australian deployment to the Gulf War included 38 female ADF personnel. These included 21 women who deployed with the Navy, 8 who deployed with the Army and 9 who deployed with the Air Force. During the contact and recruitment phase of the study, no female Gulf War veterans were reported to be deceased, permanently overseas or found to be ineligible for participation in the study.
The originally selected comparison group for the study included 75 women. One of these was found to be ineligible for participation as she had not been a serving member of the ADF in August 1990; therefore the eligible sample of female comparison group subjects comprised 74 persons. A further one female comparison group subject was reported to be overseas long term, leaving 73 recruitable female comparison group subjects which included 28 Navy, 18 Army and 27 Air Force personnel. No female comparison group subjects were reported to be deceased.
The recruitment outcomes, for the female recruitable subjects for both study groups, are shown in Table 15.1. These recruitment outcomes are similar in pattern to those for males. In total, 32 (84.2%) female Gulf War veterans participated in the study, either through completion of both the postal questionnaire and medical assessment (78.9%) or through completion of the postal questionnaire alone (5.3%). The participation rate amongst female comparison group subjects was 54.8%, with 40 subjects participating. This included 32 (43.8%) female comparison group subjects who completed both the postal questionnaire and medical assessment, and a further eight (11%) female comparison group subjects who completed the postal questionnaire alone.
|
Recruitment outcomes: females
|
||||||
|---|---|---|---|---|---|---|
|
Gulf War veterans
|
Comparison group
|
Total females
|
||||
|
n
|
(%)
|
n
|
(%)
|
n
|
(%)
|
|
|
Total recruitable sample
|
38
|
-
|
73
|
-
|
111
|
-
|
|
Participants
|
||||||
|
Full participant
|
30
|
(78.9)
|
32
|
(43.8)
|
62
|
(55.9)
|
|
Postal quest only
|
2
|
(5.3)
|
8
|
(11.0)
|
10
|
(9.0)
|
|
Non-participants
|
||||||
|
Telephone quest only
|
1
|
(2.6)
|
10
|
(13.7)
|
11
|
(9.9)
|
|
Declined all participation
|
3
|
(7.9)
|
16
|
(21.9)
|
19
|
(17.1)
|
|
Non-responders
|
0
|
(0)
|
2
|
(2.7)
|
2
|
(1.8)
|
|
Non-contactables
|
1
|
(2.6)
|
5
|
(6.8)
|
6
|
(5.4)
|
back to top
15.3.2 Demographic, socioeconomic and lifestyle factors
Differences between the two groups in the patterns of demographic, socioeconomic and lifestyle factors were assessed for all 32 female Gulf War veterans and 40 female comparison group participants.
Female Gulf War veterans were slightly older than female comparison group participants with a mean age of 37.8 years compared with 35.8 years. The breakdown of female Gulf War veterans and comparison group participants into age categories at the time of participation in the study, and also service type and rank at the time of the Gulf War, are shown in Table 15.2.
Participating female Gulf War veterans were more likely to be from the Navy and less likely to be from the Air Force, than female comparison group participants. Participating female Gulf War veterans were also more likely to have a higher rank and less likely to have a lower rank, than participating female comparison group subjects.
| Age, service type and rank | ||||
|---|---|---|---|---|
|
Gulf War veterans
N=32 |
Comparison group
N=40 |
|||
|
n
|
(%)
|
n
|
(%)
|
|
|
Age at participation
|
||||
|
< 35
|
16
|
(50.0)
|
25
|
(62.5)
|
|
>= 35
|
16
|
(50.0)
|
17
|
(42.5)
|
|
Service Type
|
||||
|
Navy
|
17
|
(53.1)
|
16
|
(40.0)
|
|
Army
|
8
|
(25.0)
|
8
|
(20.0)
|
|
Air Force
|
7
|
(21.9)
|
16
|
(40.0)
|
|
Rank
|
||||
|
Officer
|
13
|
(40.6)
|
12
|
(30.0)
|
|
Other rank-supervisory
|
10
|
(31.3)
|
9
|
(22.5)
|
|
Other rank-non supervisory
|
9
|
(28.1)
|
19
|
(47.5)
|
In relation to additional demographic measures (data not shown) approximately 85% of participants in both groups were born in Australia and four comparison group participants (10%), but no Gulf War veterans, identified themselves as being of aboriginal or Torres Strait Islander origin. Two thirds of the participants in both groups were married or in defacto relationships.
Gulf War veterans had achieved slightly higher levels of education than the comparison group, with 40% of Gulf War veterans reporting that they had attained an undergraduate or postgraduate degree compared with 30% of the comparison group. More than 80% of the female Gulf War veterans and 70% of the comparison group were currently in part-time of full-time employment. Only three subjects in total (one Gulf War veteran and two comparison group participants) reported that were not working due to ill-health.
