Psychological health and psychosocial correlates in Australian Gulf War veterans: a longitudinal investigation

Abstract

Background: Over the past two decades, veterans of the 1990-1991 Gulf War have been found to consistently report poorer health and subjective wellbeing than comparison groups. Whilst the poor psychological health of Gulf War veterans has now been clearly identified, the psychosocial factors that may be associated with mitigating their symptoms are still being investigated to determine the nature of their role. Aim: This thesis attempts to elucidate key predictors and correlates in relation to Gulf War veterans’ psychological health. Predictive factors that were investigated included military psychological stress, the personality trait of Neuroticism, psychiatric history and support mechanisms. Appraisals of post-deployment experiences, attribution of symptoms and quality of life were also investigated to provide insight into the experience and burden of poor psychological health in Australian Gulf War veterans and a military-era comparison group and highlight important longitudinal implications. Methods: The Australian Gulf War Veterans’ Health Study was conducted in 2000-2002 and a follow-up study was conducted in 2011-2012 to assess veterans’ health over time. These studies, at both time points, involved a cohort of Australian Gulf War veterans and a military-era comparison group who were operationally active at the time of the Gulf War but were not deployed to that conflict. The studies included a self-administered questionnaire and a psychological health interview as well as data linkage with health services. The analyses based on the data from these two studies were complemented by a systematic review of support mechanisms and personal vulnerabilities in relation to posttraumatic stress disorder in veterans of the 1990-1991 Gulf War, Iraq War and deployments to Afghanistan. Results: The predictive factors of support mechanisms demonstrated a consistent relationship with PTSD but it was highlighted that further longitudinal investigation is required to establish the direction of these relationships. Personal vulnerabilities, Neuroticism and psychiatric history, indicated relationships with PTSD but more research is required in veteran populations to establish this relationship consistently. Post-Deployment Appraisals, categorised as Personal Development, Lack of Recognition and Appreciation of Life and Country, demonstrated weak to moderate relationships with military psychological stress and psychological health. Gulf War veterans consistently reported poorer quality of life than the military-era comparison group. However, the pattern of factors affecting quality of life did not differ between veterans and comparison group, with psychological health being the most significant contributor compared with social support and physical health. Furthermore, persistence and recency of psychiatric disorders cumulatively affected quality of life in veterans. Lastly, although symptom attributional style did not differ between Gulf War veterans and the comparison group, it did demonstrate significant relationships with symptom reporting and the persistence and incidence of symptoms. Symptom attribution also had significant relationships with treatment-seeking behaviours and should be considered part of the constellation of factors that influence healthcare usage. Conclusions: Veterans are faced with a range of challenges when they return from deployment, from reintegration and navigating relationships to illness and poor psychological functioning, and these issues may continue for decades after deployment. Although individual reactions are variable, this thesis has identified a number of factors for veterans that are associated with improved or deteriorated outcomes. To help mitigate poor psychological health outcomes for veterans in the future, it is necessary to manage the range of influential psychosocial factors in veterans’ post-deployment lives. The effects of potentially traumatic events or general stress experienced on deployment may be mitigated by understanding this constellation and the longitudinal role of these factors. These need to be well understood so that veterans can be supported in an effective manner.