Skip to main content

Advertisement

SpringerLink
Log in

Irritable bowel syndrome in the UK military after deployment to Iraq: what are the risk factors?

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Diarrhoea and vomiting (D & V) was common in military personnel during deployment to the initial phases of the Iraq war. D & V is an established risk factor for irritable bowel syndrome (IBS). This study examined the prevalence of IBS in a military sample with a history of deployment to Iraq and the association between D & V and common mental disorder (CMD) with IBS.

Methods

The study used data from a two-phase cohort study of military/personnel. The sample was restricted to individuals who had been deployed to Iraq before phase 1 of the study and who had completed the self-report D & V question. A measure of probable IBS was derived at both phases of the study based on self-reported symptoms in the previous month. CMD was assessed by the General Health Questionnaire (GHQ-12).

Results

Fifty-nine percent of the sample reported a D & V event and 6.6 % met the criteria for probable IBS at phase 1. Reporting D & V, thinking one might be killed on deployment, poor physical health and CMD were associated with probable IBS at phase 1. CMD at phase 1 was strongly associated with chronic symptoms of IBS.

Conclusions

There was a high prevalence of D & V during deployment to the early stages of the Iraq war, yet the prevalence of probable IBS on return from deployment was relatively low. D & V was strongly associated with IBS after deployment, and CMD was a risk factor for chronic symptoms of IBS.

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

Similar content being viewed by others

References

  1. Muller-Lissner SA, Bollani S, Brummer RJ, Coremans G, Dapoigny M, Marshall JK, Muris JW, Oberndorff-Klein Wolthuis A, Pace F, Rodrigo L, Stockbrugger R, Vatn MH (2001) Epidemiological aspects of irritable bowel syndrome in Europe and North America. Digestion 64(3):200–204

    Article  PubMed  CAS  Google Scholar 

  2. Wilson S, Roberts L, Roalfe A, Bridge P, Singh S (2004) Prevalence of irritable bowel syndrome: a community survey. Br J Gen Pract 54:495–502

    PubMed  Google Scholar 

  3. Spiegel BM, Farid M, Esrailian E, Talley J, Chang L (2010) Is irritable bowel syndrome a diagnosis of exclusion?: a survey of primary care providers, gastroenterologists, and IBS experts. Am J Gastroenterol 105(4):848–858

    Article  PubMed  Google Scholar 

  4. Chitkara DK, van Tilburg MAL, Blois-Martin N, Whitehead WE (2008) Early life risk factors that contribute to irritable bowel syndrome in adults: a systematic review. Am J Gastroenterol 103(3):765–774

    Article  PubMed  Google Scholar 

  5. Rey E, Talley NJ (2009) Irritable bowel syndrome: novel views on the epidemiology and potential risk factors. Dig Liver Dis 41(11):772–780

    Article  PubMed  CAS  Google Scholar 

  6. Irwin C, Falsetti SA, Lydiard RB, Ballenger JC, Brock CD, Brener W (1996) Comorbidity of posttraumatic stress disorder and irritable bowel syndrome. J Clin Psychiatry 57(12):576–578

    Article  PubMed  CAS  Google Scholar 

  7. Halvorson HA, Schlett CD, Riddle MS (2006) Postinfectious Irritable Bowel Syndrome—A Meta-Analysis. Am J Gastroenterol 101(8):1894–1899

    Article  PubMed  Google Scholar 

  8. Kanazawa M, Hongo M, Fukudo S (2011) Visceral hypersensitivity in irritable bowel syndrome. J Gastroenterol Hepatol 26:119–121

    Article  PubMed  Google Scholar 

  9. Dunlop SP, Jenkins D, Spiller RC (2003) Distinctive clinical, psychological, and histological features of postinfective irritable bowel syndrome. Am J Gastroenterol 98(7):1578–1583

    Article  PubMed  Google Scholar 

  10. Thabane M, Kottachchi DT, Marshall JK (2007) Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther 26(4):535–544

    Article  PubMed  CAS  Google Scholar 

  11. Neal KR, Barker L, Spiller RC (2002) Prognosis in post-infective irritable bowel syndrome: a six year follow up study. Gut 51(3):410–413

