Gulf War Illness (GWI) is a chronic, multi-symptomatic disorder affecting an estimated 25–32% of the returning military veterans of the 1990–1991 Persian Gulf War. GWI presents with a wide range of symptoms including fatigue, muscle pain, cognitive problems, insomnia, rashes and gastrointestinal issues and continues to be a poorly understood illness. This heterogeneity of GWI symptom presentation complicates diagnosis as well as the identification of effective treatments. Defining subgroups of the illness may help alleviate these complications. Our aim is to determine if GWI can be divided into distinct subgroups based on PTSD symptom presentation. Veterans diagnosed with GWI (n = 47) and healthy sedentary veteran controls (n = 52) were recruited through the Miami Affairs (VA) Medical Health Center. Symptoms were assessed via the RAND short form health survey (36), the multidimensional fatigue inventory, and the Davidson trauma scale. Hierarchal regression modeling was performed on measures of health and fatigue with PTSD symptoms as a covariate. This was followed by univariate analyses conducted with two separate GWI groups based on a cut-point of 70 for their total Davidson Trauma Scale value and performing heteroscedastic t-tests across all measures. Overall analyses returned two symptom-based subgroups differing significantly across all health and trauma symptoms. These subgroups supported PTSD symptomatology as a means to subgroup veterans. Hierarchical models showed that GWI and levels of PTSD symptoms both impact measures of physical, social, and emotional consequences of poor health (ΔR2 = 0.055–0.316). However, GWI appeared to contribute more to fatigue measures. Cut-point analysis retained worse health outcomes across all measures for GWI with PTSD symptoms compared to those without PTSD symptoms, and healthy controls. Significant differences were observed in mental and emotional measures. Therefore, this research supports the idea that comorbid GWI and PTSD symptoms lead to worse health outcomes, while demonstrating how GWI and PTSD symptoms may uniquely contribute to clinical presentation.

中文翻译：

---

创伤后应激对海湾战争疾病健康结果的影响

海湾战争病 (GWI) 是一种慢性、多种症状的疾病，影响估计 25-32% 1990-1991 年波斯湾战争返回的退伍军人。GWI 表现出多种症状，包括疲劳、肌肉疼痛、认知问题、失眠、皮疹和胃肠道问题，并且仍然是一种人们知之甚少的疾病。GWI 症状表现的这种异质性使诊断以及有效治疗的确定变得复杂。定义疾病的亚组可能有助于减轻这些并发症。我们的目的是确定 GWI 是否可以根据 PTSD 症状表现分为不同的亚组。诊断患有 GWI 的退伍军人 (n = 47) 和健康的久坐退伍军人对照组 (n = 52) 是通过迈阿密事务 (VA) 医疗健康中心招募的。通过兰德简短健康调查 (36)、多维疲劳量表和戴维森创伤量表评估症状。以 PTSD 症状作为协变量，对健康和疲劳指标进行分层回归模型。随后对两个独立的 GWI 组进行单变量分析，其总戴维森创伤量表值的切点为 70，并对所有测量值进行异方差 t 检验。总体分析返回了两个基于症状的亚组，它们在所有健康和创伤症状方面均存在显着差异。这些亚组支持 PTSD 症状学作为亚组退伍军人的一种手段。分层模型表明，GWI 和 PTSD 症状水平都会影响健康状况不佳对身体、社会和情感后果的衡量（ΔR2 = 0.055–0.316）。然而，GWI 似乎对疲劳测量的贡献更大。与没有 PTSD 症状的 GWI 和健康对照相比，切点分析在所有指标中保留了有 PTSD 症状的 GWI 的健康结果更差。在精神和情绪测量方面观察到显着差异。因此，这项研究支持这样的观点，即共病 GWI 和 PTSD 症状会导致更糟糕的健康结果，同时证明 GWI 和 PTSD 症状可能如何独特地影响临床表现。