Quality of Life in Gulf War Veterans: the Influence of Recency and Persistence of Psychiatric Morbidity

Important contributors to quality of life (QOL), such as psychosocial factors, have received limited exploration in veteran populations, in contrast to a significant amount of research focused on health-related quality of life (HRQL). This study investigated QOL and HRQL amongst Gulf War veterans compared with an era-military comparison group 20years after the 1990/91 Gulf War, and whether psychiatric status over time and psychiatric comorbidities predicted QOL and HRQL. We then investigated which of a range of psychological health, physical health and social factors contribute greatest to QOL. Psychological interviews and postal questionnaires were administered to a cohort of Gulf War veterans and a military-era comparison group in 2000-02 and 2011-12. Gulf War veterans had poorer QOL and HRQL compared with a military comparison group, but the pattern of factors that influenced QOL was the same for both groups. Poorer QOL and HRQL were significantly associated with more recent and persistent psychiatric morbidity over time. Further analyses showed that affective disorders, followed by anxiety disorders had the largest impact on QOL and HRQL, and that QOL and HRQL were negatively affected by each additional psychiatric diagnosis. The importance of these findings was highlighted in a structural equation model that revealed psychological health contributed most to QOL, social support contributed a moderate amount, but physical health contributed only a very small amount. QOL in veterans is an important issue even many years after deployment and psychological health plays a predominant role in QOL.