Abstract
We aim to describe risk and protective factors for health and wellbeing in veterans who have served during and since the Persian Gulf War. Some have experienced combat, but all have experienced the ‘deployment stress’ of peacekeeping duties. Most cope well, but a significant few are at risk of poor health outcomes from their experience, either the early ‘signature injury’ of post-traumatic stress disorder (PTSD) or the later appearance of minor but multiple health complaints, ‘multiple symptom illness’ (MSI). The personal attributes of resilience and ability to cope, along with good social support, are likely to be protective. Adverse outcomes are more likely in a person with anxiety, depression, aches and pains (somatic symptoms) and insomnia. Building protective attributes during service will improve ‘life after service’, and the outcomes of this study will define the ‘at risk’ veteran health profile. Our hypothesis is that recognition followed by intervention and support will minimize the risk of chronic health problems such as sleep apnoea, poor mental health and obesity.
A questionnaire survey of contemporary veterans will identify health outcomes along with risk and protective factors. Two statistical models will be developed. A wellbeing model will predict a good overall health score on the EQ-5D, a standardised measure of health outcome. An adverse model will predict PTSD as measured by the Posttraumatic Stress Checklist, military version (PCL-M).
Protective factors will be the physical, psychological, environmental and social domains of wellbeing measured by the World Health Organization Quality of Life (WHOQOL) questionnaire; resilience by the Connor Davidson Resilience Scale; coping ability through the Brief Cope questionnaire, and social support through the Social Provisions Scale. Risk factors are demographic and psychological, the latter addressed by items on the General Health Questionnaire 28 (GHQ28). An epidemiological case definition of MSI will be developed by analyzing the pattern of health complaints identified, to assess firstly the role of MSI as a risk factor and secondly to develop a clinical case definition.
The immediate outcome will be a screening instrument which identifies the at risk veteran prior to leaving service. Next steps will involve developing community support mechanisms.