Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness

Objective Conditions defined by persistent “medically unexplained” physical symptoms and syndromes (MUS) are common and disabling. Veterans from the Gulf War (deployed 1990–1991) have notably high prevalence and disability from MUS conditions. Individuals with MUS report that providers do not recognize their MUS conditions. Our goal was to determine if Veterans with MUS receive an ICD-10 diagnosis for a MUS condition or receive disability benefits available to them for these conditions. Methods A chart review was conducted with US Veterans who met case criteria for Gulf War Illness, a complex MUS condition (N = 204, M = 53 years-old, SD = 7). Three coders independently reviewed Veteran’s medical records for MUS condition diagnosis or service-connection along with comorbid mental and physical health conditions. Service-connection refers to US Veterans Affairs disability benefits eligibility for conditions or injuries experienced during or exacerbated by military service. Results Twenty-nine percent had a diagnosis of a MUS condition in their medical record, the most common were irritable colon/irritable bowel syndrome (16%) and fibromyalgia (11%). Slightly more Veterans were service-connected for a MUS condition (38%) as compared to diagnosed. There were high rates of diagnoses and service-connection for mental health (diagnoses 76% and service-connection 74%), musculoskeletal (diagnoses 86%, service-connection 79%), and illness-related conditions (diagnoses 98%, service-connection 49%). Conclusion Given that all participants were Gulf War Veterans who met criteria for a MUS condition, our results suggest that MUS conditions in Gulf War Veterans are under-recognized with regard to clinical diagnosis and service-connected disability. Veterans were more likely to be diagnosed and service-connected for musculoskeletal-related and mental health conditions than MUS conditions. Providers may need education and training to facilitate diagnosis of and service-connection for MUS conditions. We believe that greater acknowledgement and validation of MUS conditions would increase patient engagement with healthcare as well as provider and patient satisfaction with care.

Experiencing Trauma Before Trauma: Posttraumatic Memories, Nightmares and Flashbacks Among Finnish Soldiers

This chapter discusses the appearance of trauma symptoms among the Finnish soldiers of World War II. Kivimäki analyzes three kinds of sources: wartime psychiatric patient files, war veterans’ dream reminiscences and war-related fiction movies in the postwar era. These materials reveal that posttraumatic memories, nightmares and flashbacks were a wide-spread phenomenon already in the 1940s, although the concept of trauma was not yet developed within Finnish psychiatry. The chapter suggests that traumatic symptoms are not simply born out of psychiatric paradigms, but that the culture that shapes and produces the symptoms must be understood more broadly. In the end, Kivimäki proposes the concept of experience as a move forward in the historical analysis of human reactions to trauma.

Correlates of Psychological Well-being Among Korean Vietnam War Veterans

Prior research on Veterans’ mental health has largely focused on identifying risk and protective factors for negative psychological symptoms such as PTSD. However, mental health indicates not merely absence of psychopathology, but also the existence of positive psychological well-being (Keyes, 2005). Thus, the current study aimed to examine the correlates of psychological well-being, which is less studied, in an Asian sample, Korean veterans. Data for this 2017 study were from Korean Vietnam War Veterans Study. Participants were 348 male veterans, and their mean age was about 72 years old (SD = 2.7, range = 65-84). Using Keyes’ (2002) classification criteria, psychological well-being was divided into three types: flourishing (9.5%), moderately health (59.95%), and languishing (25.3%). Own-way analyses of variance showed that the groups did not differ in demographic variables (age, marital status, education, and income). Further, there were no differences in combat exposure, negative appraisals of military service, smoking, and alcohol consumption. However, significant group differences were found for resources; Scheffé's post-hoc analyses indicated that optimism, positive appraisals of military service, four types of social support (family, significant others, friend, and military peer), and self-rated health were significantly different among the groups, and highest in the flourishing group. The moderately health group showed higher levels of positive appraisals of military service and four types of social support than the languishing group. Thus, the majority (about 60%) of Korean Vietnam veterans were moderately psychologically healthy in this sample, but those with positive psychosocial resources were more likely to be healthiest.

The Department of Veterans Affairs Gulf War Veterans’ Illnesses Biorepository: Supporting Research on Gulf War Veterans’ Illnesses

Aims: To introduce resource supporting research on Gulf War illness (GWI) and related disorders, the Gulf War Veterans’ Illnesses Biorepository (GWVIB). Methods: Gulf War era veterans (GWVs) are recruited nationally and enrolled via telephone and email/postal mail. Enrolled veterans receive annual telephone and mail follow-up to collect health data until their passing. A postmortem neuropathological examination is performed, and fixed and frozen brain and spinal cord samples are banked to support research. Investigators studying GWI and related disorders may request tissue and data from the GWVIB. Results: As of September 2021, 127 GWVs from 39 states were enrolled; 60 met the criteria for GWI, and 14 met the criteria for chronic multisymptom illness (CMI). Enrollees have been followed up to six years. Postmortem tissue recoveries were performed on 14 GWVs. The most commonly found neuropathologies included amyotrophic lateral sclerosis, chronic traumatic encephalopathy, and Lewy body disease. Tissue was of good quality with an average RNA integrity number of 5.8 (SD = 1.0) and ≥4.8 in all of the cases. Discussion: The availability of health data and high-quality CNS tissue from this well-characterized GWV cohort will support research on GWI and related disorders affecting GWVs. Enrollment is ongoing.

