Skip to main content

Advertisement

SpringerLink
Log in

Quality of Life in Gulf War Veterans: the Influence of Recency and Persistence of Psychiatric Morbidity

  • Published:
Applied Research in Quality of Life Aims and scope Submit manuscript

Abstract

Important contributors to quality of life (QOL), such as psychosocial factors, have received limited exploration in veteran populations, in contrast to a significant amount of research focused on health-related quality of life (HRQL). This study investigated QOL and HRQL amongst Gulf War veterans compared with an era-military comparison group 20 years after the 1990/91 Gulf War, and whether psychiatric status over time and psychiatric comorbidities predicted QOL and HRQL. We then investigated which of a range of psychological health, physical health and social factors contribute greatest to QOL. Psychological interviews and postal questionnaires were administered to a cohort of Gulf War veterans and a military-era comparison group in 2000–02 and 2011–12. Gulf War veterans had poorer QOL and HRQL compared with a military comparison group, but the pattern of factors that influenced QOL was the same for both groups. Poorer QOL and HRQL were significantly associated with more recent and persistent psychiatric morbidity over time. Further analyses showed that affective disorders, followed by anxiety disorders had the largest impact on QOL and HRQL, and that QOL and HRQL were negatively affected by each additional psychiatric diagnosis. The importance of these findings was highlighted in a structural equation model that revealed psychological health contributed most to QOL, social support contributed a moderate amount, but physical health contributed only a very small amount. QOL in veterans is an important issue even many years after deployment and psychological health plays a predominant role in QOL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Andrews, F., & Withey, S. (1976). Social indicators of well-being: Americans' perceptions of life quality. New York: Plenum.

    Book  Google Scholar 

  • Andrews, G., Slade, T., & Issakidis, C. (2002). Deconstructing current comorbidity: data from the Australian national survey of mental health and well-being. The British Journal of Psychiatry, 181(4), 306–314.

    Article  Google Scholar 

  • Bennett, S., Perkins, S., Lane, K., Deer, M., Brater, D., & Murray, M. (2001). Social support and health-related quality of life in chronic heart failure patients. Quality of Life Research, 10(8), 671–682.

    Article  Google Scholar 

  • Britton, P. C., Ouimette, P. C., & Bossarte, R. M. (2012). The effect of depression on the association between military service and life satisfaction. Quality of Life Research, 21(10), 1857–1862.

    Article  Google Scholar 

  • Chan, Y.-F., Huang, H., Bradley, K., & Unützer, J. (2014). Referral for substance abuse treatment and depression improvement among patients with co-occurring disorders seeking behavioral health services in primary care. Journal of Substance Abuse Treatment, 46, 106–112. https://doi.org/10.1016/j.jsat.2013.08.016.

    Article  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.

    Google Scholar 

  • Cubo, E., Rojo, A., Ramos, S., Quintana, S., Gonzalez, M., Kompoliti, K., et al. (2002). The importance of educational and psychological factors in Parkinson's disease quality of life. European Journal of Neurology, 9(6), 589–593.

    Article  Google Scholar 

  • Der-Martirosian, C., Cordasco, K. M., & Washington, D. L. (2013). Health-related quality of life and comorbidity among older women veterans in the United States. Quality of Life Research, 22(10), 2749–2756.

    Article  Google Scholar 

  • Duffy, S. A., Terrell, J. E., Valenstein, M., Ronis, D. L., Copeland, L. A., & Connors, M. (2002). Effect of smoking, alcohol, and depression on the quality of life of head and neck cancer patients. General Hospital Psychiatry, 24(3), 140–147.

    Article  Google Scholar 

  • Engel Jr., C. C., Liu, X., McCarthy, B. D., Miller, R. F., & Ursano, R. (2000). Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for Gulf War-related health concerns. Psychosomatic Medicine, 62(6), 739–745.

    Article  Google Scholar 

  • Forman-Hoffman, V. L., Carney, C. P., Sampson, T. R., Peloso, P. M., Woolson, R. F., Black, D. W., et al. (2005). Mental health comorbidity patterns and impact on quality of life among veterans serving during the first Gulf War. Quality of Life Research: an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 14(10), 2303–2314.

