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Dieterich-Hartwell R, Malhotra B, Arslanbek A, DeBeer B, Alverio T, Kaimal G. Living With Toxic Wounds: The Voices and Visual Self-Representations of Gulf War Veterans. QUALITATIVE HEALTH RESEARCH 2024; 34:411-423. [PMID: 38019750 DOI: 10.1177/10497323231213818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Operations Desert Shield and Storm occurred over 30 years ago, yet many of those who were deployed continue to experience chronic and debilitating symptoms, now recognized as Gulf War Illness (GWI). While efforts have been made to explore clinical treatments for GWI, misperceptions and skepticism about its complex nature and a lack of consensus on its etiology impede progress in this area. A critical necessity remains to better understand the experiences, needs, and concerns of veterans with GWI. In this qualitative research study, 40 Gulf War veterans were interviewed about their perceptions regarding symptoms of physical health, cognitive functioning, quality of life, and the quality of care received. In addition, they depicted their experiences through an artistic elicitation collage. Through a grounded theory method, key findings indicated that there are remaining hurdles, such as challenging symptoms, persisting unknowns about the illness, and variations in treatment quality. Veterans have mostly managed and coped with GWI, but they voice the need for acknowledgment and support. The main implication from this study is the significance of both clinical and institutional validation and recognition of the GWI experience as well as the need for specific support systems.
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Affiliation(s)
| | - Bani Malhotra
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
| | - Aslı Arslanbek
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
| | - Bryann DeBeer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VHA Medical Center, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tabitha Alverio
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VHA Medical Center, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Girija Kaimal
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
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Sultana E, Shastry N, Kasarla R, Hardy J, Collado F, Aenlle K, Abreu M, Sisson E, Sullivan K, Klimas N, Craddock TJA. Disentangling the effects of PTSD from Gulf War Illness in male veterans via a systems-wide analysis of immune cell, cytokine, and symptom measures. Mil Med Res 2024; 11:2. [PMID: 38167090 PMCID: PMC10759613 DOI: 10.1186/s40779-023-00505-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND One-third of veterans returning from the 1990-1991 Gulf War reported a myriad of symptoms including cognitive dysfunction, skin rashes, musculoskeletal discomfort, and fatigue. This symptom cluster is now referred to as Gulf War Illness (GWI). As the underlying mechanisms of GWI have yet to be fully elucidated, diagnosis and treatment are based on symptomatic presentation. One confounding factor tied to the illness is the high presence of post-traumatic stress disorder (PTSD). Previous research efforts have demonstrated that both GWI and PTSD are associated with immunological dysfunction. As such, this research endeavor aimed to provide insight into the complex relationship between GWI symptoms, cytokine presence, and immune cell populations to pinpoint the impact of PTSD on these measures in GWI. METHODS Symptom measures were gathered through the Multidimensional fatigue inventory (MFI) and 36-item short form health survey (SF-36) scales and biological measures were obtained through cytokine & cytometry analysis. Subgrouping was conducted using Davidson Trauma Scale scores and the Structured Clinical Interview for Diagnostic and statistical manual of mental disorders (DSM)-5, into GWI with high probability of PTSD symptoms (GWIH) and GWI with low probability of PTSD symptoms (GWIL). Data was analyzed using Analysis of variance (ANOVA) statistical analysis along with correlation graph analysis. We mapped correlations between immune cells and cytokine signaling measures, hormones and GWI symptom measures to identify patterns in regulation between the GWIH, GWIL, and healthy control groups. RESULTS GWI with comorbid PTSD symptoms resulted in poorer health outcomes compared with both Healthy control (HC) and the GWIL subgroup. Significant differences were found in basophil levels of GWI compared with HC at peak exercise regardless of PTSD symptom comorbidity (ANOVA F = 4.7, P = 0.01,) indicating its potential usage as a biomarker for general GWI from control. While the unique identification of GWI with PTSD symptoms was less clear, the GWIL subgroup was found to be delineated from both GWIH and HC on measures of IL-15 across an exercise challenge (ANOVA F > 3.75, P < 0.03). Additional differences in natural killer (NK) cell numbers and function highlight IL-15 as a potential biomarker of GWI in the absence of PTSD symptoms. CONCLUSION We conclude that disentangling GWI and PTSD by defining trauma-based subgroups may aid in the identification of unique GWI biosignatures that can help to improve diagnosis and target treatment of GWI more effectively.
