Is there a Gulf War Syndrome? Searching for syndromes by factor analysis of symptoms

R. W. Haley, T. L. Kurt and J. Hom
Epidemiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 75235-8874, USA.

OBJECTIVE: To search for syndromes in Persian Gulf War veterans. PARTICIPANTS: Two hundred forty-nine (41%) of the 606 Gulf War veterans of the Twenty-fourth Reserve Naval Mobile Construction Battalion living in 5 southeastern states participated; 145 (58%) had retired from service, and the rest were still serving in the battalion. DESIGN: Participants completed a standardized survey booklet measuring the anatomical distributions or characteristics of each symptom, a booklet measuring wartime exposures, and a standard psychological personality assessment inventory. Two-stage factor analysis was used to disentangle ambiguous symptoms and identify syndromes. MAIN OUTCOME MEASURES: Factor analysis-derived syndromes. RESULTS: Of 249 participants, 175 (70%) reported having had serious health problems that most attributed to the war, and 74 (30%) reported no serious health problems. Principal factor analysis yielded 6 syndrome factors, explaining 71% of the variance. Dichotomized syndrome indicators identified the syndromes in 63 veterans (25%). Syndromes 1 ("impaired cognition," characterized by problems with attention, memory, and reasoning, as well as insomnia, depression, daytime sleepiness, and headaches), 2 ("confusion-ataxia," characterized by problems with thinking, disorientation, balance disturbances, vertigo, and impotence), and 3 ("arthro-myo-neuropathy," characterized by joint and muscle pains, muscle fatigue, difficulty lifting, and extremity paresthesias) represented strongly clustered symptoms; whereas, syndromes 4 ("phobia-apraxia"), 5 ("fever-adenopathy"), and 6 ("weakness-incontinence") involved weaker clustering and mostly overlapped syndromes 2 and 3. Veterans with syndrome 2 were 12.5 times (95% confidence interval, 3.5-44.8) more likely to be unemployed than those with no health problems. A psychological profile, found in 48.4% of those with the syndromes, differed from posttraumatic stress disorder, depression, somatoform disorder, and malingering. CONCLUSION: These findings support the hypothesis that clusters of symptoms of many Gulf War veterans represent discrete factor analysis-derived syndromes that appear to reflect a spectrum of neurologic injury involving the central, peripheral, and autonomic nervous systems.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Acetylcholinesterase inhibitors and Gulf War illnesses
Golomb
Proc. Natl. Acad. Sci. USA 2008;105:4295-4300.
ABSTRACT | FULL TEXT  

Atmospheric Movement of Microorganisms in Clouds of Desert Dust and Implications for Human Health
Griffin
Clin. Microbiol. Rev. 2007;20:459-477.
ABSTRACT | FULL TEXT  

Health consequences of the first Persian Gulf War on French troops
Salamon et al.
Int J Epidemiol 2006;35:479-487.
ABSTRACT | FULL TEXT  

Can epidemiology clear the fog of war? Lessons from the 1990-91 Gulf War
Hotopf and Wessely
Int J Epidemiol 2005;34:791-800.
ABSTRACT | FULL TEXT  

The health of Australian veterans of the 1991 Gulf War: factor analysis of self-reported symptoms
Forbes et al.
Occup. Environ. Med. 2004;61:1014-1020.
ABSTRACT | FULL TEXT  

Enhanced heart rate variability and baroreflex index after stress and cholinesterase inhibition in mice
Joaquim et al.
Am. J. Physiol. Heart Circ. Physiol. 2004;287:H251-H257.
ABSTRACT | FULL TEXT  

Symptom Patterns Among Gulf War Registry Veterans
Hallman et al.
Am. J. Public Health 2003;93:624-630.
ABSTRACT | FULL TEXT  

Fibromyalgia and the therapeutic domain. A philosophical study on the origins of fibromyalgia in a specific social setting
Hazemeijer and Rasker
Rheumatology (Oxford) 2003;42:507-515.
ABSTRACT | FULL TEXT  

RE: "INVITED COMMENTARY: UNEXPLAINED HEALTH PROBLEMS AFTER GULF WAR SERVICE--FINDING ANSWERS TO COMPLEX QUESTIONS"
Wartenberg et al.
Am J Epidemiol 2003;157:567-568.
FULL TEXT  

Prevalence of Symptoms and Symptom-based Conditions among Gulf War Veterans: Current Status of Research Findings
Barrett et al.
Epidemiol Rev 2002;24:218-227.
FULL TEXT  

Reduced bone formation in UK Gulf War veterans: a bone histomorphometric study
Compston et al.
J. Clin. Pathol. 2002;55:897-899.
ABSTRACT | FULL TEXT  

Neurophysiologic analysis of neuromuscular symptoms in UK Gulf War veterans: A controlled study
Sharief et al.
Neurology 2002;59:1518-1525.
ABSTRACT | FULL TEXT  

Factor Analysis of Gulf War Illness: What Does It Add to Our Understanding of Possible Health Effects of Deployment?
Shapiro et al.
Am J Epidemiol 2002;156:578-585.
ABSTRACT | FULL TEXT  

Management of Patients Exposed to Biological and Chemical Warfare Agents
Marik and Bowles
J Intensive Care Med 2002;17:147-161.
ABSTRACT  

Self-reported Symptoms and Medical Conditions among 11,868 Gulf War-era Veterans : The Seabee Health Study
Gray et al.
Am J Epidemiol 2002;155:1033-1044.
ABSTRACT | FULL TEXT  

Health-related Quality of Life in Gulf War Era Military Personnel
Voelker et al.
Am J Epidemiol 2002;155:899-907.
ABSTRACT | FULL TEXT  

Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution
Jones et al.
BMJ 2002;324:321-321.
ABSTRACT | FULL TEXT  

Battlefield use of depleted uranium and the health of veterans
Bolton and Foster
Trauma 2002;4:1-10.
ABSTRACT  

Severely Reduced Functional Status in Veterans Fitting a Case Definition of Gulf War Syndrome
Haley et al.
Am. J. Public Health 2002;92:46-47.
FULL TEXT  

Prevalence of Gulf war veterans who believe they have Gulf war syndrome: questionnaire study
Chalder et al.
BMJ 2001;323:473-476.
ABSTRACT | FULL TEXT  

Invited Commentary: Unexplained Health Problems after Gulf War Service--Finding Answers to Complex Questions
Steele
Am J Epidemiol 2001;154:406-409.
ABSTRACT | FULL TEXT  

Posttraumatic Stress Symptomatology Is Associated With Unexplained Illness Attributed to Persian Gulf War Military Service
Ford et al.
Psychosom. Med. 2001;63:842-849.
ABSTRACT | FULL TEXT  

Locomotor and Sensorimotor Performance Deficit in Rats following Exposure to Pyridostigmine Bromide, DEET, and Permethrin, Alone and in Combination
Abou-Donia et al.
Toxicol Sci 2001;60:305-314.
ABSTRACT | FULL TEXT  

Multiple Chemical Sensitivity and Chronic Fatigue Syndrome in British Gulf War Veterans
Reid et al.
Am J Epidemiol 2001;153:604-609.
ABSTRACT | FULL TEXT  

Repeated Formaldehyde Effects in an Animal Model for Multiple Chemical Sensitivity
Sorg et al.
Ann. N. Y. Acad. Sci. 2001;933:57-67.
ABSTRACT | FULL TEXT  

Proposed explanations for excess injury among veterans of the Persian Gulf War and a call for greater attention from policymakers and researchers
Bell et al.
Inj. Prev. 2001;7:4-9.
ABSTRACT | FULL TEXT  

RE: "FACTOR ANALYSIS OF SELF-REPORTED SYMPTOMS: DOES IT IDENTIFY A GULF WAR SYNDROME?"
Haley et al.
Am J Epidemiol 2000;152:1204-1206.
FULL TEXT  

Prevalence and Patterns of Gulf War Illness in Kansas Veterans: Association of Symptoms with Characteristics of Person, Place, and Time of Military Service
Steele
Am J Epidemiol 2000;152:992-1002.
ABSTRACT | FULL TEXT  

Psychiatric aspects of chronic exposure to organophosphates: diagnosis and management
Davies et al.
Adv. Psychiatr. Treat. 2000;6:356-361.
FULL TEXT  

Defining the Neurological Basis of the Gulf War Syndrome
Rosenberg
Arch Neurol 2000;57:1263-1263.
FULL TEXT  

Effect of Basal Ganglia Injury on Central Dopamine Activity in Gulf War Syndrome: Correlation of Proton Magnetic Resonance Spectroscopy and Plasma Homovanillic Acid Levels
Haley et al.
Arch Neurol 2000;57:1280-1285.
ABSTRACT | FULL TEXT  

Factor Analysis of Self-reported Symptoms: Does It Identify a Gulf War Syndrome?
Knoke et al.
Am J Epidemiol 2000;152:379-388.
ABSTRACT | FULL TEXT  

Cardiovascular Stress Responses and Their Relation to Symptoms in Gulf War Veterans With Fatiguing Illness
Peckerman et al.
Psychosom. Med. 2000;62:509-516.
ABSTRACT | FULL TEXT  

Brain Abnormalities in Gulf War Syndrome: Evaluation with
Haley et al.
Radiology 2000;215:807-817.
ABSTRACT | FULL TEXT  

Functional Somatic Syndromes
Kurt
ANN INTERN MED 2000;132:329-329.
FULL TEXT  

PON1 Status and Neurologic Symptom Complexes in Gulf War Veterans
Furlong
Genome Res. 2000;10:153-155.
FULL TEXT  

Chronic Multisystem Illness Among Gulf War Veterans
Haley et al.
JAMA 1999;282:327-329.
FULL TEXT  

Development of a brief questionnaire for screening for multiple chemical sensitivity syndrome
Hu et al.
Toxicol Ind Health 1999;15:582-588.
ABSTRACT  

Relationship of Psychiatric Status to Gulf War Veterans' Health Problems
Wolfe et al.
Psychosom. Med. 1999;61:532-540.
ABSTRACT | FULL TEXT  

Persistently Exaggerated Startle Responses in Rats Treated with Pyridostigmine Bromide
Servatius et al.
J. Pharmacol. Exp. Ther. 1998;287:1020-1028.
ABSTRACT | FULL TEXT  

Chronic Multisymptom Illness Affecting Air Force Veterans of the Gulf War
Fukuda et al.
JAMA 1998;280:981-988.
ABSTRACT | FULL TEXT  

Rheumatic Findings in Gulf War Veterans
Grady et al.
Arch Intern Med 1998;158:367-371.
ABSTRACT | FULL TEXT  

Gulf War Syndrome: More Complex Than Middle East Politics
Journal Watch Dermatology 1997;1997:15-15.
FULL TEXT  

Gulf War Syndrome: More Complex Than Middle East Politics
JWatch Psychiatry 1997;1997:15-15.
FULL TEXT  

GULF WAR SYNDROME: MORE COMPLEX THAN MIDDLE EAST POLITICS
JWatch General 1997;1997:2-2.
FULL TEXT  

Gulf war illness
David et al.
BMJ 1997;314:239-239.
FULL TEXT