Annual enrolment in the assessment programme increased during the study period: after the first 2 patients in 1993, 55 patients were seen in 1994, 258 in 1995, and 578 in 1996. A further 107 patients were seen in 1997 up to 24 February.
Demographic characteristics of patients
Table presents comparative sociodemographic information for the first 1000 patients seen, all personnel who served in the Gulf at some time during 1 September 1990 to 30 June 1991, and all those in service elsewhere on 1 January 1991. A greater proportion of study patients than Gulf war veterans overall were reservists (7% v 2%) or women (5% v 2%); a smaller proportion were officers (9% v 11%); and a greater proportion were army personnel (77% v 70%). The mean age among the patients was slightly higher (28 years v 27 years).
Sociodemographic data for 1000 Gulf war veterans in study, all Gulf veterans, and personnel serving elsewhere. Values are numbers (percentages) of veterans
Patients presented with a wide variety of symptoms, which were grouped into 19 broad categories (table ) similar to those used by physicians examining US Gulf war veterans for the Department of Veterans Affairs and the Department of Defense.5
The veterans in our study had a median of five symptoms; 191 patients had 10 or more recorded symptoms. Affective symptoms, such as mood swings, personality change, irritability, and depression, were common complaints, occurring in 49% of all patients. Fatigue was the next most common complaint (42%), followed by joint and muscle pain (40%) and cognitive symptoms (such as short term memory loss and difficulty concentrating) (26%).
Symptoms and complaints in 1000 Gulf war veterans in study
Table summarises the recorded diagnoses. Altogether, 588 patients were diagnosed with more than one condition; 182 patients were diagnosed with conditions classified as diseases of the musculoskeletal system and connective tissue; 178 patients had a diagnosis of a mental or behavioural disorder (excluding the psychiatric disorders mentioned above), 87 of whom were diagnosed with the chronic fatigue syndrome; 155 patients had diseases of the respiratory system, of which asthma was the most common diagnosis (100 patients); and 137 patients had diseases of the digestive system.
Diagnoses in 1000 Gulf war veterans, by ICD-10 chapter. Values are numbers (percentages) of patients
Over a third of patients (387) had a condition for which no firm somatic or psychological diagnosis could be given, and whose symptoms were classified as “symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified”; table shows the symptom diagnoses for the patients whose main condition was in this category. Ninety of these patients had no other main diagnosis, and, of these, 51 had a symptom diagnosis of fatigue, lethargy, or malaise. If all the patients with symptom diagnoses of fatigue are added to those with confirmed chronic fatigue syndrome, 239 patients had a main condition characterised by fatigue.
Diagnoses of conditions in 269 Gulf veterans whose main diagnosis was classified in chapter 18 (Symptoms, signs, and abnormal clinical and laboratory findings) of ICD-10. Values are numbers (percentages) of patients
Ninety five patients were concerned about infertility, their partner’s health, or the possibility of congenital damage in their offspring. Fifty two patients were in the programme because they were concerned about their long term health and had attended solely for a medical check up.
The cases of 501 patients were reviewed for diagnostic information from a consultant psychiatrist, either because a provisional psychiatric diagnosis had been made or because they had been routinely referred for psychological assessment. Information was obtained for 233 patients. Post-traumatic stress disorder was diagnosed for 115 of these patients (12% of all patients in the study seen, 49% of those with psychiatric information) (table ). Other psychiatric disorders were diagnosed in another 75 patients; 43 patients had no psychiatric illness.
Psychiatric disorders in 233 Gulf war veterans for whom psychiatric infomation was available. Values are numbers (percentages) of patients
Of the 115 patients in whom post-traumatic stress disorder had been diagnosed, 15 also had a diagnosis of a depressive illness, 10 had a diagnosis of alcohol misuse, 11 had asthma, 7 had the chronic fatigue syndrome, and 11 had fatigue as a symptom diagnosis. Of all patients in the programme, 39 had a diagnosis of alcohol misuse and 10 a diagnosis of drug misuse.