Gulf War and Health Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress

摘要

On August 2, 1990, Iraq invaded Kuwait, and Operation Desert Storm was launched on January 16, 1991, with an air offensive to liberate Kuwait. On February 24, 1991, the ground war began; by February 28, the war was over, and a ceasefire was signed in April. All U.S. troops who had participated in the ground war had returned home by June 13. About 697,000 U.S. military personnel were deployed to the Persian Gulf during the buildup and the war. Most of them were active-duty military personnel, but 261,871 reservists were called to active duty, and 106,047 of them were deployed to the gulf. The United States is once again engaged in a military conflict in the Middle East. Operation Enduring Freedom (OEF) began on October 7, 2001, in response to the September 11, 2001, terrorist attacks on the United States. Troops are stationed in and around Afghanistan, Southwest Asia, and other locations for military and humanitarian purposes. Operation Iraqi Freedom (OIF) began on March 19, 2003, when U.S.-led coalition forces invaded Iraq. As of November 4, 2006, about 1.4 million U.S. troops had been deployed to the conflicts in OEF and OIF. In response to the growing concern about the physical and psychologic health of the Gulf War veterans from the 1990-1991 conflict, Congress passed two laws in 1998: PL 105-277, the Persian Gulf War Veterans Act, and PL 105-368, the Veterans Programs Enhancement Act. Those laws directed the secretary of veterans affairs to enter into a contract with the National Academy of Sciences (NAS) to review and evaluate the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental or wartime hazards, and preventive medicines or vaccines in members of the armed forces who were exposed to such agents. PL 105-277 also gave NAS permission to identify other agents, hazards, or medicines or vaccines to which members of the Armed Forces may have been exposed. In 1996, the Presidential Advisory Committee on Gulf War Veterans Illnesses found that stress was an important contributor to those veterans illnesses and encouraged the government to continue its research on stress-related disorders. In response to the above laws, the Institute of Medicine (IOM) has had a program to examine health risks posed by specific agents and hazards to which Gulf War veterans might have been exposed during their deployment. Four reports have examined health effects related to depleted uranium, pyridostigmine bromide, sarin, and vaccines; insecticides and solvents; fuels, combustion products, and propellants; and infectious diseases. A fifth report by IOM evaluated the current health status of Gulf Wardeployed veterans compared with their nondeployed counterparts. In recent years, the charge to IOM has been expanded to include not only veterans of the 1990-1991 Gulf War but veterans returning from OEF and OIF. Many of the biologic and chemical exposures and their possible health effects have been considered in previous IOM reports, but the health effects associated with deployment-related stress had yet to be considered.