Persian Gulf War veterans report significantly higher rates of medical and psychiatric symptoms than military personnel deployed elsewhere during the war, according to a recent study.

"The Iowa Persian Gulf Research Project is one of the first population-based, controlled epidemiologic studies to document that difference," said David Schwartz, M.D., a professor of internal medicine and preventive medicine at the University of Iowa College of Medicine in Iowa City.

Schwartz reported at an AMA-sponsored press briefing last month in Washington, D.C., that military personnel deployed to the Persian Gulf area, in particular Iraq, Saudi Arabia, or Kuwait, had increased prevalence rates of 11 percent for cognitive dysfunction, 9 percent for fibromyalgia, 6 percent for depression, 5 percent for alcohol abuse, 2 percent for anxiety disorder, and 1 percent for PTSD and chronic fatigue.

Veterans with high symptom rates also reported a significant impairment in social activities and decreased performance, noted Schwartz.

Researchers also found that veterans exposed to multiple toxic substances during the Persian Gulf War were more likely to have medical and psychiatric problems. For example, depression was associated with an increased prevalence of exposure to solvents, smoke, sources of infectious agents, sources of lead from fuels, pesticides, ionizing and nonionizing forms of radiation, chemical warfare agents, and pyridostigmine bromide, a pretreatment for potential poison gas exposure, said Schwartz.

Contrary to previous reports suggesting that the type of military service is linked to symptom prevalence, Schwartz and his colleagues found that the National Guard and reservists reported only a 1 percent increase in chronic fatigue symptoms and a 4 percent increase in alcohol abuse symptoms.

The 3,695 subjects studied were selected from a larger population of 28,968 military personnel who listed Iowa as their residence and represented all four branches of the military, noted Schwartz. The Persian Gulf War subjects were deployed in more than 950 military units throughout the region. A comparison group consisted of military personnel who served outside the Persian Gulf region during the war.

Schwartz noted that 91 percent of subjects contacted by telephone five years after the war completed detailed interviews. Moreover, about 30 researchers from different institutions were involved in the study, including the University of Iowa, the Iowa Department of Public Health, and the Centers for Disease Control and Prevention.

Philip Landrigan, M.D., a member of the Presidential Advisory Committee on Gulf War Veterans, commented on Schwartz's study in an editorial in the January 15 issue of the Journal of the American Medical Association (JAMA), the same issue that contained Schwartz's study.

"The study is particularly robust. It includes a representative sample of all veterans from Iowa who served in the Persian Gulf. Participation rates were high."

Landrigan is also chair of the department of community medicine and director of environmental and occupational medicine at Mount Sinai School of Medicine in New York City.

A limitation of the study, however, "which Schwartz et al. acknowledge, is that all symptoms and exposures are self-reported and thus subject to recall bias," continued Landrigan.

Schwartz noted this bias "could substantially alter the frequency of illness or exposures between exposed and nonexposed subjects, which is a potential problem in any retrospective epidemiologic study."

Landrigan added that the researchers' focus on all four branches of the military may have precluded "a detailed examination of hazards that may have affected only certain groups of veterans."

Limiting the sample to residents of Iowa, which has a relatively low proportion of women and minorities, may have compromised the generalizability of the results, said Schwartz.

"More objective clinical studies are needed to fully characterize the self-reported medical and psychiatric conditions," he observed. Specific attention should be paid to problems that might have differentially affected women and minority personnel deployed to the Persian Gulf, stated Schwartz.

Investigators should also focus on the "individual and combined effects of potential etiologic agents including medications and vaccines, infectious agents, biological and chemical warfare, and psychological stressors," suggested Schwartz. (Psychiatric News, February 7, 1997)