    Article  Google Scholar 

  • Foster, J., Powell, J., Marshall, E., & Peters, T. (1999). Quality of life in alcohol-dependent subjects – a review. Quality of Life Research, 8(3), 255–261.

    Article  Google Scholar 

  • Gallant, M. P. (2003). The influence of social support on chronic illness self-management: a review and directions for research. Health Education & Behavior, 30(2), 170–195.

    Article  Google Scholar 

  • Gill, T. M., & Feinstein, A. R. (1994). A critical appraisal of the quality of quality-of-life measurements. JAMA: the Journal of the American Medical Association, 272(8), 619–626.

    Article  Google Scholar 

  • Golden, J., Conroy, R. M., & Lawlor, B. A. (2009). Social support network structure in older people: underlying dimensions and association with psychological and physical health. Psychology, Health & Medicine, 14(3), 280–290. https://doi.org/10.1080/13548500902730135.

    Article  Google Scholar 

  • Guyatt, G. (1997). Insights and limitations from health-related quality of life research. Journal of General Internal Medicine, 12(11), 720–721.

    Article  Google Scholar 

  • Hawthorne, G., Herrman, H., & Murphy, B. (2006). Interpreting the WHOQOL-BREF: preliminary population norms and effect sizes. Social Indicators Research, 77(1), 37–59.

    Article  Google Scholar 

  • Holahan, C. J., & Moos, R. H. (1981). Social support and psychological distress: a longitudinal analysis. Journal of Abnormal Psychology, 90(4), 365.

    Article  Google Scholar 

  • Hu, L. t., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: a Multidisciplinary Journal, 6(1), 1–55.

    Article  Google Scholar 

  • Ikin, J. F., Sim, M., Creamer, M., Forbes, A., McKenzie, D., Kelsall, H., et al. (2004). War-related psychological stressors and risk of psychological disorders in Australian veterans of the 1991 Gulf War. British Journal of Psychiatry, 185(2), 116–126.

    Article  Google Scholar 

  • Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. (Research Support, Non-U.S. Gov't Validation Studies). Journal of General Internal Medicine, 16(9), 606–613.

    Article  Google Scholar 

  • McKenzie, D. P., Ikin, J. F., McFarlane, A. C., Creamer, M., Forbes, A. B., Kelsall, H. L., et al. (2004). Psychological health of Australian veterans of the 1991 Gulf War: an assessment using the SF-12, GHQ-12 and PCL-S. Psychological Medicine, 34(08), 1419–1430.

    Article  Google Scholar 

  • Mendlowicz, M. V., & Stein, M. B. (2000). Quality of life in individuals with anxiety disorders. American Journal of Psychiatry, 157(5), 669–682.

    Article  Google Scholar 

  • Muldoon, M. F., Barger, S. D., Flory, J. D., & Manuck, S. B. (1998). What are quality of life measurements measuring? British Medical Journal, 316, 542–544.

    Article  Google Scholar 

  • Pirkola, S., Saarni, S., Suvisaari, J., Elovainio, M., Partonen, T., Aalto, A.-M., et al. (2009). General health and quality-of-life measures in active, recent, and comorbid mental disorders: a population-based health 2000 study. Comprehensive Psychiatry, 50(2), 108–114.

    Article  Google Scholar 

  • Proctor, S. P., Harley, R., Wolfe, J., Heeren, T., & White, R. F. (2001). Health-related quality of life in Persian Gulf War veterans. Military Medicine, 166(6), 510–519.

    Article  Google Scholar 

  • Sareen, J., Cox, B. J., Stein, M. B., Afifi, T. O., Fleet, C., & Asmundson, G. J. (2007). Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine, 69(3), 242–248.

    Article  Google Scholar 

  • Schwarz, N., & Clore, G. L. (1983). Mood, misattribution, and judgments of well-being: informative and directive functions of affective States. Journal of Personality and Social Psychology, 45(3), 513.

    Article  Google Scholar 

  • Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine, 32, 705–714.

    Article  Google Scholar 

  • Singh, J., Mattoo, S. K., Sharan, P., & Basu, D. (2005). Quality of life and its correlates in patients with dual diagnosis of bipolar affective disorder and substance dependence. Bipolar Disorders, 7(2), 187–191.

    Article  Google Scholar 

  • Slade, T., Johnston, A., Oakley Browne, M. A., Andrews, G., & Whiteford, H. (2009). 2007 national survey of mental health and wellbeing: methods and key findings. Australasian Psychiatry, 43(7), 594–605.