    Article  PubMed  CAS  Google Scholar 

  12. Neal KR, Hebden J, Spiller R (1997) Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients. BMJ 314(7083):779

    Article  PubMed  CAS  Google Scholar 

  13. Bailey MS, Boos CJ, Vautier G, Green AD, Appleton H, Gallimore CI, Gray JJ, Beeching NJ (2005) Gastroenteritis outbreak in British troops. Iraq Emerg Infect Dis 11(10):1625–1628

    Article  Google Scholar 

  14. Fear NT, Jones M, Murphy D, Hull L, Iversen AC, Coker B, Machell L, Sundin J, Woodhead C, Jones N, Greenberg N, Landau S, Dandeker C, Rona RJ, Hotopf M, Wessely S (2010) What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. Lancet 375(9728):1783–1797

    Article  PubMed  Google Scholar 

  15. Porter CK, Gloor K, Cash BD, Riddle MS (2011) Risk of functional gastrointestinal disorders in US military following self-reported diarrhoea and vomiting during deployment. Dig Dis Sci 56(11):3262–3269

    Article  PubMed  Google Scholar 

  16. Trivedi KH, Schlett CD, Tribble DR, Monteville MR, Sanders JW, Riddle MS (2011) The impact of post-infectious functional gastrointestinal disorders and symptoms on the health-related quality of life of US military personnel returning from deployment to the Middle East. Dig Dis Sci 56(12):3602–3609

    Article  PubMed  Google Scholar 

  17. Hotopf M, Hull L, Fear NT, Browne T, Horn O, Iversen A, Jones M, Murphy D, Bland D, Earnshaw M, Greenberg N, Hacker Hughes J, Tate AR, Dandeker C, Rona R, Wessely S (2006) The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 367(9524):1731–1741

    Article  PubMed  Google Scholar 

  18. Russell R, Hodgetts T, Ollerton J, Massetti P, Skeet J, Bray I, Harrison K (2007) The operational emergency department attendance register (OPEDAR): a new epidemiological tool. J R Army Med Corps 153(4):244–250

    Article  PubMed  CAS  Google Scholar 

  19. Forbes H, Jones N, Woodhead C, Greenberg N, Harrison K, White S, Wessely S, Fear N (2012) What are the effects of having an illness or injury whilst deployed on post deployment mental health? A population based record linkage study of UK Army personnel who have served in Iraq or Afghanistan. BMC Psychiatry 12(1):178

    Article  PubMed  Google Scholar 

  20. Drossman DA, Dumitrascu DL (2006) Rome III: new standard for functional gastrointestinal disorders. J Gastrointest Liver Dis 15(3):237–241

    Google Scholar 

  21. Iversen AC, Fear NT, Simonoff E, Hull L, Horn O, Greenberg N, Hotopf M, Rona R, Wessely S (2007) Influence of childhood adversity on health among male UK military personnel. Br J Psychiatry 191(6):506–511

    Article  PubMed  Google Scholar 

  22. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med 14(4):245–258

    Article  PubMed  CAS  Google Scholar 

  23. MacManus D, Dean K, Iversen A, Hull L, Jones N, Fahy T, Wessely S, Fear N (2012) Impact of pre-enlistment antisocial behaviour on behavioural outcomes among UK military personnel. Soc Psychiatry Psychiatr Epidemiol 47(8):1353–1358

    Article  PubMed  Google Scholar 

  24. Weathers F, Litz B, Herman D, Huska J, Keane T (1994) The PTSD checklist–civilian version (PCL-C). National Centre for PTSD, Boston

    Google Scholar 

  25. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27(01):191–197

    Article  PubMed  CAS  Google Scholar 

  26. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483

    Article  PubMed  Google Scholar 

  27. Babor T, Higgins-Biddle J, Saunders J, Monteiro M (2001) AUDIT. The alcohol use disorders identification test. Department of Mental Health and Substance Dependence, WHO, Geneva