Twenty five percent of female comparison group participants were current smokers and further 25% were former smokers. Gulf War veterans were less likely (18.8%) to be current smokers and more likely (34.4%) to be former smokers. Mean number of pack years for current smokers were 11.9 for Gulf War veterans and 20.4 for the comparison group. Mean number of pack years for former smokers were 13.4 for Gulf War veterans and 8.1 for the comparison group.
back to top15.3.3 Reported Gulf War and other exposures
Gulf War and other exposures were self-reported in the postal questionnaire and assessed for all 32 female Gulf War veteran participants and 40 female comparison group participants.
15.3.3.1 Service characteristics of female Gulf War veterans during the Gulf War
Female Gulf War veteran participants included 17 Navy, 8 Army and 7 Air Force personnel. Of these, 20 females reported to have deployed to the Gulf War in ships; seven in the supply ship HMAS Westralia and thirteen in the hospital ship USNS Comfort.
Personnel attached to HMAS Westralia reported various job descriptions including radio operations and engineering.
All 13 females on USNS Comfort reported that their primary duties were medical related.
Five Army participants reported serving as part of Operation Habitat and all reported that their primary duties were medical related.
Six of the seven Air Force females served with 33 Squadron and most reported to be flight stewards on standby to evacuate Australian personnel if necessary.
Most female Gulf War veterans (91%) were still on deployment in the Gulf region at the time of the start of the air war on January 17th 1991.
15.3.3.2 Other active deployments
Four female Gulf War veterans (13%) and seven comparison group participants (18%) had been on one or more active deployments other than the Gulf War. These included deployments to East Timor, Korea, Malaysia, the Gulf area outside of the time of the Gulf War, Solomon Islands, Somalia, Thailand and Vietnam.
15.3.3.3 Immunisations and preventive medications reported for the Gulf War deployment
Female Gulf War veterans estimated receiving a median of seven immunisations for the Gulf War deployment (range 0 to 11), similar to the median of six estimated by the men. Four female Gulf War veterans (13%) reported receiving no immunisations at all, whereas twelve (38%) reported receiving a cluster of more than five immunisations within a period of one week or less, in a time period prior to deployment.
Gulf War veterans were provided with a list of types of immunisations from which respondents reported which ones they believed they had received as part of the Gulf War deployment. Participants also reported whether or not they had received anti-nerve agent pills (NAPS), anti-biological warfare tablets or anti-malarial medications. The results are shown in Table 15.3 and are very similar to those reported for male Gulf War veterans. The most common immunisations reported by female Gulf War veterans were those for cholera, typhoid, Hepatitis B and polio and these include three of the most common immunisations reported by male Gulf War veterans. For all listed immunisations, more than 20% of the female veterans did not know whether they had received them or not. This percentage was as high as 40% or more in relation to pertussis, MMR and anthrax and these immunisations were also commonly included in the “Don’t know” category by male Gulf War veterans. Female veterans were a little less likely than the male veterans to report that they received anthrax and plague.
In relation to medications, no female participants reported taking anti-biological warfare tablets whereas six percent of the men reported taking these. Women were also less likely than the men to report taking NAPS and antimalarials.
Only two female Gulf War veterans reported having a ‘significant’ reaction to an immunisation or medication (data not shown).
| Immunisations and medications (N=32)* | ||||||
|---|---|---|---|---|---|---|
|
Yes
|
No
|
Don’t know
|
||||
|
n
|
(%)*
|
n
|
(%)*
|
n
|
(%)*
|
|
|
Immunisations
|
||||||
|
Cholera
|
21
|
(67.7)
|
2
|
(6.3)
|
8
|
(25.8)
|
|
Typhoid
|
20
|
(64.5)
|
3
|
(9.7)
|
8
|
(25.8)
|
|
Hepatitis B
|
18
|
(60.0)
|
6
|
(20.0)
|
6
|
(20.0)
|
|
Polio (oral Sabin)
|
18
|
(60.0)
|
4
|
(13.3)
|
8
|
(26.7)
|
|
Diptheria, Tetanus (ADT)
|
17
|
(53.1)
|
6
|
(20.0)
|
7
|
(23.3)
|
|
Hepatitis A (Havrix)
|
12
|
(40.0)
|
9
|
(30.0)
|
9
|
(30.0)
|
|
Smallpox
|
12
|
(40.0)
|
9
|
(30.0)
|
9
|
(30.0)
|
|
Plague
|
8
|
(25.8)
|
14
|
(45.2)
|
9
|
(29.0)
|
|
Tuberculosis (BCG)
|
5
|
(17.2)
|
13
|
(44.8)
|
11
|
(37.9)
|
|
Measles, Mumps, Rubella (MMR)
|
5
|
(16.1)
|
13
|
(41.9)
|
13
|
(41.9)
|
|
Pertussis
|
3
|
(10.3)
|
12
|
(41.4)
|
14
|
(48.3)
|
|
Anthrax
|
3
|
(10.0)
|
15
|
(50.0)
|
12
|
(40.0)
|
|
Any other immunisation
|
19
|
(65.5)
|
1
|
(3.4)
|
9
|
(31.0)
|
|
Preventive medications
|
||||||
|
Antimalarials
|
11
|
(34.4)
|
14
|
(43.8)
|
7
|
(21.9)
|
|
Anti-nerve agent pills (NAPS)
|
6
|
(18.8)
|
22
|
(68.8)
|
4
|
(22.5)
|
|
Anti-biological warfare tablets
|
0
|
(0)
|
27
|
(84.4)
|
5
|
(15.6)
|
* The value of N from which each percentage is derived may vary by up to 3 fewer respondents for individual table items.
