In January 1995 the Institute of Medicine released a preliminary report containing initial findings and recommendations on the federal government's response to reports by some veterans and their families that they were suffering from illnesses related to military service in the Persian Gulf War. The committee was asked to review the government's means of collecting and maintaining information for assessing the health consequences of military service and to recommend improvements and epidemiological studies if warranted. This new volume reflects an additional year of study by the committee and the full results of its three-year effort.
This initial volume in an ongoing study of the potential health consequences of service during the Persian Gulf War responds to a request from Congress to determine whether actions taken to evaluate health effects have been appropriate. It reflects the committee's examination of health outcomes and related research efforts, women's health and reproductive health issues, infrastructure and procedures for data collection, health services influences, the role of psychiatric diagnosis, and a review of the activities of boards and coordinating groups, as well as how issues stemming from involvement in the Persian Gulf might be relevant for possible future conflicts. While the committee continues its full-length study of the problem, the recommendations in this volume are for actions it feels should be taken immediately.
Many individuals, groups, and federal agencies have a strong interest in finding answers to the numerous and complex questions regarding the health of Gulf War veterans. Various types of research and health measurement are needed to address these diverse issues. The Institute of Medicine (IOM) was asked by the Department of Veterans Affairs (VA) and the Department of Defense (DoD) to undertake a study to identify important questions concerning the health of Gulf War veterans and then to design a study to answer those questions. The committee determined that it is of fundamental importance to ask how healthy are Gulf War veterans? Are they as healthy as others? What characteristics are associated with differences between the health of Gulf War veterans and the health of others? To address these questions, it will be necessary to measure not only the health status of those who served in the Gulf War, but also to compare Gulf War veterans with other groups. Further, one must continue to follow these groups through time to determine whether the groups differ in the way their health status is changing. As the committee began to develop a design that would address the fundamental questions identified, it realized that such a study could have important implications for understanding not only the health of Gulf War veterans, but also the health of veterans of other conflicts.
The Gulf War in 1990-1991 was considered a brief and successful military operation, with few injuries or deaths of US troops. The war began in August 1990, and the last US ground troops returned home by June 1991. Although most Gulf War veterans resumed their normal activities, many soon began reporting a variety of nonexplained health problems that they attributed to their participation in the Gulf War, including chronic fatigue, muscle and joint pain, loss of concentration, forgetfulness, headache, and rash. Because of concerns about the veterans' health problems, the Department of Veterans Affairs (VA) requested that the Institute of Medicine (IOM) review the scientific and medical literature on the long-term adverse health effects of agents to which the Gulf War veterans may have been exposed. This report is a broad overview of the toxicology of sarin and cyclosarin. It assesses the biologic plausibility with respect to the compounds in question and health effects.
Chronic multisymptom illness (CMI) is a serious condition that imposes an enormous burden of suffering on our nation's veterans. Veterans who have CMI often have physical symptoms (such as fatigue, joint and muscle pain, and gastrointestinal symptoms) and cognitive symptoms (such as memory difficulties). For the purposes of this report, the committee defined CMI as the presence of a spectrum of chronic symptoms experienced for 6 months or longer in at least two of six categories-fatigue, mood, and cognition, musculoskeletal, gastrointestinal, respiratory, and neurologic-that may overlap with but are not fully captured by known syndromes (such as CFS, fibromyalgia, and IBS) or other diagnoses. Despite considerable efforts by researchers in the United States and elsewhere, there is no consensus among physicians, researchers, and others as to the cause of CMI. There is a growing belief that no specific causal factor or agent will be identified. Many thousands of Gulf War veterans1 who have CMI live with sometimes debilitating symptoms and seek an effective way to manage their symptoms. Estimates of the numbers of 1991 Gulf War veterans who have CMI range from 175,000 to 250,000 (about 25-35% of the 1991 Gulf War veteran population), and there is evidence that CMI in 1991 Gulf War veterans may not resolve over time. Preliminary data suggest that CMI is occurring in veterans of the Iraq and Afghanistan wars as well. In addition to summarizing the available scientific and medical literature regarding the best treatments for chronic multisymptom illness among Gulf War veterans, Gulf War and Health: Volume 9: Treatment for Chronic Multisymptom Illness recommends how best to disseminate this information throughout the VA to improve the care and benefits provided to veterans, recommends additional scientific studies and research initiatives to resolve areas of continuing scientific uncertainty and recommends such legislative or administrative action as the IOM deems appropriate in light of the results of its review.
Emotional Aftermath of the Persian Gulf War explores the impact of war from a unique perspective -- it addresses not only the effect of trauma on soldiers in combat but also the toll war takes on families and communities as a whole. In this book, experts from the Department of Defense (including Dick Cheney, former Secretary of Defense, who provides the preface), the Veterans Administration, the National Institute of Mental Health, Israel Defense Forces, and academia provide an integrated look at the psychiatric and psychological effects of war and the treatment of war-related stress and psychiatric disorders. The authors focus on the experience of servicemembers and of their families in response to deployment, separation, and loss, and reintegration after the war. They discuss the treatment of combat casualties, those with and without psychiatric illness, who were rapidly returned home still in the acute stage of their injuries. The authors emphasize providing the best support, both medically and psychologically, for military personnel and their families for the essential mental health and effectiveness of the fighting force and the improved quality of life of individual people. The special needs of families and of reserve and guard members are considered, and models of community outreach programs for coping with the stressors of war are discussed. Unique in terms of the role that technology played -- including live TV coverage, Patriot missiles, and "smart" bombs -- the Gulf War was a part of the day-to-day lives of the fighting forces and their families, communities, and nations.
The third in a series of congressionally mandated reports on Gulf War veterans' health, this volume evaluates the long-term, human health effects associated with exposure to selected environmental agents, pollutants, and synthetic chemical compounds believed to have been present during the Gulf War. The committee specifically evaluated the literature on hydrogen sulfide, combustion products, hydrazine and red fuming nitric acid. Both the epidemiologic and toxicologic literature were reviewed.
"The editors of Treating Young Veterans and the authors of the individual chapters [provide] practitioners with essential information about the needs, desires, and possibilities for veteransÖand their families. This book represents a thoughtful, sensitive, and sensible approach to working with military personnel and veterans who have been deployed to wars in the Persian Gulf, Iraq, and Afghanistan." From the Foreword by Peter B. Vaughan Dean, Graduate School of Social Service () Fordham University, New York, NY Many veterans unsuccessfully attempt to self-manage their mental and physical health needs. This volume examines the multiple challenges awaiting the new generation of young veterans returning to civilian life, and provides strategies for mental health professionals to assist them in the process of readjustment. It incorporates multidisciplinary, state-of-the-art research to present practice and advocacy opportunities that facilitate a healthy and socially engaged reintegration into society for both traditional veterans (enlisted and career military personnel) and nontraditional veterans (reservists, national guardsmen, and women) aged 18 to 40 years. The volume is divided into three sections: Assessment and Practice Approaches to Promote Resilience; Outreach and Practice With Special Communities, and Advocacy Practice to Promote Young Veterans' Well-Being. Each section includes an introduction highlighting the chapters, and an epilogue delineating important steps in practice, outreach, and advocacy. Key Features: Targets the specific needs of veterans of the Iraqi and Afghani conflicts Includes chapters on women and sexual trauma in the military and homeless combat veterans Addresses the special needs of children of veterans and the nature of ambiguous loss as "veteran-by-proxy," employment issues, and equity issues related to reservists Authored by recognized experts including military officers, attorneys, and Veterans Affairs administrators Designed for both general and scholarly readers
