Clinician attributions for symptoms and treatment of Gulf War-related health concerns

Background: Several clinical syndromes are defined solely on the basis of s ymptoms, absent an identifiable medical etiology. When evaluating and treat ing individuals with these syndromes, clinicians' beliefs might shape decis ions regarding referral, diagnostic testing, and treatment. To assess clini cian beliefs about the etiology and treatment of "Gulf War illness," we sur veyed a sample of general internal medicine clinicians (GIMCs) and mental h ealth clinicians (MHCs). Methods: Clinicians (77 GIMCs and 214 MHCs) at the Veterans Affairs Puget S ound Health Care System, Seattle, Wash, and the Veterans Affairs Medical Ce nter in Portland, Ore, responded to a mailed survey of their beliefs about Gulf War illness. Results: Compared with GIMCs, MHCs were more likely to believe that Gulf Wa r illness was the result of a "physical disorder" and that symptoms resulte d from viruses or bacteria, immunizations, exposure to toxins, chemical wea pons, or a combination of toxins and stress (P < .05). Conversely, GIMCs we re more likely than MHCs to believe that Gulf War illness was a "mental dis order" and that symptoms were due to stress or posttraumatic stress disorde r (P<.05). In addition, MHCs were more likely to endorse biological interve ntions to treat Gulf War illness (P<less than>.01), whereas GIMCs were more likely to endorse psychological interventions. Conclusion: Clinicians' beliefs about the etiology and effective treatment of Gulf War illness vary and thus might contribute to the multiple referral s often reported by Gulf War veterans. Health care models for Gulf War vete rans and others with symptom-based disorders necessitate collaborative,inte rdisciplinary approaches.