Table of Contents
Authors ............................................................................................................................... i
Acknowledgements ............................................................................................................ ii
Advisory Committee .......................................................................................................... iii
Ethics Committees ............................................................................................................ iv
Table of Contents............................................................................................................... v
List of Tables .................................................................................................................... ix
List of Figures ................................................................................................................. xiv
1 Introduction ...............................................................................................................1
2 Mortality and Cancer Incidence Study.......................................................................5
2.1 Introduction ..........................................................................................................5
2.2 Aim ......................................................................................................................5
2.3 Research questions .............................................................................................5
2.4 Results ................................................................................................................8
2.5 Key findings .......................................................................................................12
3 Health Study ...........................................................................................................13
3.1 Study design ......................................................................................................13
3.2 Research questions ...........................................................................................13
4 Health Study Methods.............................................................................................14
4.1 Participants ........................................................................................................14
4.2 Contact and recruitment methods ......................................................................14
4.3 Participation options ..........................................................................................16
4.4 Data collection, instrumentation and measures..................................................16
4.4.1 Postal questionnaire-derived data ...............................................................16
4.4.2 Psychological health interview .....................................................................31
4.4.3 Data linkage with Medicare Australia and DVA ............................................34
4.5 Data management .............................................................................................35
4.5.1 Checking, keying and secure transfer of electronic data ..............................36
4.5.2 Additional data checking, cleaning and coding ............................................36
4.5.3 Methods to ensure privacy and security.......................................................37
4.5.4 Long term storage of data............................................................................37
4.6 Statistical methods.............................................................................................37
4.7 Chemical, environmental and medical exposure assessment ............................40
4.7.1 Deployments ...............................................................................................41
4.7.2 Pattern of self-reported exposures by Ship and other deployments .............41
4.7.3 Documents from the Australian Department of Defence records .................53
4.7.4 Methodology for information extraction from Ships Logs, Reports of
Proceedings and Ships’ Medical Journals ...................................................56
4.7.5 Information extracted from Ships Logs, Reports of Proceedings and
Ships’ Medical Journals ...............................................................................57
4.7.6 Other sources of information .......................................................................69
4.7.7 Deployment-based metrics used for the analyses of associations
between exposures and health outcomes at follow up .................................71
5 Results....................................................................................................................74
5.1 Recruitment .......................................................................................................74
5.1.1 Key findings.................................................................................................75
5.2 Comparison of participants with non-participants ...............................................76
5.3 Participant characteristics ..................................................................................79
5.3.1 Demographic and socioeconomic factors ....................................................79
5.3.2 Recent ADF Service ....................................................................................79
5.3.3 Key findings.................................................................................................82
5.4 General physical and mental health ...................................................................83
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5.4.1 Self-perceived physical and mental health status at follow up .....................83
5.4.2 Association between Gulf War-deployment characteristics and selfperceived physical and mental health in veterans at follow up .....................84
5.4.3 Change in self-perceived physical and mental health status since
baseline .......................................................................................................86
5.4.4 Key findings.................................................................................................86
5.5 Symptoms..........................................................................................................87
5.5.1 Self-reported symptoms ..............................................................................87
5.5.2 Multisymptom illness ...................................................................................96
5.5.3 Patterns of symptom reporting.....................................................................99
5.5.4 Symptom patterns at follow-up ..................................................................100
5.5.5 Comparison of baseline and follow up symptom patterns ..........................105
5.5.6 Key findings...............................................................................................105
5.6 Neuropathic Symptoms....................................................................................107
5.6.1 Neuropathic symptoms at follow up ...........................................................107
5.6.2 Association between Gulf War deployment characteristics and
neuropathic symptoms in veterans at follow up .........................................109
5.6.3 Key findings...............................................................................................109
5.7 Chronic Fatigue ...............................................................................................111
5.7.1 Fatigue at follow up ...................................................................................111
5.7.2 Association between Gulf War deployment characteristics and chronic
fatigue in veterans at follow up ..................................................................112
5.7.3 Change in prevalence, also persistence, remittance and incidence of
chronic fatigue since baseline....................................................................113
5.7.4 Key findings...............................................................................................114
5.8 Sleep ...............................................................................................................116
5.8.1 Sleeping pattern ........................................................................................116
5.8.2 Daytime sleepiness ...................................................................................116
5.8.3 Sleep apnoea ............................................................................................117
5.8.4 Key findings...............................................................................................118
5.9 Pain .................................................................................................................119
5.9.1 Pain at follow up ........................................................................................119
5.9.2 Key findings...............................................................................................121
5.10 Respiratory health............................................................................................123
5.10.1 Respiratory symptoms and conditions at follow up ....................................123
5.10.2 Key findings...............................................................................................125
5.11 Irritable Bowel Syndrome and other gastro-intestinal disorders........................126
5.11.1 Irritable Bowel Syndrome and other gastro-intestinal disorders at follow
up ..............................................................................................................126
