STUDIES EXCLUDED DURING FULL-TEXT SCREENING

Appendix - Occurrence of Psychiatric Conditions or Symptoms After Military Service-Related Environmental and Chemical Toxic Exposures - NCBI Bookshelf An official website of the United States government Here's how you know The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 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Occurrence of Psychiatric Conditions or Symptoms After Military Service-Related Environmental and Chemical Toxic Exposures. Show details Nugent SM, Magnante AT, Leflore-Lloyd N, et al. Washington (DC): Department of Veterans Affairs (US) ; 2024 Jun. Contents Search term < Prev Next > Appendix SEARCH STRATEGIES Librarian searcher: Sarah Cantrell, MLIS; Duke University Medical Center Library and Archives, Duke University School of Medicine Peer review of search conducted by: Leila Ledbetter, MLIS; Duke University Medical Center Library and Archives, Duke University School of Medicine MEDLINE (via Ovid) Search date: 7/28/2023 Note: Ovid MEDLINE ALL 1946 to July 27, 2023 View in own window Search Set # + Description Search Strategy Results #1 Military terms exp Military Personnel/ or exp Veterans/ or exp Military Health/ or exp Veterans Health/ or (military or veteran* or air force or army or coast guard or (marine adj3 (personnel or corps or corp)) or marines or navy or armed forces or special forces or armed services or sailor* or soldier* or submariner* or service member* or servicemember* or active duty or national guard or national reserves).ti,ab. 139759 #2 Exposure terms environmental exposure/ or exp inhalation exposure/ or occupational exposure/ or war exposure/ or radiation exposure/ or exp hazardous waste/ or exp radioactive waste/ or exp hazardous waste sites/ or exp air pollutants, occupational/ or exp air pollutants, radioactive/ or exp water pollution/ or exp soil pollutants/ or exp chemical warfare agents/ or exp nerve agents/ or exp agent orange/ or chemically-induced disorders/ or exp herbicides/ or exp defoliants, chemical/ or pesticides/ or acaricides/ or fungicides, industrial/ or insecticides/ or pesticide residues/ or rodenticides/ or exp biological warfare agents/ or exp organophosphates/ or exp organophosphate poisoning/ or exp gas poisoning/ or exp heavy metal poisoning, nervous system/ or exp lead poisoning, nervous system/ or exp manganese poisoning/ or mercury poisoning, nervous system/ or exp arsenic poisoning/ or exp asbestos/ or exp chromium/ or exp polychlorinated biphenyls/ or exp plutonium/ or exp uranium/ or ((environment* or inhalation or inhalant* or occupation* or presumptive or toxic* or neurotox*) adj3 exposure*).ti,ab. or ((airborne or chemical* or environment*) adj3 (hazard* or toxin* or toxic* or poison*)).ti,ab. or (radiation adj3 (exposure* or illness* or sickness* or syndrome* or injur*)).ti,ab. or ((acaricide* or arsenic or asbestos or chemical* or chromium or debris or defoliant* or dust or fire* or fuel* or fume* or fungicide* or hazard* or herbicide* or heavy metal* or incinerator* or (industrial adj2 solvent*) or insecticide* or lead or lewisite or mustard gas or neurotox* or nuclear or organophosphate* or particulate matter or PCBs or polychlorinated biphenyl or PFAs or perfluoroalkyl or polyfluoroalkyl or pesticide* or