Skip to main content

Advertisement

SpringerLink
Log in

Upward trends in symptom reporting in the UK Armed Forces

  • GENERAL MEDICINE
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Several reports have shown increases in the prevalence of non-specific symptoms in the general population. Research in the military tends to focus on comparisons between deployed and non-deployed personnel and does not examine trends over time. 4,257 and 4,295 male participants of the Gulf war and Iraq war studies not deployed to either of these wars were randomly sampled and surveyed in 1997/1998 and 2004/2006 in two independent cross-sectional studies. Information was collected on 50 symptoms and the General Health Questionnaire (GHQ-12). Factor analysis was performed to identify an underlying pattern of symptom dimensions, and multivariate regressions were carried out to examine changes in symptom dimensions between the two surveys and the possible role of psychological morbidity. Factor analysis identified a robust pattern of eight symptom dimensions. An increase in the prevalence of symptoms was evident across all symptom dimensions. Adjustment for demographic and service characteristics revealed increases in the odds of scoring highly on symptom dimensions, varying from odds ratios 1.57, 95% CI 1.36–1.81 (cardio-respiratory dimension) to 2.24, 95% CI 1.93–2.60 (fatigue dimension). Unexpectedly, increases were even greater when adjusting for psychological morbidity. There is clear evidence of an increase in the reporting of non-specific symptoms over a 7 year period in the UK Armed Forces. It suggests that the threshold for reporting symptoms has decreased and cannot be explained by psychological distress. The possible implication of this trend for medical practice in the wider population deserves close scrutiny.

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

Similar content being viewed by others

Abbreviations

GHQ:

General Health Questionnaire

OR:

Odds ratio

UK:

United Kingdom

References

  1. Barraclough R, Devereux G, Hendrick DJ, Stenton SC. Apparent but not real increases in asthma prevalence during the 1990s. Eur Respir J. 2002;20:826–33.

    Article  CAS  PubMed  Google Scholar 

  2. Gallagher AM, Thomas JM, Hamilton WT, White PD. Incidence of fatigue symptoms and diagnoses presenting in UK primary care from 1990 to 2001. J Royal Soc Med. 2004;97:571–5.

    Article  Google Scholar 

  3. Hallsten L, Lundberg I, Waldenstrom P. Chapter 6. Low mental well-being—trends in and outside the labour market. In: Gustafsson RA, Lundberg I, editors. Worklife and health in Sweden 2004. Sweden: National Institute for Working Life Stockholm; 2005. p. 159–81.

    Google Scholar 

  4. Harkness EF, Macfarlane GJ, Silman AJ, McBeth J. Is musculoskeletal pain more common now than 40 years ago? two population-based cross-sectional studies. Rheumatology. 2005;44:890–5.

    Article  CAS  PubMed  Google Scholar 

  5. Palmer KT, Walsh K, Bendall H, Cooper C, Coggon D. Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years. Br Med J. 2000;320:1577–8.

    Article  CAS  Google Scholar 

  6. Stewart-Brown S, Evans J, Patterson J, Petersen S, Doll H, Balding J, et al. The health of students in institutes of higher education: an important and neglected public health problem? J Public Health Med. 2000;22:492–9.

    Article  CAS  PubMed  Google Scholar 

  7. Magnus P, Jaakkola JJK. Secular trend in the occurrence of asthma among children and young adults: critical appraisal of repeated cross sectional surveys. Br Med J. 1997;314:1795–9.

    CAS  Google Scholar 

  8. Wessely S, Hotopf M. Are some public-health problems better neglected? Lancet. 2001;357:976–7.

    Article  CAS  PubMed  Google Scholar 

  9. Barsky A. The paradox of health. N Engl J Med. 1988;318:414–8.

    Article  CAS  PubMed  Google Scholar 

  10. Hirani V. Anthropometric measures, overweight and obesity. In: Sporston K, Primatesta P, editors. The Health Survey for England 2003, Cardiovascular Disease. London: The Stationery Office; 1990.

    Google Scholar 

  11. Passa P. Diabetes trends in Europe. Diabetes Metab Res Rev. 2002;18:S3–8.

    Article  PubMed  Google Scholar 

  12. Burr ML, Butland BK, King S, Vaughan Williams E. Changes in asthma prevalence: two surveys 15 years apart. Arch Dis Child. 1989;64:1452–6.

    Article  CAS  PubMed  Google Scholar 

  13. Peat JK, van den Berg RH, Gree WF, Mellis CM, Leeder SR, Woolcock AJ. Changing prevalence of asthma in Australian children. BMJ. 1994;308:1591–6.

    CAS  PubMed  Google Scholar 

  14. Barrett DH, Gray GC, Doebbeling BN, Clauw DJ, William C. Prevalence of Symptoms and Symptom-based Conditions among Gulf War Veterans: Current Status of Research Findings. Epidemiol Rev. 2002;24:218–27.

    Article  PubMed  Google Scholar 

  15. Ismail K, Everitt B, Blatchley N, Hull L, Unwin C, David A, et al. Is there a Gulf War syndrome? Lancet. 1999;353:179–82.

    Article  CAS  PubMed  Google Scholar 

  16. Horn O, Hull L, Jones M, Murphy D, Browne T, Fear NT, et al. Is there an Iraq war syndrome? comparison of the health of UK service personnel after the Gulf and Iraq wars. Lancet. 2006;367:1742–6.

