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IIR 02-296 – HSR&D Study

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IIR 02-296
Prospective Study of Functional Status in Veterans at Risk for Unexplained Illnesses
Karen S. Quigley PhD
East Orange Campus of the VA New Jersey Health Care System, East Orange, NJ
East Orange, NJ
Funding Period: January 2004 - June 2010

BACKGROUND/RATIONALE:
The 1991 Gulf War highlighted the importance of unexplained illness and its signature feature, non-specific physical symptoms. Non-specific physical symptoms (NSPS) are a significant problem in civilian and veteran populations with patients who have significant NSPS having twice the healthcare costs. After prior wars combat veterans were especially likely to experience NSPS. Previous research on NSPS was limited by retrospective and cross-sectional designs and by primarily studying treatment seeking populations. This study addressed these methodological problems.

OBJECTIVE(S):
1. To determine pre-deployment and immediate post-deployment factors that predict later NSPS and poor functional status, 2. To improve on previous methodological problems in studies of NSPS, 3. To relate pre-deployment person factors to post-deployment functional status, 4. To relate prospective resilience factors to post-deployment functional status, and 5. To identify individuals at risk for developing NSPS to guide future work on intervention strategies.

METHODS:
This was a four phase longitudinal prospective cohort study of Army National Guard and Reserve enlisted personnel who deployed to Operations Enduring Freedom (OEF) or Iraqi Freedom (OIF). Individuals were recruited pre-deployment (Phase 1) during their medical processing with follow up measures completed immediately after return from deployment (Phase 2) at the military installation, and at 3 months (Phase 3) and one year (Phase 4) after return from deployment. At all phases, self-report measures were administered including personality, exposure, health, social support, coping style, and control variables. At Phases 1 and 2, non-invasive physiological measures were recorded including heart rate, blood pressure, cardiac autonomic indices, and cortisol both at rest and after laboratory stressor tasks.

FINDINGS/RESULTS:
Analyses determined bivariate pre-deployment and deployment-related predictors of NSPS and physical function at Phase 2. Significant bivariate predictors were entered into one regression analysis to predict NSPS at Phase 2 which revealed that gender and pre-deployment NSPS severity were significant predictors of immediate post-deployment NSPS severity (gender r =.20, p < .001; Phase 1 NSPS =.48, p < .001). Two deployment-related variables, unit cohesion (r = -.18, p < .01) and stressful deployment experiences (e.g., seeing or handling dead bodies, etc.; r =.21, p < .001), were significantly associated with immediate post-deployment NSPS over and above gender and pre-deployment NSPS severity. A different analysis, comparing symptom reporters and non-reporters in a logistic regression showed essentially the same findings. A second regression analysis predicting physical function at Phase 2 showed that physical function before deployment (r = .21, p < .01) was strongly associated with physical function after deployment, and that pre-deployment systolic blood pressure reactivity during laboratory stressor tasks was significantly related to Phase 2 physical function (r = .15, p < .05) over and above these factors. Lastly, deployment injury (r = -.19, p < .01) was related to physical function at Phase 2.
Further analyses and findings will appear in project citations.

IMPACT:
The study has already provided the following new evidence and more will be forthcoming as additional analyses are completed: (1) NSPS severity is increased immediately after deployment relative to pre-deployment in those deploying to OEF and OIF, (2) Unit cohesion and stressful deployment experiences affect increased symptom severity from pre- to immediate post-deployment with unit cohesion related to reduced NSPS severity and more stressful deployment experiences related to increased NSPS severity, (3) Physical function is reduced immediately following a combat deployment, and (4) Lower physical function after deployment has physiological pre-deployment correlates (pre-deployment lower physical function and blunted blood pressure reactivity to stressful tasks). Together these data suggest that having pre-deployment measures is critical for assessing changes in health parameters as a function of deployment for individual Veterans.

PUBLICATIONS:

Journal Articles

  1. McAndrew LM, Helmer DA, Phillips LA, Chandler HK, Ray K, Quigley KS. Iraq and Afghanistan Veterans report symptoms consistent with chronic multisymptom illness one year after deployment. Journal of rehabilitation research and development. 2016 Feb 1; 53(1):59-70.
  2. Yan GW, McAndrew L, D'Andrea EA, Lange G, Santos SL, Engel CC, Quigley KS. Self-reported stressors of National Guard women veterans before and after deployment: the relevance of interpersonal relationships. Journal of general internal medicine. 2013 Jul 1; 28 Suppl 2:S549-55.
  3. McAndrew LM, D'Andrea E, Lu SE, Abbi B, Yan GW, Engel C, Quigley KS. What pre-deployment and early post-deployment factors predict health function after combat deployment?: a prospective longitudinal study of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) soldiers. Health and Quality of Life Outcomes. 2013 Apr 30; 11(1):73.
  4. Falvo MJ, Serrador JM, McAndrew LM, Chandler HK, Lu SE, Quigley KS. A retrospective cohort study of U.S. service members returning from Afghanistan and Iraq: is physical health worsening over time? BMC public health. 2012 Dec 28; 12:1124.
  5. Quigley KS, McAndrew LM, Almeida L, D'Andrea EA, Engel CC, Hamtil H, Ackerman AJ. Prevalence of environmental and other military exposure concerns in Operation Enduring Freedom and Operation Iraqi Freedom veterans. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. 2012 Jun 1; 54(6):659-64.
Conference Presentations