plant* or plutonium or pollut* or radiation or radioactive or rodenticide* or sand or smoke or sulfur or toxin* or uranium or waste) adj7 (exposed or exposure* or poison*)).ti,ab. or ((air or soil or water or groundwater or radioactive) adj3 (contaminat* or pollut* or toxi* or poison*)).ti,ab. or ((biological or bioterror* or biowarfare or bio-warfare or chemical or infectious or nerve or neurotox* or radioactive or warfare) adj3 agent*).ti,ab. or ((biological or bioterror* or chemical or neurotox* or radioactive or radiation) adj3 weapon*).ti,ab. or ((radioactive or chemical or hazard* or toxic or neurotoxic) adj3 waste).ti,ab. or (toxic adj3 fragment*).ti,ab. or (“agent orange” or burn pit* or “CARC paint” or “Chemical Agent Resistant Coating” or nerve gas* or oil well fire* or “project 112” or “project SHAD” or Astugi or camp lejeune or fort mcclellan).ti,ab. or ((“Edgewood/Aberdeen” or Edgewood or Aberdeen or “Edgewood-Aberdeen”) adj2 experiment*).ti,ab. 773464 #3 Mental health terms exp mental disorders/ or exp adjustment disorders/ or exp aggression/ or exp anhedonia/ or exp anxiety/ or exp anxiety disorders/ or exp dementia/ or exp “disruptive, impulse control, and conduct disorders”/ or exp dissociative disorders/ or exp “feeding and eating disorders”/ or exp mood disorders/ or exp “bipolar and related disorders”/ or exp depressive disorder/ or exp neurocognitive disorders/ or exp amnesia/ or exp cognition disorders/ or exp “schizophrenia spectrum and other psychotic disorders”/ or exp mental health/ or exp behavioral symptoms/ or hallucinations/ or exp cognition/ or dyssomnias/ or exp “stress disorders, post-traumatic”/ or exp persian gulf syndrome/ or exp guilt/ or exp grief/ or exp neurotic disorders/ or exp paranoid behavior/ or exp personality disorders/ or exp phobic disorders/ or exp problem behavior/ or exp obsessive-compulsive disorder/ or exp self-injurious behavior/ or exp self-mutilation/ or exp sleep wake disorders/ or ((behavioral or behavioural or mental or mood or psychological or psychiatric or neurocogn* or neuropsychiatric or neuropsychological) adj3 (disease or diseases or disorder or disorders or illness or ill or symptom or symptoms or syndrome or syndromes)).ti,ab. or ((cognit* or memory or confusion or amnesia) adj3 (disorder or disorders or symptom or symptoms)).ti,ab. or ((mental or mentally) adj3 (disorder or disorders or illness or ill or illnesses)).ti,ab. or ((“gulf war” or “Persian gulf”) adj3 (disorder or disorders or illness or illnesses or symptom or symptoms or syndrome or syndromes)).ti,ab. or ((adjustment or affective or panic or phobic or phobia or psychotic or reactive or somatoform or stress) adj3 (disorder or disorders)).ti,ab. or ((sex or sexual or psychosexual) adj3 (dysfunction* or disorder or disorders)).ti,ab. or (agitat* or agoraphob* or agress* or anger or rage or anhedonia* or anxiety or anxious* or anorexi* or apath* or bipolar or bulimi* or dementia or depersonali* or depressi* or delusion* or dissocia* or dysphoria or dysphoric or hallucinat* or hypervigilan* or hypochondria* or inattention or inattentive* or irritab* or “impulse control” or impulsiv* or guilt or grief or grieving or mourning or “mental health” or mood* or neurotic* or neurosis or neuroses or OCD or “obsessive