{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:14:16Z","timestamp":1786965256006,"version":"build-2736575974"},"reference-count":64,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T00:00:00Z","timestamp":1649289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Health","award":["5T32-GM071340"],"award-info":[{"award-number":["5T32-GM071340"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This study examines how health-related quality of life (HRQOL) and related indices vary by Gulf War illness (GWI) case status. The study population included veterans from the Gulf War Era Cohort and Biorepository (n = 1116). Outcomes were physical and mental health from the Veterans RAND 12 and depression, post-traumatic stress (PTSD), sleep disturbance, and pain. Kansas (KS) and Centers for Disease Control and Prevention (CDC) GWI definitions were used. Kansas GWI derived subtypes included GWI (met symptom criteria; no exclusionary conditions (KS GWI: Sym+\/Dx\u2212)) and those without GWI: KS noncase (1): Sym+\/Dx+, KS noncase (2): Sym\u2212\/Dx+, and noncase (3): Sym\u2212\/Dx\u2212. CDC-derived subtypes included CDC GWI severe, CDC GWI mild-to-moderate and CDC noncases. Case status and outcomes were examined using multivariable regression adjusted for sociodemographic and military-related characteristics. Logistic regression analysis was used to examine associations between GWI case status and binary measures for depression, PTSD, and severe pain. The KS GWI: Sym+\/Dx\u2212 and KS noncase (1): Sym+\/Dx+ groups had worse mental and physical HRQOL outcomes than veterans in the KS noncase (2): Sym\u2212\/Dx+ and KS noncase (3): Sym\u2212\/Dx\u2212 groups (ps &lt; 0.001). Individuals who met the CDC GWI severe criteria had worse mental and physical HRQOL outcomes than those meeting the CDC GWI mild-to-moderate or CDC noncases (ps &lt; 0.001). For other outcomes, results followed a similar pattern. Relative to the less symptomatic comparison subtypes, veterans who met the Kansas symptom criteria, regardless of exclusionary conditions, and those who met the CDC GWI severe criteria experienced lower HRQOL and higher rates of depression, PTSD, and severe pain.<\/jats:p>","DOI":"10.3390\/ijerph19084425","type":"journal-article","created":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T13:39:51Z","timestamp":1649338791000},"page":"4425","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Health-Related Quality of Life by Gulf War Illness Case Status"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1488-0286","authenticated-orcid":false,"given":"Elizabeth J.","family":"Gifford","sequence":"first","affiliation":[{"name":"Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA"},{"name":"Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, NC 27708, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen H.","family":"Boyle","sequence":"additional","affiliation":[{"name":"Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0449-295X","authenticated-orcid":false,"given":"Jacqueline","family":"Vahey","sequence":"additional","affiliation":[{"name":"Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA"},{"name":"Computational Biology and Bioinformatics Program, Duke University School of Medicine, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kellie J.","family":"Sims","sequence":"additional","affiliation":[{"name":"Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4890-5111","authenticated-orcid":false,"given":"Jimmy T.","family":"Efird","sequence":"additional","affiliation":[{"name":"Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA"},{"name":"Department of Radiation Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blair","family":"Chesnut","sequence":"additional","affiliation":[{"name":"Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crystal","family":"Stafford","sequence":"additional","affiliation":[{"name":"Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2668-2535","authenticated-orcid":false,"given":"Julie","family":"Upchurch","sequence":"additional","affiliation":[{"name":"Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina D.","family":"Williams","sequence":"additional","affiliation":[{"name":"Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew A.","family":"Helmer","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA"},{"name":"Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0367-9189","authenticated-orcid":false,"given":"Elizabeth R.","family":"Hauser","sequence":"additional","affiliation":[{"name":"Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA"},{"name":"Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Molecular Physiology Institute, Durham, NC 27710, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1001\/jama.280.11.981","article-title":"Chronic multisymptom illness affecting Air Force veterans of the Gulf War","volume":"280","author":"Fukuda","year":"1998","journal-title":"JAMA"},{"key":"ref_2","unstructured":"Institute of Medicine (2014). 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