Autonomic Symptoms in Gulf War Veterans Evaluated at the War Related Illness and Injury Study Center

• Published in: Military medicine Vol. 184; no. 3-4; pp. e191 - e196
• Main Authors: Fox, Apollonia, Helmer, Drew, Tseng, Chin-Lin, McCarron, Kelly, Satcher, Serena, Osinubi, Omowunmi
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-03-2019
• Subjects: Adult; Anxiety; Autonomic Nervous System Diseases - epidemiology; Combat Disorders - epidemiology; Combat Disorders - etiology; Female; Gulf War; Humans; Male; Mental disorders; Mental health; Middle Aged; Persian Gulf Syndrome - epidemiology; Persian Gulf War; Physiology; Post traumatic stress disorder; Surveys and Questionnaires; United States - epidemiology; Veterans; Veterans - statistics & numerical data; Veterans health care; United States; autonomic; Veteran health; Gulf War Illness; War Related Illness and Injury Study Center; Beck Anxiety Inventory; COMPASS-31
• ISSN: 0026-4075; 1930-613X
• DOI: 10.1093/milmed/usy227

Abstract
Introduction
We characterized the presence of autonomic symptoms in a sample of Veterans with Gulf War Illness (GWI) using the Composite Autonomic Symptom Scale (COMPASS-31). In addition, we examined the report of autonomic symptoms across comorbid mental health conditions in this sample.
Materials and Methods
Case-series follow-up of Gulf War veterans evaluated by the War Related Illness and Injury Study Center (WRIISC) between 2011 and 2016 (n = 153). Phone-based interview consisted of questionnaires designed to investigate autonomic symptoms, physical symptoms, mental health conditions, and GWI. Sixty-One Veterans agreed to participate in this follow-up arm of the study. We restricted our analysis to only those Veterans meeting CDC and/or Kansas criteria for GWI, leaving us with a sample of 56 Veterans.
Results
Veterans in our sample were, male (n = 55, 98%), 49 (±6.8) years old and used 8 (±6.6) medications. The mean COMPASS-31 score for our sample was 45.6 (±18.3). There were no differences in reports of autonomic symptoms between participants who screened positive or negative for depression or post-traumatic stress disorder, but COMPASS-31 scores were higher among those who screened positive for anxiety (49.6 (±16.0)) compared with those who screened negative (29.3 (±18.9)) (p < 0.001).
Conclusions
The elevated COMPASS-31 scores suggest that there may be autonomic dysfunction present in our sample of Veterans with GWI, consistent with other published reports. Additionally, we believe that the high scores on the anxiety measure may reflect assessment of physiological symptoms that are not specific to anxiety, and may reflect GWI symptoms. Objective physiological tests of the autonomic nervous system are warranted to better characterize autonomic function and the clinical relevance of COMPASS-31 in this population.