back to top15.3.3.4 Self reported psychological stressors during Gulf War service and during non Gulf War service
Military Service Experience questionnaire items reported by five or more female Gulf War veterans in relation to the Gulf War deployment, are shown in Table 15.4 in decreasing order of frequency. Total numbers of “yes” responses to individual items are quite small and therefore discussion of differences between Gulf War service versus non-Gulf War service, and between the two study groups in relation to non-Gulf War service, are limited to items where the differences are most apparent.
Items relating to fear or threat of attack including artillery or missile attack or biological or chemical attack, and fear for ones life including fear of entrapment below the waterline of a ship, were commonly reported in relation to the Gulf War deployment and rarely reported in relation to non-Gulf War military service. Feeling cut off or separated from family or significant others was the most common psychological stressor reported in relation to the Gulf War deployment. This item was common in relation to non-Gulf War service also, but only half as common compared with the Gulf War deployment.
Most items were more commonly reported in relation to the Gulf War deployment when compared to non-Gulf War service. The rarity of combat-type stressors or exposures during non-Gulf War service is probably related to the finding that very small numbers of female Gulf War veterans had been on active deployment other than the Gulf War, and very small numbers of comparison group participants had ever been on an active deployment.
Sexual harassment was very common. It was more likely to be reported by females in the comparison group (50%), compared with Gulf War veterans during Gulf War service (23%) or during non-Gulf war service (24%), and more likely to be reported by female participants in both study groups when compared with male participants (<3%).
In other comparisons with male Gulf War veterans in relation to the Gulf War deployment, female Gulf War veterans were more likely to report feeling not sufficiently trained or prepared and less likely to report a ‘near miss’ or ‘close call’ incident, encountering undetonated mines or being responsible for detecting incoming attacks or spotting sea-mines. However, the four most common MSE items reported by female Gulf War veterans were also the four most common MSE items reported by male Gulf War veterans, though in a differing order.
| Military Service Experience questionnaire | ||||||
|---|---|---|---|---|---|---|
|
Gulf War service
|
Non-Gulf War service
|
|||||
|
Gulf War veterans
N=32* |
Gulf War veterans
N=30* |
Comp group
N=40* |
||||
|
MSE item
|
n
|
(%)*
|
n
|
(%)*
|
n
|
(%)*
|
| You felt cut off or separated from family or significant others. |
20
|
(62.5)
|
9
|
(31.0)
|
15
|
(37.5)
|
| You were in fear of artillery, missile, SCUD rocket or bomb attack. |
18
|
(56.3)
|
0
|
(0)
|
0
|
(0)
|
| You were on formal alert for, or felt in threat of nuclear, biological or chemical agent attack. |
16
|
(50.0)
|
0
|
(0)
|
2
|
(5.0)
|
| You were on a ship or aircraft (including a helicopter) passing through hostile waters or air space. |
16
|
(50.0)
|
2
|
(6.9)
|
5
|
(12.5)
|
| You felt not sufficiently trained or prepared for military activities. |
15
|
(46.9)
|
5
|
(17.9)
|
11
|
(27.5)
|
| You were in fear for your life. |
14
|
(45.2)
|
3
|
(10.7)
|
1
|
(2.5)
|
| On board a ship you feared death, injury or entrapment below the waterline as a result of missile attack or hitting a sea-mine. |
14
|
(43.8)
|
0
|
(0)
|
0
|
(0)
|
| You experienced lack of leadership in your team, crew or unit. |
11
|
(34.4)
|
9
|
(30.0)
|
15
|
(37.5)
|
| You felt lack of togetherness or cohesion in your team or unit. |
10
|
(32.3)
|
12
|
(41.4)
|
14
|
(35.0)
|
| You saw Defence personnel or civilians who were killed, dead, dying or maimed. |
10
|
(31.3)
|
9
|
(31.0)
|
7
|
(17.5)
|
| Your supplies or equipment were inadequate, insufficient or faulty. |
9
|
(28.1)
|
4
|
(13.8)
|
9
|
(23.1)
|
| You were sexually harassed. |
7
|
(22.6)
|
7
|
(24.1)
|
20
|
(50.0)
|
| You were required to administer medical aid for which you were not adequately trained or equipped, eg geriatrics, paediatrics, palliative care. |
7
|
(21.9)
|
2
|
(6.9)
|
1
|
(2.5)
|
| You felt alienated from other military personnel around you. |
7
|
(21.9)
|
7
|
(24.1)
|
6
|
(15.0)
|
| Artillery, rockets, missiles, mines or something similar, exploded in the air, in the water or on the ground close to you. |
6
|
(19.4)
|
0
|
(0)
|
2
|
(5.0)
|
| You experienced a ‘near miss’ or ‘very close call’ incident where you were in imminent danger of being injured or killed. |
6
|
(18.8)
|
5
|
(17.2)
|
4
|
(10.0)
|
| You handled or came into contact with POWs or displaced refugees. |
6
|
(18.8)
|
1
|
(3.4)
|
3
|
(7.5)
|
| You had difficulty breathing as a result of exposure to oil, smoke, fumes, dust or other contaminants in the air. |
6
|
(18.8)
|
2
|
(6.9)
|
3
|
(7.7)
|
| You feared attack from bandits, rebels or other local militia groups. |
6
|
(18.8)
|
3
|
(10.7)
|
4
|
(10.0)
|
| You felt overwhelmed by the level of destruction or devastation or disease around you. |
5
|
(16.7)
|
3
|
(10.7)
|
2
|
(5.0)
|
| You encountered undetonated mines, including sea mines, or booby traps while on patrol or at your duty station. |
5
|
(15.6)
|
0
|
(0)
|
0
|
(0)
|
* The value of each N from which each percentage is derived may vary by up to 2 fewer respondents for individual MSE questionnaire items.