compulsive” or obsessive-compulsive or “obsessive behavior” or “obsessive behaviour” or paranoi* or PTSD or CPTSD or C-PTSD or “post-traumatic stress” or “posttraumatic stress” or “post-traumatic distress” or “posttraumatic distress” or psychosis or psychoses or psychotic or schizophren* or self-injur* or selfinjur* or self-harm* or selfharm* or self-mutilat* or selfmutilat* or suicide or suicidal or NSSI or NSSIs or dyssomnia* or hypersomn* or insomnia* or nightmare* or sleeplessness).ti,ab. or (sleep adj2 (depriv* or disorder* or dysfunction* or fragmentation* or inadequa* or insufficien* or syndrome*)).ti,ab. or (memory adj2 (dysfunction* or impair* or loss*)).ti,ab. 2780973 #4 Substance abuse terms Substance-Related Disorders/ or exp Alcoholism/ or exp Amphetamine-Related Disorders/ or exp Cocaine-Related Disorders/ or exp Marijuana Abuse/ or Narcotic-Related Disorders/ or exp Opioid-Related Disorders/ or exp Heroin Dependence/ or exp Morphine Dependence/ or exp Opium Dependence/ or ((substance or substances or drug or drugs or alcohol or cocaine or heroin or opioid or opioids or opiate or opiates or opium or morphine or narcotic or narcotics or marijuana or amphetamine or amphetamines or methamphetamine or methamphetamines) adj3 (abuse or abuses OR abused OR abusing OR misuse OR misuses OR misusing OR misused or dependence or dependent or disorder or disorders)).ti,ab. 301609 #5 Mental health OR substance abuse terms 3 or 4 2826473 #6 Combining: exposures + mental health + military/vets 1 and 2 and 5 1080 #7 Remove animal only research 6 not (exp animals/not exp humans/) 985 #8 Remove study designs 7 not (case reports OR editorial OR letter OR comment OR congress).pt. 919 #9 Exemplar test 8 and (35326276 OR 27634606 OR 30428552 OR 27494204 OR 34998396 OR 35150175 OR 31382236 OR 29691769 OR 29126934 OR 26837083 OR 35290683 OR 32890202).ui. 12/12 Database: Embase (via Elsevier) Search date: 7/28/2023 Notes: Search from the Results page View in own window Search Set # + Description Search Strategy Results #1 Military terms ‘military personnel’/exp OR ‘veteran’/exp OR ‘military health’/exp OR ‘veterans health’/exp OR (military OR veteran* OR ‘air force’ OR army OR ‘coast guard’ OR marines OR navy OR ‘armed forces’ OR ‘special forces’ OR ‘armed services’ OR sailor* OR soldier* OR submariner* OR ‘service member’ OR ‘service members’ OR servicemember OR servicemembers OR ‘active duty’ OR ‘national guard’ OR ‘national reserves’):ti,ab 175082 #2 Exposure terms ‘war exposure’/exp OR ‘environmental exposure’/de OR ‘occupational exposure’/exp OR ‘occupational disease’/de OR ‘cumulative trauma disorder’/de OR ‘occupational accident’/exp OR ‘occupational allergy’/exp OR ‘occupational cancer’/exp OR ‘occupational deafness’/exp OR ‘occupational lung disease’/exp OR ‘occupational poisoning’/exp OR ‘occupational skin disease’/exp OR ‘occupational asthma’/exp OR ‘radiation exposure’/de OR ‘water pollution’/de OR ‘water pollutant’/de OR ‘soil pollution’/de OR ‘soil pollutant’/de OR ‘chemical warfare agent’/de OR ‘biological warfare agent’/de OR ‘hazardous waste’/exp OR ‘radioactive waste’/exp OR ‘hazardous waste site’/exp OR ‘air pollutant’/exp OR ‘2,4,5 trichlorophenoxyacetic acid’/exp OR ‘chemically induced disorder’/exp OR ‘herbicide’/exp OR ‘defoliant agent’/exp