    Article  PubMed  Google Scholar 

  17. Unwin C, Blatchley N, Coker W, Ferry S, Hotopf M, Hull L, et al. Health of UK servicemen who served in Persian Gulf War. Lancet. 1999;353:169–78.

    Article  CAS  PubMed  Google Scholar 

  18. Hotopf M, Hull L, Fear NT, Browne T, Horn O, Iversen A, et al. The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet. 2006;367:1731–41.

    Article  PubMed  Google Scholar 

  19. Browne T, Hull L, Horn O, Jones M, Murphy D, Fear NT, et al. Explanations for the increases in mental health problems in UK reserve forces who have served in Iraq. Br J Psychiatry. 2007;190:484–9.

    Article  PubMed  Google Scholar 

  20. Rona RJ, Fear NT, Hull L, Wessely S. Women in novel occupational roles: mental health trends in the UK Armed Forces. Int J Epidemiol. 2007;36:319–26.

    Article  PubMed  Google Scholar 

  21. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins symptom checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19:1–15.

    Article  CAS  PubMed  Google Scholar 

  22. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, et al. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med. 1997;27:191–7.

    Article  CAS  PubMed  Google Scholar 

  23. Muthen LK, Muthen BO. Mplus User’s Guide. 4th ed. Los Angeles, CA; 1998–2007.

  24. Hu LT, Bentler P. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6:1–55.

    Article  Google Scholar 

  25. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Arlington, VA: American Psychiatric Publishing Inc; 2000.

    Google Scholar 

  26. Creed F, Barsky A. A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res. 2004;56:391–408.

    Article  PubMed  Google Scholar 

  27. Wessely S. Introduction. The health of Gulf War veterans. Philos Trans R Soc B. 2006;361:531–2.

    Article  Google Scholar 

  28. Benjamin S, Morris S, McBeth J, Macfarlane GJ, Silman AJ. The association between chronic widespread pain and mental disorder. Arthritis Rheum. 2000;43:561–7.

    Article  CAS  PubMed  Google Scholar 

  29. Magni G, Moreschi C, Rigatt-Luchini S, Merskey H. Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain. 1994;56:289–97.

    Article  CAS  PubMed  Google Scholar 

  30. McBeth J, Macfarlane GJ, Benjamin S, Silman AJ. Features of somatisation predict the onset of chronic widespread pain. Arthritis Rheum. 2001;44:940–6.

    Article  CAS  PubMed  Google Scholar 

  31. Papageorgiou AC, Macfarlane GJ, Thomas E, Croft PR, Jayson MIV, Silman AJ. Psychosocial factors in the workplace—do they predict new episodes of low back pain?: evidence from the South Manchester Back Pain Study. Spine. 1997;22:1137–42.

    Article  CAS  PubMed  Google Scholar 

  32. Petrie KJ, Sivertsen B, Hysing M, Broadbent E, Moss-Morris R, Eriksen HR, et al. Thoroughly modern worries. The relationship of worries about modernity to report symptoms, health and medical care utilization. J Psychosom Res. 2001;51:395–401.

    Article  CAS  PubMed  Google Scholar 

  33. Aceves-Avila FJ, Ferrari R, Ramos-Remus C. New insights into culture driven disorders. Best Pract Res Clin Rheumatol. 2004;18:155–71.

    Article  PubMed  Google Scholar 

  34. Iversen A, Liddell K, Fear N, Hotopf M, Wessely S. Consent, confidentiality, and data protection act. BMJ. 2006;332:165–9.

    Article  PubMed  Google Scholar 

  35. Wilson J, Jones M, Fear NT, Hull L, Hotopf M, Wessely S, et al. Is previous psychological health associated with the likelihood of Iraq War deployment? an investigation of the “healthy warrior effect”. Am J Epidemiol. 2009;169:1362–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the UK Ministry of Defence for their cooperation; especially we are indebted to the Defence Medical Services Department, the Defence Analytical Services Agency, the single Services and the Veterans Unit. This study was funded by the UK Ministry of Defence. The Gulf war study was funded by the United States Department of Defense. The Iraq war study was funded by the UK Ministry of Defence.

Author information

Authors and Affiliations

  1. King’s Centre for Military Health Research, Institute of Psychiatry, King’s College London, London, SE5 9RJ, UK

    Oded Horn, Lisa Hull, Matthew Hotopf, Simon Wessely & Roberto J. Rona

  2. Centre for Population Studies, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, 51 Bedford Square, Room 309, London, WC1B 3DP, UK

    Oded Horn

  3. Centre for Population Studies, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, 51 Bedford Square, London, WC1B 3DP, UK

    Andrew Sloggett & George B. Ploubidis

Authors
  1. Oded Horn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Sloggett
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George B. Ploubidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lisa Hull
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew Hotopf
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Simon Wessely
    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

Corresponding author

Correspondence to Oded Horn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Horn, O., Sloggett, A., Ploubidis, G.B. et al. Upward trends in symptom reporting in the UK Armed Forces. Eur J Epidemiol 25, 87–94 (2010). https://doi.org/10.1007/s10654-009-9414-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-009-9414-z

Keywords

Search

Navigation