Gulf War and Health: Physiologic, Psychologic, Psychosocial Effects of Deployment-Related Stress Book

Contents

ACRONYM....................xiii
PREFACE....................xvii
SUMMARY....................1
Committee's Interpretation of Its Charge....................2
Committee's Approach to Its Charge....................2
Evaluation Criteria....................3
Categories of Association....................4
Limitations of Veteran Studies....................5
Deployment-Related Stressors....................5
The Stress Response....................6
Posttraumatic Stress Disorder....................6
Health Effects....................7
Summary of Conclusions....................7
Recommendations....................9
1 INTRODUCTION....................11
Demographics....................12
Committee's Interpretation of Its Charge....................3
Committee's Approach to Its Charge....................14
Organization of the Report....................15
References....................16
2 CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE....................17
Identification of the Literature....................17
Types of Evidence....................18
Inclusion Criteria....................23
Additional Considerations....................24
Considerations in Assessing the Strength of Evidence....................25
Categories of Association....................26
Limitations of Veteran Studies....................28
Summary....................28
References....................29
3 DEPLOYMENT-RELATED STRESSORS....................31
Stressors During Combat....................32
Noncombat Stressors....................35
Anticipation of Deployment to a WarZone....................36
Military Sexual Assault and Harassment....................37
Living Conditions....................38
Environmental and Chemical Stressors....................39
Reserve and National Guard Troops....................39
Peacekeepers....................40
Women....................41
Conclusion....................43
References....................43
4 THE STRESS RESPONSE....................49
Central Role of the Brain....................50
Modifiers of the Stress Response....................56
Chronic Stress and Health....................59
Conclusion....................66
References....................66
5 POSTTRAUMATIC STRESS DISORDER....................75
Diagnosis and Clinical Features....................76
Prevalence....................78
Course....................81
Comorbidity and Disability....................84
Risk and Protective Factors....................86
Neurobiology....................94
Conclusion....................100
Reference....................100
6 HEALTH EFFECTS....................115
Organization of This Chapter....................115
Cancer....................117
Endocrine Diseases....................133
Psychiatric Disorders....................142
Substance-Use Disorders....................158
Neurobehavioral and Neurocognitive Effects....................167
Chronic Fatigue Syndrome....................174
Sleep Disturbances....................179
Cardiovascular Diseases....................183
Respiratory System Diseases....................197
Digestive System Disorders....................204
Skin Disorders....................214
Fibromyalgia and Chronic Widespread Pain....................222
Reproductive Effects....................229
Suicide and Accidental Death....................237
Symptom Reporting....................248
Reference....................261
7 PSYCHOSOCIAL EFFECTS....................283
Marital and Family Conflict....................283
Homelessness....................299
Incarceration....................304
Employment....................308
Reference....................312
8 CONCLUSIONS AND RECOMMENDATIONS....................317
Quality of the Studies....................317
Overview of Health Effects....................318
Reference....................321
INDEX....................323