American Journal of Epidemiology Advance Access originally published online on August 30, 2006
American Journal of Epidemiology 2006 164(7):709-710; doi:10.1093/aje/kwj298
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Letter to the Editor |
THE FIRST AUTHOR REPLIES
1 Medical Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO 63106
2 Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63106
(e-mail: mblancha{at}im.wustl.edu)
We thank Hunt et al. (1
) for their comments and for sharing preliminary findings in their cohort of veterans returning from the current conflicts. They report finding a lower prevalence of medically unexplained symptoms among more than 375 veterans returning from the conflicts in Iraq and Afghanistan than the 28.9 percent we found in a representative sampling of veterans deployed in Gulf War I (2). Hunt et al. suggest that differences in the types of threats encountered by veterans in the current conflicts as compared with the 1991 Gulf War accounts for the lower current symptom prevalence they have observed. We agree that threats, regardless of the source and regardless of whether they are real or perceived, can have psychological, physiologic, and physical consequences. This may be particularly true among veterans with vulnerabilities such as the prewar depression and anxiety disorders we identified. The manifestations of these symptoms may be mediated by a common pathway—for example, the hypothalamic-pituitary adrenal axis.
In our cohort, veterans with chronic multisymptom illness (CMI) had twice the risk of metabolic syndrome, a constellation of risk factors associated with chronic stress and possibly mediated by the hypothalamic-pituitary adrenal axis. According to this common-pathway hypothesis, exposure to life stressors in vulnerable nondeployed veterans may have accounted for their CMI. Whether the threat of toxic exposure is more likely to cause CMI than the stress of direct combat is much less clear and requires further study. Of interest, post-traumatic stress disorder has not been associated with metabolic syndrome, which suggests a difference in pathogenesis for post-traumatic stress disorder and CMI.
ACKNOWLEDGMENTS
Conflict of interest: none declared.
References
- Hunt SC, Jakupcak M, McFall M, et al. Re: "Chronic multisymptom illness complex in Gulf War I veterans 10 years later." (Letter). Am J Epidemiol 2006;164:708–9.
[Free Full Text] - Blanchard MS, Eisen SA, Alpern R, et al. Chronic multisymptom illness complex in Gulf War I veterans 10 years later. Am J Epidemiol 2006;163:66–75.
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