OR ‘pesticide’/exp OR ‘acaricide’/exp OR ‘fungicide’/exp OR ‘insecticide’/exp OR ‘rodenticide’/exp OR ‘organophosphorus compound’/exp OR ‘organophosphate poisoning’/exp OR ‘gas poisoning’/exp OR ‘heavy metal poisoning’/exp OR ‘asbestos’/exp OR ‘chromium’/exp OR ‘polychlorinated biphenyl’/exp OR ‘plutonium’/exp OR ‘uranium’/exp OR ((environment OR environmental OR inhalation OR inhalant OR inhalants OR occupation OR occupational OR toxic OR toxin OR toxins OR neurotoxic OR neurotoxin OR neurotoxins) NEAR/3 (exposure OR exposures)):ti,ab OR ((airborne OR chemical OR chemicals OR environment OR environmental) NEAR/3 (hazard OR hazards OR hazardous OR toxin OR toxins OR toxic OR toxicity OR poison OR poisons OR poisoning)):ti,ab OR (radiation NEAR/3 (exposure OR exposures OR illness OR illnesses OR sickness OR sicknesses OR syndrome OR syndromes OR injury OR injuries)):ti,ab OR ((arsenic OR asbestos OR chemical OR chemicals OR chemically OR chromium OR debris OR defoliant OR defoliants OR dust OR fire OR fires OR fuel OR fuels OR fume OR fumes OR fungicide OR fungicides OR hazard OR hazards OR hazardous OR herbicide OR herbicides OR ‘heavy metal’ OR ‘heavy metals’ OR incinerator OR incinerators OR insecticide OR insecticides OR lead OR lewisite OR ‘mustard gas’ OR neurotoxic OR neurotoxin OR neurotoxins OR neurotoxicity OR neuorotoxicities OR nuclear OR organophosphate OR ‘particulate matter’ OR ‘polychlorinated biphenyl’ OR perfluoroalkyl OR polyfluoroalkyl OR pesticide OR pesticides OR plant OR plants OR plutonium OR pollututant OR pollutants OR pollution OR radiation OR radioactive OR rodenticide OR rodenticides OR sand OR smoke OR sulfur OR toxin OR toxins OR uranium OR waste) NEAR/5 (exposed OR exposure OR exposures OR poison OR poisonous OR poisons OR poisoning)):ti,ab OR ((air OR soil OR water OR groundwater OR radioactive) NEAR/3 (contaminant OR contaminants OR contaminate OR contaminates OR contaminating OR contamination OR pollutant OR pollutants OR pollution OR toxic OR toxin OR toxins OR poison OR poisons OR poisonous OR poisoning)):ti,ab OR ((biological OR bioterrorism OR biowarfare OR chemical OR infectious OR nerve OR neurotoxic OR neurotoxin OR neurotoxins OR radioactive OR warfare) NEAR/3 (agent OR agents)):ti,ab OR ((biological OR bioterrorism OR bioterrorist OR chemical OR neurotoxic OR neurotoxin OR neurotoxins OR radioactive OR radiation) NEAR/3 (weapon OR weapons)):ti,ab OR ((radioactive OR chemical OR hazard OR hazards OR hazardous OR toxic OR neurotoxic) NEAR/3 waste):ti,ab OR (toxic NEAR/3 (fragment OR fragments)):ti,ab OR (‘agent orange’ OR ‘burn pit’ OR ‘burn pits’ OR ‘CARC paint’ OR ‘Chemical Agent Resistant Coating’ OR ‘nerve gas’ OR ‘nerve gases’ OR ‘oil well fire’ OR ‘oil well fires’ OR ‘project 112’ OR ‘project SHAD’ OR Astugi OR ‘camp lejeune’ OR ‘fort mcclellan’):ti,ab OR ((‘Edgewood Aberdeen’ OR Edgewood OR Aberdeen) NEAR/2 experiment*):ti,ab 1768170 #3 Mental health terms ‘mental disease’/exp OR ‘adjustment disorder’/exp OR ‘aggression’/exp OR ‘anhedonia’/exp OR ‘anxiety’/exp OR ‘anxiety disorder’/exp OR ‘dementia’/exp OR ‘impulse control disorder’/exp OR ‘dissociative disorder’/exp OR ‘eating disorder’/exp OR ‘mood disorder’/exp OR ‘bipolar disorder’/exp OR ‘depression’/exp OR ‘disorders of higher cerebral