back to top15.3.3.5 Self reported chemical and environmental exposures during the Gulf War and other active deployments
Chemical and environmental exposures reported by four or more female Gulf War veterans in relation to the Gulf War deployment, are shown in Table 15.5 in decreasing order of frequency. Because only four female Gulf War veterans and seven comparison group participants had been on one or more active deployment other than the Gulf War, chemical and environmental exposures reported in relation to those deployments were too few to be compared and they have not been tabulated.
Female Gulf War veterans reported a range of exposure types including locally supplied foods, insects, sunscreens, SMOIL, fuels, solvents and pesticides. Compared with male Gulf War veterans, female Gulf War veterans were more likely to report exposure to SMOIL and pesticides and less likely to report exposure to solvents, fuels, engine exhausts and dust storms.
Possible exposure to depleted uranium was very rare and no female Gulf War veterans reported exposure to CARC paint or wearing flea collars.
| Gulf War deployment chemical and environmental exposures | ||
|---|---|---|
| Gulf War veterans N=32 | ||
| n | (%) | |
| Ate locally sourced, non-military issue food eg from local villagers. | 24 | (75.0) |
| Bitten by flies, sand flies, fleas, mosquitoes or other insects | 18 | (56.3) |
| Used a sunscreen when outdoors | 17 | (53.1) |
| Exposed to SMOIL | 17 | (53.1) |
| Exposed to intense smoke eg from forest fires or burning oil | 12 | (37.5) |
| Undertook refuelling | 12 | (37.5) |
| Ate locally sourced, military issue food | 10 | (31.3) |
| Swam or bathed in local lakes, rivers or the sea | 9 | (28.1) |
| Drank water from local taps or wells | 8 | (25.0) |
| Had solvents, oils, diesel or other fuel on your skin | 7 | (22.6) |
| Exposed to solvents eg from cleaning or painting | 7 | (21.9)* |
| Clothing or uniforms treated with pesticides | 5 | (15.6) |
| Lived or worked in an area that had been recently sprayed or fogged with a pesticide | 5 | (15.6) |
| Tent treated with pesticides | 4 | (12.5) |
| In an area where chemical warfare agents had probably been used | 4 | (12.5) |
* For this item N=31
15.3.3.6 Other occupational exposures during military postings and during civilian occupations
Self reported exposure to pesticides, solvents, fuels and exhausts during military postings of three months or more are shown in Table 15.6. Exposure to solvents and exhausts were relatively common in both study groups, reported by between 20% and 31% of all participants. Exposure to pesticides was relatively common in the Gulf War veteran group but less common in the comparison group.
In relation to civilian occupations (data not shown), exposure to chemical agents such as pesticides, solvents and fuels were rare in both study groups. Exposure to infectious diseases and to trauma to others were both reported by more than 40% of female Gulf War veterans and by only 12% of the comparison group.
| Military postings exposures | ||||
|---|---|---|---|---|
|
Gulf War veterans
N=32 |
Comparison group
N=40 |
|||
|
n
|
(%)
|
n
|
(%)
|
|
| Pesticides |
6
|
(18.8)
|
2
|
(5.0)
|
| Solvents |
10
|
(31.3)
|
11
|
(27.5)
|
| Fuels |
7
|
(21.9)
|
6
|
(15.0)
|
| Engine exhausts |
9
|
(28.1)
|
8
|
(20.0)
|
back to top
15.3.4 General health
The 32 female Gulf War veterans and 40 female comparison group participants were assessed for differences in their self report of health symptoms experienced in the previous month, doctor diagnosed or treated medical conditions that were first experienced in 1991 or later, number of hospitalisations in the previous twelve months, functional impairment due to illness in the previous two weeks, current use of medication and Short-Form-12 Health Survey summary scores.
The 30 female Gulf War veterans and 32 female comparison group participants, who attended HSA for the medical assessment, were assessed for differences in measures of height, weight and Body Mass Index, waist and hip circumference and hip-to-waist ratio, blood pressure and fitness test results.