Return to Vietnam

Between 1981 and 2016, thousands of American and Australian Vietnam War veterans returned to Việt Nam. This comparative, transnational oral history offers the first historical study of these return journeys. It shows how veterans returned in search of resolution, or peace, manifesting in shifting nostalgic visions of 'Vietnam.' Different national war narratives shaped their returns: Australians followed the 'Anzac' pilgrimage tradition, whereas for Americans the return was an anti-war act. Veterans met former enemies, visited battlefields, mourned friends, found new relationships, and addressed enduring legacies of war. Many found their memories of war eased by witnessing Việt Nam at peace. Yet this peacetime reality also challenged veterans' wartime connection to Vietnamese spaces. The place they were nostalgic for was Vietnam, a space in war memory, not Việt Nam, the country. Veterans drew from wartime narratives to negotiate this displacement, performing nostalgic practices to reclaim their sense of belonging.

SOCIAL WORK WITH SERVICEMAN AND THEIR FAMILIES IN THE CONDITIONS OF LONG CONFLICT IN EASTERN UKRAINE

The purpose of the article is to study the current state, features, content, methods, and technologies of social work with the military and their families amid the current conflict in eastern Ukraine. In line with the activities of the Information and Social Center for IDPs of Kharkiv Humanitarian and Pedagogical Academy of the Kharkiv Regional Council, the authors conducted a pilot focus group survey to determine the quality of social assistance to the servicemen and their families using a proprietary questionnaire “Assessing the quality of social service for the servicemen and their families members.” It has been found that social work with servicemen includes social protection, social support, social services, and adaptation work. The following major areas of social work with the military have been identified: social, socio-legal, socio-healthcare, socio-economic, financial, and socio-labour. However, it is necessary to develop socio-psychological, socio-pedagogical, socio-informational areas that will ensure a person’s adaptation in society, personal growth, and self-improvement. Development and implementation of ways to promote public and professional awareness of servicemen's social problems and their families are also relevant in current conditions along with constant scientific and practical search, and effective assistance to this social group in solving their problems in practice. The article proves that the goals of current social work are to preserve the physical and mental strength of servicemen, adjust their attitudes, and enhance their development in society. The article outlines the need for enrichment methods and technologies (individual therapy, group therapy, family therapy, counselling, and support) of social work with servicemen. It establishes that optimization of present-day technologies of social work with war veterans is possible under the following conditions: expansion of the range of services in the state network of social services, creation of alternative centres for social services; availability of social work professionals trained to work in the military environment and solve the problems of the military; organization of self-help and mutual assistance for the families of servicemen; formation of an effective social policy of the state in general and in the field of social protection of war veterans in Ukraine in particular. The article also includes practical recommendations for social workers on improving mechanisms of regulation of social protection for servicemen and families members.

The Associations Between Health-related Physical Fitness and Fasting Blood Glucose in War Veterans: a Population-based Study

The main purpose of the study was to analyze the associations between health-related physical fitness and fasting blood glucose in war veterans. In this cross-sectional study, we recruited 764 men and women aged 45–75 years, who were part of the Homeland War between 1990 and 1995 (33.5% women). Health-related physical fitness included: 1) fat mass and fat-free mass (body composition), 2) push-ups in 30 sec (muscular dynamic endurance of upper extremities), 3) sit-ups in 30 sec (repetitive upper body strength), 4) chair-stands in 30 sec (lower body strength), 5) sit-and-reach test (flexibility) and 6) the 2-minute step test (cardiorespiratory function). Laboratory measurement of fasting blood glucose was performed according to standardized procedures in resting seated position after a 12-h overnight fast. Generalized estimating equations with multiple regression models were used to calculate the associations between health-related physical fitness and fasting blood glucose. In model adjusted for sex and age, fasting blood glucose was associated with fat mass (β = 0.12, p = 0.012), fat-free mass (β=-0.19, p < 0.001), push-ups in 30 sec (β=-0.19, p < 0.001), chair-stands in 30 sec (β=-0.15, p < 0.001), sit-ups in 30 sec (β=-0.21, p < 0.001), sit-and-reach test (β=-0.15, p < 0.001) and the 2-minute step test (β=-0.25, p < 0.001). The multiple regression model was strongly correlated with fasting blood glucose (R = 0.78, R2 = 0.61, standard error of the estimate = 0.88 mmol/L, p < 0.001). This study shows that fasting blood glucose may be predicted by health-related physical fitness test in war veterans.

Warrior candidates: Do voters value combat experience in postwar elections?

Electoral competition in postwar societies is often dominated by war veterans. The question whether voters actually reward candidates’ records of war service, however, remains open. We answer it using a unique dataset with detailed information on the records of combat service of nearly four thousand candidates in two cycles of parliamentary elections held under proportional representation rules with preferential voting in Croatia. Our analysis shows war veterans’ electoral performance to be conditional on the voters’ communities’ exposure to war violence: combat veterans receive a sizeable electoral bonus in areas whose populations were more exposed to war violence, but are penalized in areas whose populations avoided destruction. This divergence is particularly pronounced for candidates of nationalist rightwing parties, demonstrating the importance of the interaction between lived war experiences and political ideology in postwar societies.