SPECIAL FEATURE Proposed explanations for excess injury among veterans of the Persian Gulf War and a call for greater attention from policymakers and researchers

Introduction—Death rates among US veterans of the Persian Gulf War were lower than rates among non-deployed veterans and the US population at large, with the exception of injury deaths; returning veterans were at significantly greater risk of injury mortality. Similar patterns of excess injury mortality were documented among US and Australian veterans returning from Vietnam. In spite of these consistent findings little has been done to explain these associations and in particular to determine whether or not, and how, war related exposures influence injury risk among veterans returning home after deployments. Hypothesized pathways—Several potential pathways are proposed through which injury might be related to deployment. First, increases in injury mortality may be a consequence of depression, posttraumatic stress disorder, and symptoms of other psychiatric conditions developed after the war. Second, physical and psychological traumas experienced during the war may result in the postwar adoption of “coping” behaviors that also increase injury risk (for example, heavy drinking). Third, greater injury risk may be the indirect consequence of increased experiences of ill defined diseases and symptoms reported by many returning veterans. Fourth, veterans may experience poorer survivability for a given injury event resulting in greater mortality but not morbidity. Finally, the process that selects certain individuals for deployment may lead to a spurious association between deployment status and injury mortality by preferentially selecting individuals who are risk takers and/or exposed to greater hazards. Conclusions—More research and attention from policymakers is needed to clarify the link between deployment and postwar increased risk of injury. (Injury Prevention 2001;7:4–9)