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Affiliation(s)
- Esha Sultana
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Nandan Shastry
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Rishabh Kasarla
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Jacob Hardy
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Fanny Collado
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Kristina Aenlle
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Maria Abreu
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Emily Sisson
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Travis J A Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
- Department of Computer Science, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
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Slaba O, Sadova-Chuba Z, Hrushkovska D, Hurka O. Comparative analysis of the quality of life of women who left the territory of Ukraine during the ongoing Russia - Ukraine war and women who stayed at their homes. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:42-46. [PMID: 38431806 DOI: 10.36740/wlek202401106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Aim: To investigate the quality of life of women who left Ukraine and those who did not leave their homes under the threat of war. PATIENTS AND METHODS Materials and Methods: We used the WHOQOL-100 questionnaire for quality assessment. 376 young women (aged 25-44) were interviewed using a Google questionnaire (WHOQOL BREF). The respondents were divided into 2 groups: group 1 - women who left the territory of Ukraine during the war (n-176); group 2 - women who did not leave their homes (n-200). RESULTS Results: The general level of quality of life for group 1 (62.9% ± 9.3) was slightly lower than group 2 (66.7% ± 9.1). In terms of quality of life, group 2 prevails over group 1 in the domain of microsocial support. CONCLUSION Conclusions: Therefore, women who did not leave their homes during the full-scale invasion of Russia on the territory of Ukraine rate their quality of life higher than women who left the territory of Ukraine. Respondents of group 2 are more satisfied with their social support, sexual life, support from friends, enjoy life more than respondents of group 1.
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Affiliation(s)
- Oksana Slaba
- DANYLO HALYTSKY LVIV NATIONAL MEDICAL UNIVERSITY, LVIV, UKRAINE
| | | | | | - Oksana Hurka
- DANYLO HALYTSKY LVIV NATIONAL MEDICAL UNIVERSITY, LVIV, UKRAINE
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Malhotra D, Boyle SH, Gifford EJ, Sullivan BA, Nguyen Wenker TH, Abs ND, Ahmed ST, Upchurch J, Vahey J, Stafford C, Efird JT, Hunt SC, Bradford A, Sims KJ, Hauser ER, Helmer DA, Williams CD. Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder. Neurogastroenterol Motil 2023; 35:e14548. [PMID: 36942766 DOI: 10.1111/nmo.14548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/08/2022] [Accepted: 01/11/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Gulf War Illness (GWI) is a chronic, multi-symptom disorder affecting 25%-32% of Gulf War veterans. Veterans with GWI disproportionately suffer from gastrointestinal (GI) disorders. Given the increasing evidence supporting a gut-brain axis, we explore the relationship between post-traumatic stress disorder (PTSD), GWI, and self-reported GI disorders among GW veterans. METHODS Veterans from the Gulf War Era Cohort and Biorepository responded to a mail-based survey (N = 1058). They were stratified by GWI (Centers for Disease Control definition) and PTSD status. This yielded three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression adjusting for demographic and military characteristics examined associations between GWI/PTSD groups and GI disorders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). KEY RESULTS The most frequently reported GI disorders were irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and colon polyps (CP). The GWI+/PTSD+ group had a higher odds of these disorders than the GWI+/PTSD- group (aORIBS = 3.12, 95% CI: 1.93-5.05; aORGERD = 2.04, 95% CI: 1.44-2.90; aORCP = 1.85, 95% CI: 1.23-2.80), which had a higher odds of these disorders than the GWI- group (aORIBS = 4.38, 95% CI: 1.55-12.36; aORGERD = 2.51 95% CI: 1.63-3.87; aORCP = 2.57, 95% CI: 1.53-4.32). CONCLUSIONS & INFERENCES GW veterans with GWI and PTSD have significantly higher odds of specific self-reported GI disorders than the other groups. Given the known bidirectional influences of the gut and brain, these veterans may benefit from a holistic healthcare approach that considers biopsychosocial contributors to the assessment and management of disease.
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Affiliation(s)
- D Malhotra
- Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - S H Boyle
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - E J Gifford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
| | - B A Sullivan
- Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - T H Nguyen Wenker
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Nono-Djotsa Abs
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC, Washington, USA
| | - S T Ahmed
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - J Upchurch
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - J Vahey
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Computational Biology and Bioinformatics Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Stafford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - J T Efird
- VA Cooperative Studies Program Coordinating Center, Boston, Massachusetts, USA
- Department of Radiation Oncology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - S C Hunt
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - A Bradford
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - K J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - E R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Molecular Physiology Institute, Durham, North Carolina, USA
| | - D A Helmer
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - C D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
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