  1. Quigley KS. Assessing resilience through functional status: Pre- to Post-Deployment Changes in reservists deploying to OEF/OIF. Paper presented at: AcademyHealth Annual Research Meeting; 2011 Jun 12; Seattle, WA.
  2. Chandler H, Rusiewicz A, McAndrew LM, Quigley KS, Lange G. Differential Impact of Pain and Fatigue on Physical and Mental Health Functioning in Veterans. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2011 Apr 28; Washington, DC.
  3. Quigley KS. Resilience & Reintegration: What Can We Learn from Research? Paper presented at: VA WRIISC Caring for Veterans with Post Deployment Health Concerns: Past, Present and Future Conference; 2010 Sep 15; Chicago, IL.
  4. Quigley KS. Provider Presentation: Resilience & Reintegration: What can we learn from Research? Paper presented at: VA WRIISC Caring for Veterans with Post Deployment Health Concerns: Past, Present and Future Conference; 2010 May 12; Orlando, FL.
  5. McAndrew L, D'Andrea E, Ackerman A, Chandler H, Chandler H, Yen C, Batorsky B, Engel CC, Quigley KS. Impact of combat deployment on weight. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2010 Apr 9; Seattle, WA.
  6. Quigley KS. Promises and pitfalls of psychophysiological research in applied settings. Paper presented at: Society for Psychophysiological Research Annual Meeting; 2009 Oct 23; Berlin, Germany.
  7. Quigley KS, D'Andrea E, Engel CC, Lyons J, Raphael K. The HEROES Project: Prospective study of post-deployment health in Iraq and Afghanistan veterans. Paper presented at: VA / DoD Evolving Paradigms II OEF / OIF National Conference; 2009 Sep 23; Las Vegas, NV.
  8. Quigley KS, D'Andrea E, Ackerman A, Hamtil H, Yen C, Engel C. Stress reactivity during preparation for combat deployment: resilience and risk factors for Post deployment physical health. Paper presented at: Association for Applied Psychophysiology and Biofeedback Annual Meeting; 2009 Apr 3; Albuquerque, NM.
  9. Quigley KS, D'Andrea E, Ackerman A, Hamtil H, Yen C, Engel C. Unit cohesion and pre-war stress reactivity: what makes soldiers more resilient after deployment to Iraq or Afghanistan? Paper presented at: American Psychosomatic Society Annual Scientific Meeting; 2009 Mar 7; Chicago, IL.
  10. Rowell D, Chandler H, Lange G, Quigley KS. The effect of posttraumatic stress and irritable bowel symptoms on health functioning among Iraq and Afghanistan war Veterans. Paper presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2008 Nov 13; Orlando, FL.
  11. D'Andrea E, Ackerman EA, Yen C, Hamtil H, Engel C, Quigley KS. Social support in soldiers returned from deployment in Iraq or Afghanistan: Predicting physical symptoms. Poster session presented at: Association of Military Surgeons of the United States Annual Meeting; 2008 Nov 9; San Antonio, TX.
  12. Quigley KS, D'Andrea E, Ackerman A, Yen C, Hamtil H, Engel C. Blood pressure reactivity and recovery to a lab stressor in soldiers deploying to Iraq and Afghanistan predicted self-reported physical health at return from deployment. Poster session presented at: Society for Psychophysiological Research Annual Meeting; 2008 Oct 4; Austin, TX.
  13. Quigley KS, D'Andrea E, Ackerman A, Hamtil H, Yen C, Engel CC. Military Stress and Virtual Reality Stress Inoculation and Treatment. Paper presented at: Association for Applied Psychophysiology and Biofeedback Annual Meeting; 2008 May 16; Daytona Beach, FL.
  14. Quigley KS. VA-DoD Research collaborations. Paper presented at: VA HSR&D National Meeting; 2008 Feb 15; Baltimore, MD.
  15. D'Andrea EA, Ackerman A, Hamtil H, Engel CE, Quigley KS. Health and psychosocial features of soldiers deploying to Iraq and Afghanistan. Poster session presented at: Association of Military Surgeons of the United States Annual Meeting; 2006 Nov 1; San Antonio, TX.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational, Prevention
Keywords: Adjustment Disorders, Deployment Related, PTSD, Risk Adjustment, Risk Factors
MeSH Terms: none

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