Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness
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 recogn...
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| Veröffentlicht in: | PloS one 2021-12, Vol.16 (12), p.e0259341 |
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| creator | Kane, Naomi S Anastasides, Nicole Litke, David R Helmer, Drew A Hunt, Stephen C Quigley, Karen S Pigeon, Wilfred R McAndrew, Lisa M |
| description | 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.
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.
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%).
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. |
| doi_str_mv | 10.1371/journal.pone.0259341 |
| format | Article |
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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.
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%).
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0259341</identifier><identifier>PMID: 34874939</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Chronic fatigue syndrome ; Coders ; Colon ; Criteria ; Diagnosis ; Female ; Fibromyalgia ; Gulf War ; Gulf War syndrome ; Health aspects ; Health care ; Health care policy ; Humans ; Illnesses ; International Classification of Diseases ; Irritable bowel syndrome ; Male ; Medical records ; Medically Unexplained Symptoms ; Medicine and health sciences ; Mental disorders ; Mental health ; Middle Aged ; Migraine ; Military ; Military personnel ; Patients ; Persian Gulf Syndrome - epidemiology ; Persian Gulf War ; Persian Gulf War veterans ; Prevalence ; Problem Solving ; Social Sciences ; Somatoform disorders ; United States - epidemiology ; United States Department of Veterans Affairs ; Veterans ; Veterans Disability Claims ; War</subject><ispartof>PloS one, 2021-12, Vol.16 (12), p.e0259341</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication: https://creativecommons.org/publicdomain/zero/1.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-404ae46d9367d576360d4fec112f3e0b54dafae0d7cc503dcce83a8d5c6350fa3</citedby><cites>FETCH-LOGICAL-c692t-404ae46d9367d576360d4fec112f3e0b54dafae0d7cc503dcce83a8d5c6350fa3</cites><orcidid>0000-0002-1350-8773</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8651123/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8651123/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34874939$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Chao, Linda</contributor><creatorcontrib>Kane, Naomi S</creatorcontrib><creatorcontrib>Anastasides, Nicole</creatorcontrib><creatorcontrib>Litke, David R</creatorcontrib><creatorcontrib>Helmer, Drew A</creatorcontrib><creatorcontrib>Hunt, Stephen C</creatorcontrib><creatorcontrib>Quigley, Karen S</creatorcontrib><creatorcontrib>Pigeon, Wilfred R</creatorcontrib><creatorcontrib>McAndrew, Lisa M</creatorcontrib><title>Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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.
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%).
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Chronic fatigue syndrome</subject><subject>Coders</subject><subject>Colon</subject><subject>Criteria</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Fibromyalgia</subject><subject>Gulf War</subject><subject>Gulf War syndrome</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Health care policy</subject><subject>Humans</subject><subject>Illnesses</subject><subject>International Classification of Diseases</subject><subject>Irritable bowel syndrome</subject><subject>Male</subject><subject>Medical records</subject><subject>Medically Unexplained Symptoms</subject><subject>Medicine and health sciences</subject><subject>Mental disorders</subject><subject>Mental health</subject><subject>Middle Aged</subject><subject>Migraine</subject><subject>Military</subject><subject>Military personnel</subject><subject>Patients</subject><subject>Persian Gulf Syndrome - 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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.
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.
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%).
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34874939</pmid><doi>10.1371/journal.pone.0259341</doi><tpages>e0259341</tpages><orcidid>https://orcid.org/0000-0002-1350-8773</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-12, Vol.16 (12), p.e0259341 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2607595612 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; PubMed (Medline); Free E-Journal (出版社公開部分のみ）; PLoS_OA刊; Free Full-Text Journals in Chemistry |
| subjects | Adult Aged Chronic fatigue syndrome Coders Colon Criteria Diagnosis Female Fibromyalgia Gulf War Gulf War syndrome Health aspects Health care Health care policy Humans Illnesses International Classification of Diseases Irritable bowel syndrome Male Medical records Medically Unexplained Symptoms Medicine and health sciences Mental disorders Mental health Middle Aged Migraine Military Military personnel Patients Persian Gulf Syndrome - epidemiology Persian Gulf War Persian Gulf War veterans Prevalence Problem Solving Social Sciences Somatoform disorders United States - epidemiology United States Department of Veterans Affairs Veterans Veterans Disability Claims War |
| title | Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T08%3A13%3A07IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Under-recognition%20of%20medically%20unexplained%20symptom%20conditions%20among%20US%20Veterans%20with%20Gulf%20War%20Illness&rft.jtitle=PloS%20one&rft.au=Kane,%20Naomi%20S&rft.date=2021-12-07&rft.volume=16&rft.issue=12&rft.spage=e0259341&rft.pages=e0259341-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0259341&rft_dat=%3Cgale_plos_%3EA685742462%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2607595612&rft_id=info:pmid/34874939&rft_galeid=A685742462&rft_doaj_id=oai_doaj_org_article_7b748b54d1cf45f1ba160e29edf44231&rfr_iscdi=true |