IS GULF-WAR SYNDROME DUE TO STRESS - THE EVIDENCE REEXAMINED

Medical policy-makers have concluded that stress from wartime trauma a nd deployment constitutes an important cause of the chronic physical s ymptoms observed in US veterans who served in the Persian Gulf War, Th e author reviewed scientific articles from peer-reviewed journals refe renced in the final report of the Presidential Advisory Committee on G ulf War Veterans' Illnesses and conducted a MEDLINE literature search, All reported prevalence rates of post-traumatic stress disorder (PTSD ) in Gulf War veterans were defined by critical cutpoints on psychomet ric scales constructed by summing veterans' responses on standardized symptom questionnaires rather than by clinical psychiatric interviews, Observed PTSD rates varied from 0% to 36% (mean, 9%), Correcting for measurement errors with previously determined values of the sensitivit y (range 0.77 to 0.96) and specificity (range 0.62 to 0.89) of the psy chometric tests yielded estimated true PTSD rates of 0% for 18 of the 20 reported rates, Mean scores on the Mississippi PTSD scale in all su bgroups of Gulf War veterans were within the range of values for well- adjusted Vietnam veterans (50-89) and far below that of Vietnam vetera ns with psychiatrically confirmed PTSD (120-140). Most PTSD and ''stre ss-related symptoms'' reported in studies of Gulf War Veterans appear to represent false-positive errors of measurement reflecting nonspecif ic symptoms of other conditions.