function’/exp OR ‘amnesia’/exp OR ‘cognitive defect’/exp OR ‘schizophrenia’/exp OR ‘psychosis’/exp OR ‘mental health’/exp OR ‘hallucination’/exp OR ‘dyssomnia’/exp OR ‘posttraumatic stress disorder’/exp OR ‘Persian Gulf syndrome’/exp OR ‘guilt’/exp OR ‘neurosis’/exp OR ‘paranoid psychosis’/exp OR ‘personality disorder’/exp OR ‘phobia’/exp OR ‘problem behavior’/exp OR ‘obsessive compulsive disorder’/exp OR ‘automutilation’/exp OR ‘sleep disorder’/exp OR ((behavioral OR behavioural OR mental OR mood OR psychological OR psychiatric OR neurocognitive OR neuropsychiatric OR neuropsychological) NEAR/3 (disease OR diseases OR disorder OR disorders OR illness OR ill OR symptom OR symptoms OR syndrome OR syndromes)):ti,ab OR ((cognition OR cognitive OR memory OR confusion OR amnesia) NEAR/3 (disorder OR disorders OR symptom OR symptoms)):ti,ab OR ((mental OR mentally) NEAR/3 (disorder OR disorders OR illness OR ill OR illnesses)):ti,ab OR ((‘gulf war’ OR ‘Persian gulf’) NEAR/3 (disorder OR disorders OR illness OR illnesses OR symptom OR symptoms OR syndrome OR syndromes)):ti,ab OR ((adjustment OR affective OR panic OR phobic OR phobia OR psychotic OR reactive OR somatoform OR stress) NEAR/3 (disorder OR disorders)):ti,ab OR ((sex OR sexual OR psychosexual) NEAR/3 (dysfunction OR dysfunctions OR dysfunctional OR disorder OR disorders)):ti,ab OR (agitate OR agitated OR agitation OR agoraphobia OR agoraphobic OR aggressive OR aggression OR anger OR rage OR anhedonia OR anxiety OR anxious OR anorexia OR anorexic OR apathy OR apathetic OR bipolar OR bulimia PR bulimic OR dementia OR depersonalization OR depersonalize OR depersonalizes OR depersonalizing OR depressive OR depression OR delusion OR delusions OR dissociation OR dissociative OR dysphoria OR dysphoric OR hallucinate OR hallucinates OR hallucinated OR hallucinating OR hallucinations OR hallucination OR hypervigilant OR hypervigilance OR hypochondria OR hypochondriac OR inattention OR inattentive OR inattentiveness OR irritable OR ‘impulse control’ OR impulsive OR impulsivity OR guilt OR grief OR grieving OR mourning OR ‘mental health’ OR mood OR neurotic OR neuroticism OR neurosis OR neuroses OR OCD OR ‘obsessive compulsive’ OR ‘obsessive behavior’ OR ‘obsessive behaviour’ OR paranoid OR paranoia OR PTSD OR CPTSD OR ‘post traumatic stress’ OR ‘posttraumatic stress’ OR ‘post traumatic distress’ OR ‘posttraumatic distress’ OR psychosis OR psychoses OR psychotic OR schizophrenia OR schizophrenic OR ‘self injury’ OR ‘self injurying’ OR ‘self harm’ OR ‘self harming’ OR ‘self mutilate’ OR ‘self mutilation’ OR suicide OR suicidal OR NSSI OR NSSIs OR dyssomnia OR dyssomnias OR hypersomnia OR hypersomnias OR insomnia OR nightmare OR nightmares OR sleeplessness):ti,ab OR (sleep NEAR/2 (deprived OR deprivation OR disorder OR disordered OR disorders OR dysfunction OR dysfunctions OR dysfunctional OR fragmentation OR inadequate OR inadequacy OR insufficient OR insufficiency OR syndrome syndromes)):ti,ab OR (memory NEAR/2 (dysfunction OR dysfunctional OR impaired OR impairment OR loss OR losses)):ti,ab 3875018 #4 Substance abuse terms ‘drug dependence’/de OR ‘alcoholism’/de OR ‘benzodiazepine dependence’/de OR ‘cannabis addiction’/de OR ‘cocaine dependence’/de OR ‘drug abuse pattern’/de OR ‘drug craving’/de