    Google Scholar 

  28. StataCorp (2009) Stata Statistical Software: release 11. College Station, Stata Corporation LP, TX

    Google Scholar 

  29. Spence MJ, Moss-Morris R (2007) The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis. Gut 56(8):1066–1071

    Article  PubMed  Google Scholar 

  30. Gwee KA, Leong YL, Graham C, McKendrick MW, Collins SM, Walters SJ, Underwood JE, Read NW (1999) The role of psychological and biological factors in postinfective gut dysfunction. Gut 44(3):400–406

    Article  PubMed  CAS  Google Scholar 

  31. Sykes MA, Blanchard EB, Lackner J, Keefer L, Krasner S (2003) Psychopathology in Irritable Bowel Syndrome: support for a Psychophysiological Model. J Behav Med 26(4):361–372

    Article  PubMed  Google Scholar 

  32. Lydiard RB (2005) Increased prevalence of functional gastrointestinal disorders in panic disorder: clinical and theoretical implications. CNS Spectr 10(11):899–908

    PubMed  Google Scholar 

  33. Gros DF, Antony MM, McCabe RE, Swinson RP (2009) Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression. J Anxiety Disord 23(2):290–296

    Article  PubMed  Google Scholar 

  34. Lydiard R, Greenwald S, Weissman M, Johnson J, Drossman D, Ballenger J (1994) Panic disorder and gastrointestinal symptoms: findings from the NIMH Epidemiologic Catchment Area project. Am J Psychiatry 151(1):64–70

    PubMed  CAS  Google Scholar 

  35. Coen SJ, Kano M, Farmer AD, Kumari V, Giampietro V, Brammer M, Williams SCR, Aziz Q (2011) Neuroticism influences brain activity during the experience of visceral pain. Gastroenterology 141(3):909–917

    Article  PubMed  Google Scholar 

  36. Keough ME, Timpano KR, Zawilinski LL, Schmidt NB (2011) The association between irritable bowel syndrome and the anxiety vulnerability factors. J Health Psychol 16(1):91–98

    Article  PubMed  Google Scholar 

  37. White DL, Savas LS, Daci K, Elserag R, Graham DP, Fitzgerald SJ, Smith SL, Tan G, El-Serag HB (2010) Trauma history and risk of the irritable bowel syndrome in women veterans. Aliment Pharmacol Ther 32(4):551–561

    Article  PubMed  CAS  Google Scholar 

  38. Chang L (2011) The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome. Gastroenterology 140(3):761–765

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by the UK Ministry of Defence (MoD). The author’s work was independent of the funders and the paper was disclosed to the MoD at the point of submission. SW and MH are part funded by the South London and Maudsley NHS Foundation Trust/Institute of Psychiatry National Institute of Health Research (NIHR) Biomedical Research Centre. We acknowledge the help of Rajwinder Nijjar who contributed to an earlier draft of this manuscript.

Conflict of interest

All authors have completed the Unified Competing Interest form and declare that they received support from UK Ministry of Defence who funded this study. SW is Honorary Civilian Consultant Advisor in Psychiatry to the British Army and a Trustee of Combat Stress, a UK charity that provides services and support for veterans with mental health problems. NJ is a full time Reservist member of the UK Armed Forces and is currently seconded to King’s College London. NJ declares that he has not been instructed in any way by the UK Ministry of Defence regarding the submitted work.

Author information

Authors and Affiliations

  1. King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, SE5 9RJ, UK

    Laura Goodwin, Harriet Forbes, Matthew Hotopf, Lisa Hull, Roberto J. Rona, Simon Wessely & Nicola T. Fear

  2. Centre for Psychiatry, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK

    Julius H. Bourke

  3. Academic Centre for Defence Mental Health, Department of Psychological Medicine, King’s College London, London, UK

    Norman Jones

Authors
  1. Laura Goodwin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julius H. Bourke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harriet Forbes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew Hotopf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lisa Hull
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Norman Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Roberto J. Rona
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Simon Wessely
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nicola T. Fear
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura Goodwin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goodwin, L., Bourke, J.H., Forbes, H. et al. Irritable bowel syndrome in the UK military after deployment to Iraq: what are the risk factors?. Soc Psychiatry Psychiatr Epidemiol 48, 1755–1765 (2013). https://doi.org/10.1007/s00127-013-0699-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-013-0699-6

Keywords

Search

Navigation