News Release

Re-Analysis Of Published Studies Shows Little Evidence Of Stress As Cause Of Gulf War Syndrome

Peer-Reviewed Publication

UT Southwestern Medical Center

DALLAS Careful re-examination of reports of stress in veterans reveals little or no support for the theory that symptoms reported in Gulf War Syndrome are stress-related, a UT Southwestern Medical Center at Dallas researcher has reported in the November American Journal of Epidemiology.

Dr. Robert Haley reviewed the 16 studies cited in the January 1997 report of the Presidential Advisory Committee on Gulf War Illnesses, as well as three more recent studies, and found that the data suggested that the prevalence of post-traumatic stress disorder (PTSD) among Gulf War veterans was very low. This casts serious doubt on the conclusions of the committee, which blamed stress as an important contributing factor for Gulf War veterans' illnesses.

"My analysis shows these studies over-interpreted minimal elevations of scores on nonspecific psychological tests used to screen for PTSD, and virtually all of what appeared to be stress actually can be explained as falsely positive errors of measurement," said Haley, UT Southwestern's chief of epidemiology. "Properly interpreted, these studies show that the true rate of PTSD among the veterans is near zero."

Haley said the problem is not that PTSD is difficult to diagnose; a trained psychologist or psychiatrist can readily make the diagnosis following a structured interview for the established criteria. He found that the studies relied on psychological screening questionnaires known to be prone to misdiagnosing PTSD in people suffering from a wide range of other conditions, and the studies failed to follow-up their preliminary findings with evidence using definitive diagnostic interview techniques.

He concluded that the President's special advisory committee did not appreciate that there could be systematic errors in interpretation of the 16 studies it cited, and prematurely accepted the theory that stress caused the chronic symptoms suffered by many Gulf War veterans.

"Once we and others pointed out problems with the idea that PTSD was common in Gulf War veterans, the committee did not consider the emerging evidence for other causes but instead changed its definition of stress from PTSD to general life stress," Haley said. "The view that general life stress plays an important causal role in chronic illnesses, such as sustained hypertension, fibromyalgia and chronic fatigue syndrome, is a theoretical and popular concept, but it is not supported by the preponderance of scientific evidence."

Haley cited this example: Stomach ulcers once were widely thought to be caused by stress but now are known to be caused by chronic infection, which can be cured by antibiotics.

PTSD is the only chronic illness officially recognized to result from emotionally traumatic experiences, such as those encountered in military deployment and combat, Haley said.

In January, the Journal of the American Medical Association published three papers byHaley and a team of UT Southwestern researchers who found that the mysterious symptoms of some Gulf War veterans were associated with evidence of brain and nerve damage from wartime exposure to combinations of chemicals. In August, the Archives of Clinical Neuropsychology published results of UT Southwestern's comparison of ill and well veterans, which further linked veterans' mysterious symptoms with brain and nerve damage and ruled out PTSD and other psychological causes.

The UT Southwestern researchers recently received $3 million from the U.S. Department of Defense to expand their study to compare brain and nerve damage in ill and well Gulf War veterans, to identify a cost-effective method of screening for and diagnosing the damage, and to test possible treatments.

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