15.3.4.1 Symptoms
Table 15.7 presents those health symptoms reported to be experienced in the previous month by at least five female Gulf War veterans or more, and ordered by decreasing prevalence for the Gulf War veteran group. This includes 32 of the 63 health symptoms included in the postal questionnaire. The prevalences of these 32 symptoms are also shown for the comparison group. Gulf War veterans reported 17 of the 32 symptoms more commonly than the comparison group, whilst the comparison group reported 14 symptoms more commonly.
| Self-reported symptoms | ||||
|---|---|---|---|---|
|
Gulf War veterans
N=32 |
Comparison group
N=40 |
|||
|
Symptom
|
n
|
(%)
|
n
|
(%)
|
| Fatigue |
21
|
(65.6)
|
27
|
(67.5)
|
| Headaches |
19
|
(59.4)
|
28
|
(70.0)
|
| Irritability / outbursts of anger |
18
|
(56.3)
|
19
|
(47.5)
|
| Sleeping difficulties |
18
|
(56.3)
|
23
|
(57.3)
|
| Low back pain |
18
|
(56.3)
|
20
|
(50.0)
|
| Feeling unrefreshed after sleep |
16
|
(50.0)
|
21
|
(52.5)
|
| Loss of interest in sex |
14
|
(43.8)
|
11
|
(27.5)
|
| Flatulence or burping |
13
|
(40.6)
|
13
|
(32.5)
|
| Indigestion |
13
|
(40.6)
|
5
|
(12.5)
|
| Forgetfulness |
12
|
(37.5)
|
15
|
(37.5)
|
| General muscle aches or pains |
12
|
(37.5)
|
17
|
(42.5)
|
| Difficulty finding the right word |
11
|
(34.4)
|
15
|
(37.5)
|
| Stiffness in several joints |
11
|
(34.4)
|
14
|
(35.0)
|
| Feeling jumpy / easily startled |
10
|
(31.3)
|
8
|
(20.0)
|
| Rash or skin irritation |
9
|
(28.1)
|
9
|
(22.5)
|
| Sore throat |
9
|
(28.1)
|
12
|
(30.0)
|
| Loss of concentration |
9
|
(28.1)
|
13
|
(32.5)
|
| Avoiding doing things or situations |
9
|
(28.1)
|
5
|
(12.5)
|
| Pain, without swelling or redness, in several joints |
9
|
(28.1)
|
12
|
(30.0)
|
| Stomach cramps |
8
|
(25.0)
|
11
|
(27.5)
|
| Intolerance to alcohol |
7
|
(21.9)
|
6
|
(15.0)
|
| Diarrhoea |
7
|
(21.9)
|
7
|
(17.5)
|
| Dizziness, fainting or blackouts |
7
|
(21.9)
|
5
|
(12.5)
|
| Feeling distant or cut off from others |
6
|
(18.8)
|
6
|
(15.0)
|
| Constipation |
6
|
(18.8)
|
7
|
(17.5)
|
| Mouth ulcers |
6
|
(18.8)
|
1
|
(2.5)
|
| Increased sensitivity to noise |
6
|
(18.8)
|
3
|
(7.5)
|
| Distressing dreams |
6
|
(18.8)
|
8
|
(20.0)
|
| Unintended weight gain greater than 4kg |
6
|
(18.8)
|
4
|
(10.0)
|
| Shortness of breath |
5
|
(15.6)
|
9
|
(22.5)
|
| Skin infections eg boils |
5
|
(15.6)
|
0
|
(0)
|
| Persistent cough |
5
|
(15.6)
|
8
|
(20.0)
|
The six most prevalent symptoms for female Gulf War veterans were the same as the six most prevalent symptoms for male Gulf War veterans, and tended to be neuropsychological or musculoskeletal in nature. Whilst these were in different orders of prevalence, these six most prevalent symptoms affected between 50% and 66% of both male and female Gulf War veterans. Women were five times less likely than men to report ringing in the ears, three times less likely to report itchy or painful eyes, and twice as likely to report loss of interest in sex.
Only five symptoms, of the original 63, were not reported by any female Gulf War veterans as having been experienced in the previous month. These were double vision, shaking, seizures or convulsions, pain on passing urine and vomiting (not tabulated).
The median number of symptoms reported was 11.0 (range 0 – 27) for female Gulf War veterans and 10.5 (range 0 – 35) for female comparison group participants.
back to top15.3.4.2 Medical conditions
Table 15.8 presents those medical conditions which were reported by three or more female Gulf War veterans as being doctor diagnosed or treated and first experienced in 1991 or later. These are ordered in decreasing prevalence for Gulf War veterans. This includes 15 of the 61 medical conditions in the postal questionnaire.