OR ‘drug misuse’/exp OR ‘drug seeking behavior’/exp OR ‘methamphetamine dependence’/exp OR ‘multiple drug abuse’/exp OR ‘drug abuse’/exp OR ‘narcotic dependence’/exp OR ((substance OR substances OR drug OR drugs OR alcohol OR cocaine OR heroin OR opioid OR opioids OR opiate OR opiates OR opium OR morphine OR narcotic OR narcotics OR marijuana OR amphetamine OR amphetamines OR methamphetamine OR methamphetamines) NEAR/3 (abuse OR abuses OR abused OR abusing OR misuse OR misuses OR misusing OR misused OR dependence OR dependent OR disorder OR disorders)):ti,ab 474411 #5 Mental health OR substance abuse terms #3 OR #4 3992159 #6 Combining: exposures + mental health + military/vets #1 AND #2 AND #5 2044 #7 Remove animal only research #6 AND [humans]/lim 1818 #8 Remove study designs #7 NOT (‘case report’/exp OR ‘case study’/exp OR ‘editorial’/exp OR [editorial]/lim OR ‘letter’/exp OR [letter]/lim OR ‘note’/exp OR [note]/lim OR [conference abstract]/lim OR ‘conference abstract’/exp OR ‘conference abstract’/it) 1355 Database: APA PsycINFO (via Ovid) Search date: 7/28/2023 Notes: APA PsycINFO 1806 to July Week 3 2023 View in own window Search Set # + Description Search Strategy Results #1 Military terms exp Military Personnel/ or exp Military Veterans/ or (military or veteran* or air force or army or coast guard or (marine adj3 (personnel or corps or corp)) or marines or navy or armed forces or special forces or armed services or sailor* or soldier* or submariner* or service member* or servicemember* or active duty or national guard or national reserves).ti,ab. 64706 #2 Exposure terms environmental effects/ or exp radiation/ or environmental stress/ or occupational exposure/ or toxins/ or hazardous materials/ or neurotoxins/ or insecticides/ or exp pesticides/ or exp chemical exposure/ or exp pollution or ((environment* or inhalation or inhalant* or occupation* or presumptive or toxic* or neurotox*) adj3 exposure*).ti,ab. or ((airborne or chemical* or environment*) adj3 (hazard* or toxin* or toxic* or poison*)).ti,ab. or (radiation adj3 (exposure* or illness* or sickness* or syndrome* or injur*)).ti,ab. or ((acaricide* or arsenic or asbestos or chemical* or chromium or debris or defoliant* or dust or fire* or fuel* or fume* or fungicide* or hazard* or herbicide* or heavy metal* or incinerator* or (industrial adj2 solvent*) or insecticide* or lead or lewisite or mustard gas or neurotox* or nuclear or organophosphate* or particulate matter or PCBs or polychlorinated biphenyl or PFAs or perfluoroalkyl or polyfluoroalkyl or pesticide* or plant* or plutonium or pollut* or radiation or radioactive or rodenticide* or sand or smoke or sulfur or toxin* or uranium or waste) adj7 (exposed or exposure* or poison*)).ti,ab. or ((air or soil or water or groundwater or radioactive) adj3 (contaminat* or pollut* or toxi* or poison*)).ti,ab. or ((biological or bioterror* or biowarfare or bio-warfare or chemical or infectious or nerve or neurotox* or radioactive or warfare) adj3 agent*).ti,ab. or ((biological or bioterror* or chemical or neurotox* or radioactive or radiation) adj3 weapon*).ti,ab. or ((radioactive or chemical or hazard* or toxic or neurotoxic) adj3 waste).ti,ab. or (toxic adj3 fragment*).ti,ab. or (“agent orange” or burn pit* or “CARC paint” or “Chemical Agent Resistant Coating” or nerve gas* or oil well fire* or “project 112” or “project SHAD” or Astugi or camp lejeune or fort mcclellan).ti,ab. or ((“Edgewood/Aberdeen” or Edgewood or Aberdeen or “Edgewood-Aberdeen”) adj2 experiment*).ti,ab. 38216 #3 Mental health terms exp mental disorders/ or exp affective disorders/ or exp affective psychosis/ or exp anxiety disorders/ or exp bipolar disorder/ or exp borderline states/ or exp chronic mental illness/ or exp dissociative disorders/ or exp eating disorders/ or exp mental disorders due to general medical conditions/ or exp neurocognitive disorders/ or exp neurosis/ or exp obsessive compulsive disorder/ or exp personality disorders/ or exp psychosis/ or exp serious mental illness/ or exp sleep wake disorders/ or exp somatoform disorders/ or exp “stress and trauma related disorders”/ or exp psychiatric symptoms/ or exp disruptive mood dysregulation disorder/ or exp major depression/ or schizoaffective disorder/ or generalized anxiety disorder/ or panic attack/ or panic disorder/ or exp phobias/ or exp anxiety/ or exp guilt/ or exp grief/ or exp posttraumatic stress disorder/ or exp emotional trauma/ or exp paranoid psychosis/ or exp paranoid personality disorder/ or exp paranoid schizophrenia/ or exp cognition/ or exp amnesia/ or exp dissociative amnesia/ or exp dementia/ or exp behavior problems/ or ((behavioral or behavioural or mental or mood or psychological or psychiatric or neurocogn* or neuropsychiatric or neuropsychological) adj3 (disease or diseases or disorder or disorders or illness or ill or symptom or symptoms or syndrome or syndromes)).ti,ab. or ((cognit* or memory or confusion or amnesia) adj3 (disorder or disorders or symptom or symptoms)).ti,ab. or ((mental or mentally) adj3 (disorder or disorders or illness or ill or illnesses)).ti,ab. or ((“gulf war” or “Persian gulf”) adj3 (disorder or disorders or illness or illnesses or symptom or symptoms or syndrome or syndromes)).ti,ab. or ((adjustment or affective or panic or phobic or phobia or psychotic or reactive or somatoform or stress) adj3 (disorder or disorders)).ti,ab. or ((sex or sexual or psychosexual) adj3 (dysfunction* or disorder or disorders)).ti,ab. or (agitat* or agoraphob* or agress* or anger or rage or anhedonia* or anxiety or anxious* or anorexi* or apath* or bipolar or bulimi* or dementia or depersonali* or depressi* or delusion* or dissocia* or dysphoria or dysphoric or hallucinat* or hypervigilan* or hypochondria* or inattention or inattentive* or irritab* or “impulse control” or impulsiv* or guilt or grief or grieving or mourning or “mental health” or mood* or neurotic* or neurosis or neuroses or OCD or “obsessive compulsive” or obsessive-compulsive or “obsessive behavior” or “obsessive behaviour” or paranoi* or PTSD or CPTSD or C-PTSD or “post-traumatic stress” or “posttraumatic stress” or “post-traumatic distress” or “posttraumatic distress” or psychosis or psychoses or psychotic or schizophren* or self-injur* or selfinjur* or self-harm* or selfharm* or self-mutilat* or selfmutilat* or suicide or suicidal or NSSI or NSSIs or dyssomnia* or hypersomn* or insomnia* or nightmare* or sleeplessness).ti,ab. or (sleep adj2 (depriv* or disorder* or dysfunction* or fragmentation* or inadequa* or insufficien* or