5.11.2 Association between Gulf War-deployment characteristics and Irritable
Bowel Syndrome in veterans at follow up ..................................................127
5.11.3 Key findings...............................................................................................127
5.12 Reproductive health .........................................................................................129
5.12.1 Fertility difficulties since 1992 ....................................................................129
5.12.2 Pregnancies fathered since 1992 ..............................................................129
5.12.3 Reproductive health at follow up ................................................................130
5.12.4 Key findings...............................................................................................131
5.13 Injuries .............................................................................................................132
5.13.1 Injury events in the 12 months prior to follow up ........................................132
5.13.2 Injuries in the past three years which potentially involved concussion .......135
5.13.3 Key findings...............................................................................................135
5.14 Musculoskeletal disorders................................................................................137
5.14.1 Musculoskeletal disorders at follow up.......................................................137
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5.14.2 Key findings...............................................................................................138
5.15 Depression ......................................................................................................139
5.15.1 Depression at follow up .............................................................................139
5.15.2 Association between Gulf War-deployment characteristics and
depression in veterans at follow up............................................................141
5.15.3 Change in prevalence, also persistence, remittance and incidence of 12
month major depression since baseline .....................................................142
5.15.4 Key findings...............................................................................................143
5.16 Posttraumatic Stress Disorder .........................................................................145
5.16.1 PTSD at follow up......................................................................................145
5.16.2 Association between Gulf War-deployment characteristics and 12 month
PTSD in veterans at follow up ...................................................................146
5.16.3 Change in prevalence, also persistence, remittance and incidence of 12
month PTSD since baseline ......................................................................147
5.16.4 Key findings...............................................................................................148
5.17 Alcohol and other substance use .....................................................................149
5.17.1 Alcohol disorders at follow up ....................................................................149
5.17.2 Association between Gulf War-deployment characteristics and alcohol
disorders in veterans at follow up ..............................................................151
5.17.3 Change in prevalence, also persistence, remittance and incidence of 12
month alcohol disorder since baseline .......................................................151
5.17.4 Key findings...............................................................................................153
5.18 Other indicators of psychological health...........................................................154
5.18.1 CIDI defined disorders at follow up other than major depression,
PTSD and alcohol ................................................................................................154
5.18.2 Screening instruments for psychosis, Intermittent Explosive Disorder and
eating disorders .........................................................................................155
5.18.3 12-item General Health Questionnaire.......................................................157
5.18.4 Demoralisation ..........................................................................................158
5.18.5 Resilience..................................................................................................159
5.18.6 Suicidality ..................................................................................................159
5.18.7 Risk taking propensity ...............................................................................160
5.18.8 Key findings...............................................................................................161
5.19 Other medical conditions .................................................................................163
5.19.1 Key findings...............................................................................................164
5.20 Life Events .......................................................................................................166
5.20.1 Events due to shortage of money ..............................................................166
5.20.2 Homelessness ...........................................................................................166
5.20.3 Convictions or incarcerations.....................................................................166
5.20.4 Potentially traumatic events .......................................................................167
5.20.5 Key findings...............................................................................................168
5.21 Health risk factors ............................................................................................169
5.21.1 Health risk factors at follow up ...................................................................169
5.21.2 Change in health risk factors since baseline ..............................................171
5.21.3 Key findings...............................................................................................172
5.22 Social health ....................................................................................................173
5.22.1 Functional social support ...........................................................................173
5.22.2 Structural social support ............................................................................173
5.22.3 Involvement in ex-service organisations and commemoration of military
occasions ..................................................................................................174
5.22.4 Key findings...............................................................................................175
5.23 Quality of life ....................................................................................................176
5.23.1 Quality of life at follow up...........................................................................176
5.23.2 Key findings...............................................................................................180
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5.24 Health service utilisation and DVA healthcare support .....................................181
5.24.1 Description of linkage data obtained from Medicare and DVA healthcare
databases..................................................................................................181
5.24.2 Consultations with health professionals .....................................................183
5.24.3 Hospital services .......................................................................................187
5.24.4 Pharmaceuticals dispensed since 2001.....................................................189
5.24.5 Disability claims submitted to DVA ............................................................190
5.24.6 DVA Treatment Card history......................................................................193
5.24.7 Key findings...............................................................................................194
5.25 Health outcomes at follow up among participants with disorders at baseline ...196
5.25.1 Key findings...............................................................................................201
5.26 Gulf War deployment-related exposures and health outcomes at follow up .....202
5.26.1 Key findings...............................................................................................212
6 Discussion ............................................................................................................214
7 References ...........................................................................................................250
8 Appendices ...........................................................................................................258
8.1 Appendix 1 Abbreviations ......................................................................................
8.2 Appendix 2 Study group definitions ........................................................................
8.3 Appendix 3 Health measures and occupational exposures collected at baseline and follow
up........................................................................................................
8.4 Appendix 4 Participant questionnaire .....................................................................
8.5 Appendix 5 Mail out materials ................................................................................
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