Total numbers of female subjects reporting medical conditions first experienced in 1991 or later were very small and therefore differences between the two groups are difficult to interpret. However, the largest differences between the two groups are in relation to reported psychological conditions, with female Gulf War veterans reporting more posttraumatic stress disorder, anxiety, stress and depression and other psychiatric or psychological conditions needing treatment or counselling. Gulf War veterans were also more likely to report yeast disease or candidiasis.
back to top| Medical conditions diagnosed in 1991 or later | ||||
|---|---|---|---|---|
|
Gulf War veterans N=32*
|
Comparison group N=40*
|
|||
|
Medical condition
|
n
|
(%)*
|
n
|
(%)*
|
| Back or neck problems |
9
|
(33.3)
|
13
|
(41.9)
|
| Period problems |
9
|
(33.3)
|
9
|
(27.3)
|
| Anxiety, stress or depression |
10
|
(31.3)
|
8
|
(20.0)
|
| Miscarriages |
5
|
(17.9)
|
6
|
(15.4)
|
| Joint problems |
5
|
(17.2)
|
6
|
(17.1)
|
| Bronchitis |
4
|
(13.3)
|
3
|
(8.8)
|
| Dermatitis |
4
|
(13.3)
|
5
|
(13.5)
|
| Irritable bowel syndrome |
4
|
(12.9)
|
4
|
(10.0)
|
| Any other skin problem† |
4
|
(12.9)
|
5
|
(13.5)
|
| Other psychiatric or psychological condition needing treatment or counselling‡ |
4
|
(12.9)
|
1
|
(2.5)
|
| Hayfever |
4
|
(12.9)
|
3
|
(10.3)
|
| Yeast disease or candidiasis |
4
|
(12.5)
|
1
|
(2.9)
|
| Migraines |
3
|
(10.3)
|
3
|
(8.1)
|
| Post Traumatic Stress Disorder |
3
|
(9.4)
|
1
|
(2.5)
|
| Any disease of the genital organs |
3
|
(9.4)
|
5
|
(12.5)
|
* The value of each N from which each percentage is derived
may vary by up to 9 fewer respondents for individual medical conditions.
† Refers to skin conditions other than dermatitis, eczema, psoriasis,
malignant melanoma or other skin cancer as reported by the participant
in the postal questionnaire.
‡ Refers to psychiatric or psychological conditions other than alcohol
abuse or dependency, drug abuse or dependency, anxiety stress or depression,
or posttraumatic stress disorder as reported by the participant in the
postal questionnaire
In comparison with male Gulf War veterans, and excluding those medical conditions asked specifically of women, the most prevalent conditions reported by women were similar to the most prevalent conditions reported by men. ‘Back or neck problems’ was the most prevalent condition reported by male Gulf War veterans, ‘anxiety stress or depression’ was the 4th most prevalent condition reported by men and ‘joint problems’ was the 2nd most prevalent. Other highly prevalent conditions reported by female Gulf War veterans as being first diagnosed in 1991 or later; namely dermatitis, hayfever, other psychological disorders, posttraumatic stress disorder and migraines, were all amongst the 16 most prevalent conditions reported by male Gulf War veterans.
Of these medical conditions specific to women, miscarriage and period problems were similar in the two groups.
back to top15.3.4.3 Hospitalisations, functional impairment and use of medications
In the twelve months prior to assessment, eight (25%) female Gulf War veterans and nine (22.5%) comparison group participants reported being hospitalised overnight or longer. Amongst Gulf War veterans, one subject was hospitalised for 170 days across the 12 months; the other seven Gulf War veterans averaged 5 days. The comparison group averaged 3 days of hospitalisation.
In the two weeks prior to assessment, eleven (34.4%) female Gulf War veterans and twelve (30%) comparison group participants reported staying in bed or at home all or part of any day because they did not feel well or as a result of illnesses or injury.
Twenty (62.5%) female Gulf War veterans and sixteen (40%) comparison group participants reported that they were currently taking medicines including tablets, creams, inhalers or other drugs.
Whilst there is no apparent difference between the two groups regarding average hospitalisations in the previous 12 months and functional impairment in the previous two weeks, slightly more female Gulf War veterans report greater use of medications than female comparison group participants.
15.3.4.4 Short-Form-12 Health Survey (SF-12)
Using the SF-12, female Gulf War veterans reported similar physical health but poorer mental health than the comparison group. Mean scores for the Physical Component Summary of the SF-12 were 50.6 (SD 10.2) for Gulf War veterans and 49.4 (SD 8.1) for the comparison group. Mean scores for the Mental Component Summary of the SF-12 were 46.1 (SD 10.1) for Gulf War veterans and 51.3 (SD 10.2) for the comparison group. The mean SF-12 scores for women and pattern of poorer MCS scores found for Gulf War veterans, are similar to the mean scores and pattern found for the men.
