Simply serving in a war zone produces stress associated with
psychiatric disorders, alcohol abuse, and marital and family conflict, an
Institute of Medicine report has concluded.
Risk of accidental death or suicide in the early years after wartime
service also increased. The effects were "associated," but
evidence was not sufficient to prove that such deployment caused specific
human health effects, said the study.
The report suggested that the armed services assess psychosocial status and
psychiatric and medical conditions prior to deployment and also conduct
further evaluations right after return from war zones and at about five-year
"There are virtually no studies that measured stress at the time of
deployment," said Roberta Wedge, M.S., a senior program officer at the
Institute of Medicine (IOM) and the study's staff director. "The
committee was frustrated that there were no studies looking at troops before
they deployed to determine their medical, psychological, or psychosocial
The Department of Veterans Affairs requested the study of peer-reviewed
scientific literature on the relationship between deployment-related stress
and long-term, adverse health effects in veterans of the 1991 Persian Gulf
War. The IOM committee, chaired by Richard Mayeux, M.D., M.Sc., of Columbia
University, sought added perspective by screening 3,000 papers covering
veterans from World War II, Korea, Vietnam, and the current wars in Iraq and
Afghanistan in addition to the gulf war.
The committee decided that stresses in a war zone went beyond acute combat
exposure to include isolation, poor living conditions, heat, cold, sexual
trauma, family separation, and exposure to environmental hazards.
"Deployment to a war zone, whether or not combat is experienced, is
sufficient to elicit a stress response," they wrote of their decision to
concentrate on comparing deployment versus nondeployment.
Seven primary studies and 11 secondary studies covering veterans of the
Vietnam War and the Persian Gulf War found that deployment resulted in greater
prevalence of PTSD, anxiety disorders, and major depression compared with
veterans who served at the same times but were not stationed in a war zone. In
looking at studies of deployed veterans with and without PTSD, the committee
found increased prevalence and severity with greater combat exposure or
The interaction of deployment with marital and family conflicts was mixed,
but appeared particularly strong when the veteran was diagnosed with PTSD.
Evaluating studies on suicide and accidental death was hampered by
limitations caused by inconsistent case definition and by a change in the
coding of mortality data from ICD-9 to ICD-10 in 1999,
although the committee did find an association for both events in the five
years following deployment.
Weaker associations were found with drug abuse, chronic fatigue syndrome,
gastrointestinal symptoms, skin disorders, fibromyalgia, chronic widespread
pain, incarceration, increased reporting of symptoms, unexplained illness, and
Weaknesses in many studies reviewed should serve to guide future
researchers, noted the committee. Most of the studies used self-reports for
exposure and effects, and nearly all were retrospective, hampering evaluation.
Few studies included data on severity of combat exposure or assessed several
unrelated exposures, making it hard to determine associations, they said.
"Gulf War and Health: Volume 6. Physiologic, Psychologic, and
Psychosocial Effects of Deployment-Related Stress" is posted at<www.nap.edu/catalog.php?record_id=11922>.▪