    Google Scholar 

  • Smith, K. W., Avis, N. E., & Assmann, S. F. (1999). Distinguishing between quality of life and health status in quality of life research: a meta-analysis. Quality of Life Research, 8(5), 447–459.

    Article  Google Scholar 

  • Surìs, A., Lind, L., Kashner, T. M., & Borman, P. D. (2007). Mental health, quality of life, and health functioning in women veterans differential outcomes associated with military and civilian sexual assault. Journal of Interpersonal Violence, 22(2), 179–197.

    Article  Google Scholar 

  • Teesson, M., Slade, T., & Mills, K. (2009). Comorbidity in Australia: findings of the 2007 national survey of mental health and wellbeing. Australian and New Zealand Journal of Psychiatry, 43(7), 606–614.

    Article  Google Scholar 

  • The WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-bref quality of life assessment. Psychological Medicine, 28, 551–558.

    Article  Google Scholar 

  • Toomey, R., Kang, H. K., Karlinsky, J., Baker, D. G., Vasterling, J. J., Alpern, R., et al. (2007). Mental health of US Gulf War veterans 10 years after the war. The British Journal of Psychiatry, 190(5), 385–393.

    Article  Google Scholar 

  • Voelker, M. D., Saag, K. G., Schwartz, D. A., Chrischilles, E., Clarke, W. R., Woolson, R. F., et al. (2002). Health-related quality of life in Gulf War era military personnel. American Journal of Epidemiology, 155(10), 899–907.

    Article  Google Scholar 

  • Volk, R. J., Cantor, S. B., Steinbauer, J. R., & Cass, A. R. (1997). Alcohol use disorders, consumption patterns, and health-related quality of life of primary care patients. Alcoholism: Clinical and Experimental Research, 21(5), 899–905.

    Article  Google Scholar 

  • Von Korff, M., Ormel, J., Keefe, F. J., & Dworkin, S. F. (1992). Grading the severity of chronic pain. Pain, 50, 133–149.

    Article  Google Scholar 

  • Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 603–613.

    Article  Google Scholar 

  • Ware Jr., J. E., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.

    Article  Google Scholar 

  • Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at the 9th Annual Conference of the International Society for Traumatic Stress Studies. San Antonio.

  • Wittchen, H. (1994). Reliability and validity studies of the WHO-composite international diagnostic interview (CIDI): a critical review. Journal of Psychiatric Research, 28(1), 57–84.

    Article  Google Scholar 

  • Wolfe, J., Proctor, S. P., Erickson, D. J., Heeren, T., Friedman, M. J., Huang, M. T., et al. (1999). Relationship of psychiatric status to Gulf War Veterans' health problems. Psychosomatic Medicine, 61(4), 532–540.

    Article  Google Scholar 

  • World Health Organisation. (1997). Composite international diagnostic interview CIDI auto 2.1 administrator's guide and reference. Geneva: World Health Organisation.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Monash Centre for Occupational and Environmental Health (MonCOEH), Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Breanna K. Wright, Helen L. Kelsall & Malcolm R. Sim

  2. The Alfred Centre, Commercial Road, Melbourne, VIC, 3004, Australia

    Breanna K. Wright

  3. Department of Psychiatry, Monash Medical Centre, Monash University, Melbourne, VIC, Australia

    David M. Clarke

Authors
  1. Breanna K. Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helen L. Kelsall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Malcolm R. Sim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David M. Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Breanna K. Wright.

Ethics declarations

Conflict of Interest

The authors declare no conflicts of interest.

Disclaimer

The article has been produced using funding provided by the Australian Department of Veterans’ Affairs. However, the views expressed in the article do not necessarily represent the views of the Minister for Veterans’ Affairs or the Department of Veterans’ Affairs. The Commonwealth does not give any warranty nor accept any liability in relation to the contents of this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wright, B.K., Kelsall, H.L., Sim, M.R. et al. Quality of Life in Gulf War Veterans: the Influence of Recency and Persistence of Psychiatric Morbidity. Applied Research Quality Life 14, 23–38 (2019). https://doi.org/10.1007/s11482-017-9579-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11482-017-9579-7

Keywords

Search

Navigation