15.3.4.5 Height, weight and Body Mass Index
The two female study groups were very similar in relation to mean height, weight and Body Mass Index (BMI). Gulf War veterans were, on average, slightly taller (166cm versus 164cm) and slightly heavier (73.7kg versus 70.5kg) than the comparison group, however both groups recorded the same mean BMI of 26.
| Weight category using BMI | ||||
|---|---|---|---|---|
|
Gulf War veterans
|
Comparison group
|
|||
|
BMI (kg/m2)
|
n
|
(%)
|
n
|
(%)
|
|
Normal weight
|
||||
|
18.5-<20.00
|
1
|
(3.3)
|
1
|
(3.1)
|
|
20.00-<25.00
|
9
|
(30.0)
|
10
|
(31.3)
|
|
Overweight or obese
|
||||
|
Pre-obese (25.00-<30.00)
|
14
|
(46.7)
|
18
|
(56.3)
|
| Obese (>30.00) |
6
|
(20.0)
|
3
|
(9.4)
|
Using the individual BMI results, participants were classified as either underweight, or into categories of ‘normal weight’ or ‘overweight or obese’ according to the criteria used by the National Nutrition Survey.[289] No participants met criteria for being underweight (BMI <= 18.5). The results of the classification of participants into normal weight categories and overweight or obese categories are shown in Table 15.9. Approximately one third of both groups met criteria for normal weight. Of those remaining subjects classified as overweight, Gulf War veterans were slightly more likely than comparison group participants to meet criteria for obesity.
back to top15.3.4.6 Waist, hip, and waist-to-hip ratio
Waist and hip circumferences were very similar for the two groups, averaging 86.3cm and 105.7cm for Gulf War veterans, and 83.4cm and 104.4cm for the comparison group. Gulf War veterans (n=8, 27%) were slightly less likely than the comparison group (n=13, 41%) to have a waist-to-hip ratio greater than 0.8 which is indicative of increased risk of cardiovascular disease.
15.3.4.7 Blood Pressure
More than 90% of females in both groups recorded normal blood pressure. Of those, more than 70% recorded optimal blood pressure readings of systolic pressure <120mmHg and diastolic pressure <80mmHg. Only two subjects in each group had high-normal blood pressure and only one subject from each group had mild, grade 1 hypertension. No female subjects had grade 2 or 3 hypertension or isolated systolic hypertension.
15.3.4.8 Fitness test
20 female Gulf War veterans (66.7%) and 23 female comparison group participants (53.1%) completed a three-minute step test. The mean recovery heart rate was similar for the two groups at 146.9 bpm and 148.5 bpm respectively.
The two groups are shown in Table 15.10 after dividing the range of recovery heart rates into tertiles, with lower recovery heart rates representing higher fitness. The two groups had a very similar pattern of fitness.
| Step test recovery heart rate | ||||
|---|---|---|---|---|
|
Gulf War veterans N=20
|
Comparison group N=17
|
|||
|
Mean recovery heart rate
|
n
|
(%)
|
n
|
(%)
|
| 112 >= 139 (Higher fitness) |
7
|
(35.0)
|
5
|
(29.4)
|
| 140 >= 158 (Medium fitness) |
7
|
(35.0)
|
6
|
(35.3)
|
| 159 >= 180 (Lower fitness) |
6
|
(30.0)
|
6
|
(35.3)
|
15.3.5 Laboratory investigations
Laboratory investigations were performed on blood samples drawn from the 30 female Gulf War veterans and 32 female comparison group participants who undertook the medical assessment. No female participants declined to give blood samples.
Mean scores for all haematological, biochemistry and liver function tests are shown in Table 15.11 and are very similar between the two groups of female participants.
All parameters were reviewed for the numbers of subjects falling inside and outside of the reference ranges for each test (data not shown). The pattern of results were very similar for the two groups and very similar to those presented for the male study participants. The numbers of subjects outside of the reference ranges were typically very small and too few for any differences between the two groups to be meaningfully assessed.
