5.23
Quality of life
Quality of life was measured using the Life Satisfaction Scale89 and the WHOQOL-Bref87 in
the postal questionnaire at follow up only.
5.23.1
Quality of life at follow up
Life satisfaction
Responses to the single item Life Satisfaction Scale were positively skewed with 75% of
participants responding with a score of four or less out of a total of seven, where lower
scores indicate greater Life Satisfaction. In relation to their life as a whole, Gulf War
veterans were less likely than the comparison group to report that they felt delighted or
pleased, and more likely to report feeling unhappy, mostly dissatisfied, mixed or mostly
satisfied (see Figure 1).
Participant’s raw scores were transformed into Percent Life Satisfaction (PLS), where higher
PLS scores represent greater life satisfaction. There was a small difference in median PLS
between groups however this difference was not statistically significant when adjusted for
age, rank and service branch (veterans PLS median 66.67, IQR 50-83.33; comparison group
PLS median 83.33, IQR 66.67-83.33; adj diff 0, 95% CI -2.65, 2.65).
There was an observed lack of variability in the distribution of the Life Satisfaction Scale
results, this was partly due to the small number of response options in the Life Satisfaction
Scale. Thus, much of the variability between the 25th and 75th percentiles clustered together,
and that resulted in truncated variability in the distribution.
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Figure 1 Distribution of Life Satisfaction responses for participants at follow up
Overall Quality of Life and Health Satisfaction (WHOQOL-Bref)
Participants’ scores for the WHOQOL-Bref’s two individual measures of Overall Quality of
Life and Health Satisfaction, were negatively skewed with 75% of participants responding
with five out of a total of five, where higher scores indicate better quality of life and health
satisfaction. For Overall Quality of Life there was little difference between Gulf War veterans
and comparison group members in the distribution of their responses. Although Figure 2
shows that Gulf War veterans were less likely than the comparison group to rate their Quality
of Life as ‘very good’ and more likely to rate their quality of life as ‘very poor’, ‘poor’, ‘neither
poor nor good’ or ‘good’, the differences in distribution were not statistically significant
between the groups, including when controlled for age, rank and service type (p>0.05).
When rating their Health Satisfaction (Figure 3), Gulf War veterans were less likely than the
comparison group to rate their satisfaction as ‘very satisfied’ (p<0.05), however, none of the
other categories was significantly different. When controlled for age, rank and service type,
the small difference between the groups in the ‘very satisfied’ category was no longer
statistically significant (p>0.05). In a similar pattern to Overall Quality of Life, although the
differences were again not significant, Figure 3 shows that Gulf War veterans were less
likely to report being ‘satisfied’ or ‘very satisfied’ with their health and more likely to report
being ‘dissatisfied’ or ‘neither dissatisfied nor satisfied’.
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Very poor
Poor
Neither poor nor good
Good
Very good
Figure 2 WHOQOL-Bref Overall Quality of Life ratings by participants at follow up
Figure 3 WHOQOL-Bref Health Satisfaction ratings by participants at follow up
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Physical, Psychological, Social and Environmental Domains of Quality of Life
(WHOQOL-Bref)
The distributions of scores on the Physical, Psychological, Social and Environment domains
of the WHOQOL-Bref quality of life measure are shown in Figure 4. Gulf War veterans
reported poorer quality of life on the physical domain of the WHOQOL-Bref (veterans median
71.73 IQR 60.71 - 82.43, comparison group median 75.00 IQR 64.29 - 85.71, adj diff -3.57,
95% CI -5.65, -1.50). They also reported poorer quality of life on the psychological domain
(veterans median 70.83 IQR 54.17 - 79.17, comparison group median 75.00 IQR 45.83 79.17, adj diff -4.17, 95% CI -6.34, -1.99); as well as poorer Social quality of life (veterans
median 66.67 IQR 50.00-75.00, comparison group median 66.67 IQR 50.00 - 83.33, adj diff 8.33, 95% CI -10.94, -5.73).
Whilst the medians for Social quality of life were the same for Gulf War veterans and the
comparison group, after adjustment there was a significant difference. Consideration of the
adjustment variables (age, rank and service type) indicated that either rank or service type
was acting as a confounder in these results.
Although there was a small difference in medians for Environmental quality of life, this was
not statistically significant when adjusted for age, rank and service type (veterans median
71.88 IQR 62.50 - 81.25, comparison group median 75.00 IQR 65.63 - 84.38, adj diff 0, 95%
CI -1.84, 1.84).
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Figure 4 Box plot of the WHOQOL-Bref domains showing the means and interquartile range
5.23.2
Key findings
Twenty years after the Gulf War, veterans report significantly poorer physical, psychological
and social quality of life than the comparison group. On other measures of overall quality of
life, health satisfaction and life satisfaction, there was a consistent pattern of Gulf War
veterans generally scoring a little more poorly on these measures, however statistical
significance was not met.
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