|
Gulf War veterans
(N=30) |
Comparison group
(N=32) |
||||
|---|---|---|---|---|---|
|
Parameter
|
Reference range
|
Mean
|
(SD)
|
Mean
|
(SD)
|
|
Haematological tests
|
|||||
|
Haemoglobin (Hb)
|
115-155 g/L
|
131.8
|
(9.8)
|
134.3
|
(10.8)
|
|
Mean corpuscular volume (MCV)
|
80.0-98.0 fl
|
92.8
|
(8.1)
|
93.4
|
(2.9)
|
|
Mean corpuscular haemoglobin (MCH)
|
27.0-33.0 pg
|
29.8
|
(2.7)
|
30.3
|
(1.3)
|
|
White cell count (WCC)
|
4.0-11.0 x 109/L
|
6.7
|
(1.5)
|
6.7
|
(1.7)
|
|
Neutrophil count
|
1.8-7.5x 109/L
|
4.2
|
(1.2)
|
4.0
|
(1.3)
|
|
Lymphocyte count
|
1.0-3.5x 109/L
|
2.0
|
(0.5)
|
2.1
|
(0.7)
|
|
Eosinophils
|
0.02-0.5x 109/L
|
0.1
|
(0.1)
|
0.2
|
(0.1)
|
|
Basophils
|
0.0-0.1x 109/L
|
0.03
|
(0.01)
|
0.02
|
(0.01)
|
|
Monocytes
|
0.2-0.8 x 109/L
|
0.4
|
(0.1)
|
0.4
|
(0.1)
|
|
Platelets
|
150-400 x 109/L
|
263.6
|
(61.9)
|
269.6
|
(61.5)
|
|
Erythrocyte sedimentation rate (ESR)
|
1-12mm/hour†
|
5.7
|
(3.3)
|
6.6
|
(7.2)
|
|
Biochemical tests
|
|||||
|
Sodium
|
137-145 mmol/L
|
140.9
|
(2.2)
|
140.3
|
(2.4)
|
|
Potassium
|
3.8-4.9 mmol/L
|
4.2
|
(0.4)
|
4.4
|
(0.5)
|
|
Urea
|
2.7-8.0 mmol/L
|
4.4
|
(0.9)
|
4.8
|
(1.0)
|
|
Creatinine
|
0.05-0.12 mmol/L
|
0.1
|
(0.01)
|
0.1
|
(0.01)
|
|
Ionised calcium
|
1.10-1.25 mmol/L
|
1.1
|
(0.1)
|
1.1
|
(0.1)
|
|
Phosphate
|
0.65-1.45 mmol/L
|
1.1
|
(0.2)
|
1.2
|
(0.2)
|
|
Random plasma glucose
|
5.5-11.0 mmol/L*
|
5.0
|
(1.3)
|
4.5
|
(0.6)
|
|
C-reactive protein
|
<4-10 mg/L
|
3.4
|
(3.0)
|
3.1
|
(2.5)
|
|
Liver function tests
|
|||||
|
Albumin
|
34-48 g/L
|
39.8
|
(2.1)
|
40.4
|
(3.3)
|
|
Globulin
|
26-41 g/L
|
30.2
|
(3.5)
|
30.3
|
(3.8)
|
|
Total protein
|
65-85 g/L
|
70.1
|
(3.5)
|
70.7
|
(5.5)
|
|
Total bilirubin
|
6-24 µmol/L
|
8.2
|
(3.4)
|
9.3
|
(4.2)
|
|
GGT
|
0-60 U/L
|
19.9
|
(13.4)
|
19.1
|
(12.9)
|
|
ALP
|
30-110 U/L
|
67.9
|
(25.3)
|
66.8
|
(21.1)
|
|
ALT
|
0-55 U/L
|
22.6
|
(10.3)
|
20.4
|
(11.2)
|
|
AST
|
0-45 U/L
|
26.0
|
(7.6)
|
25.3
|
(5.1)
|
* Reference ranges used are those recommended by the
NHMRC
(http://www.health.gov.au/nhmrc/ advice/pdf/type2.pdf).
† ESR reference intervals are 1-12mm/hour (age <=50 years) and
1-20mm/hour (age >50 years)
15.3.6 Psychological health
15.3.6.1 CIDI-defined psychological disorders
All 30 female Gulf War veterans and 32 female comparison group participants, who attended HSA for the medical assessment component of the study, completed the psychologist administered CIDI interview. The numbers and percentages of female Gulf War veterans and comparison group participants who met criteria for CIDI-defined pre-Gulf War disorders, post-Gulf War disorders and disorders present within the previous 12 months, are shown in Table 15.12. Where no female subjects met criteria for a particular type of disorder, this disorder was excluded from the table.
| CIDI defined psychological disorders | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Pre-Gulf War disorders
|
Post-Gulf War disorders
|
Disorders present in previous 12 months
|
||||||||||
|
CIDI defined disorder
|
Gulf War veterans
|
Comp grp
|
Gulf War veterans
|
Comp grp
|
Gulf War veterans
|
Comp grp
|
||||||
|
n
|
(%)
|
n
|
(%)
|
n
|
(%)*
|
n
|
(%)*
|
n
|
(%)
|
n
|
(%)
|
|
|
Major depression
|
3
|
(10.0)
|
1
|
(3.1)
|
6
|
(22.2)
|
8
|
(25.8)
|
2
|
(6.7)
|
2
|
(6.3)
|
|
Posttraumatic stress disorder
|
0
|
(0)
|
1
|
(3.1)
|
3
|
(10.0)
|
2
|
(6.5)
|
2
|
(6.7)
|
0
|
(0)
|
|
Obsessive-Compulsive Disorder
|
0
|
(0)
|
0
|
(0)
|
2
|
(6.7)
|
0
|
(0)
|
2
|
(6.7)
|
0
|
(0)
|
|
Specific phobia
|
4
|
(13.3)
|
1
|
(3.1)
|
0
|
0
|
1
|
(3.2)
|
4
|
(13.3)
|
2
|
(6.3)
|
|
Social phobia
|
1
|
(3.3)
|
0
|
(0)
|
1
|
(3.4)
|
0
|
0
|
1
|
(3.3)
|
0
|
(0)
|
|
Panic disorder / Agoraphobia
|
1
|
(3.3)
|
0
|
(0)
|
1
|
(3.4)
|
1
|
(3.1)
|
1
|
(3.3)
|
1
|
(3.1)
|
|
Somatisation disorder
|
0
|
(0)
|
0
|
(0)
|
1
|
(3.3)
|
||||||