syndrome*)).ti,ab. or (memory adj2 (dysfunction* or impair* or loss*)).ti,ab. 1689452 #4 Substance abuse terms “substance use disorder”/ or “substance related and addictive disorders”/ or exp “alcohol use disorder”/ or “cannabis use disorder”/ or exp drug abuse/ or drug dependency/ or exp inhalant abuse/ or exp “opioid use disorder”/ or exp drug addiction/ or exp drug seeking/ or ((substance or substances or drug or drugs or alcohol or cocaine or heroin or opioid or opioids or opiate or opiates or opium or morphine or narcotic or narcotics or marijuana or amphetamine or amphetamines or methamphetamine or methamphetamines) adj3 (abuse or abuses OR abused OR abusing OR misuse OR misuses OR misusing OR misused or dependence or dependent or disorder or disorders)).ti,ab. 186675 #5 Mental health OR substance abuse terms 3 or 4 1708698 #6 Combining: exposures + mental health + military/vets 1 and 2 and 5 412 #7 Remove study designs 6 not (exp case report or “case report".ti. or “case reports".ti.) 408 #8 limit 7 to dissertation 46 #9 7 not 8 362 Database: PTSDpubs (via ProQuest) Search date: 7/28/2023 Notes: go to Advanced > Command Line Search View in own window Search Set # + Description Search Strategy Results #1 Military terms (TI,AB(military) OR TI,AB(veteran*) OR TI,AB(“air force”) OR TI,AB(army) OR TI,AB(“coast guard”) OR TI,AB(marines) OR TI,AB(navy) OR TI,AB(“armed forces”) OR TI,AB(“special forces”) OR TI,AB(“armed services”) OR TI,AB(sailor*) OR TI,AB(soldier*) OR TI,AB(submariner*) OR TI,AB(“service member”) OR TI,AB(servicemember) OR TI,AB(“service members”) OR TI,AB(servicemembers) OR TI,AB(“active duty”) OR TI,AB(“national guard”) OR TI,AB(“national reserves”)) 12993 #2 Exposure terms ((TI,AB(environment*) OR TI,AB(inhalation) OR TI,AB(inhalant*) OR TI,AB(occupation*) OR TI,AB(presumptive) OR TI,AB(toxic*) OR TI,AB(neurotox*)) NEAR/3 TI,AB(exposure*)) OR ((TI,AB(airborne) OR TI,AB(chemical*) OR TI,AB(environment*)) NEAR/3 (TI,AB(hazard*) OR TI,AB(toxin*) OR TI,AB(toxic*) OR TI,AB(poison*))) OR ((TI,AB(acaricide*) OR TI,AB(arsenic) OR TI,AB(asbestos) OR TI,AB(chemical*) OR TI,AB(chromium) OR TI,AB(debris) OR TI,AB(defoliant*) OR TI,AB(dust) OR TI,AB(fire*) OR TI,AB(fuel*) OR TI,AB(fume*) OR TI,AB(fungicide*) OR TI,AB(hazard*) OR TI,AB(herbicide*) OR TI,AB(“heavy metal*”) OR TI,AB(incinerator*) OR TI,AB(insecticide*) OR TI,AB(lead) OR TI,AB(lewisite) OR TI,AB(“mustard gas”) OR TI,AB(neurotox*) OR TI,AB(nuclear) OR TI,AB(organophosphate*) OR TI,AB(“particulate matter”) OR TI,AB(“polychlorinated biphenyl”) OR TI,AB(perfluoroalkyl) OR TI,AB(polyfluoroalkyl) OR TI,AB(pesticide*) OR TI,AB(plant*) OR TI,AB(plutonium) OR TI,AB(pollut*) OR TI,AB(radiation) OR TI,AB(radioactive) OR TI,AB(rodenticide*) OR TI,AB(sand) OR TI,AB(smoke) OR TI,AB(sulfur) OR TI,AB(toxin*) OR TI,AB(uranium) OR TI,AB(waste)) NEAR/7 (TI,AB(exposed) OR TI,AB(exposure*) OR TI,AB(poison*))) OR ((TI,AB(biological) OR TI,AB(bioterror*) OR TI,AB(biowarfare) OR TI,AB(chemical) OR TI,AB(infectious) OR TI,AB(nerve) OR TI,AB(neurotox*) OR TI,AB(radioactive) OR TI,AB(warfare)) NEAR/3 TI,AB(agent*)) 628 #3 Combining 1 AND 2 179 STUDIES EXCLUDED DURING FULL-TEXT SCREENING View in own window Citation Abdullah, 2023 1 4 Afkar, 2014 2 3 Ahmadi, 2014 3 3 Alishev, 2008 4 8 Allender, 2006 5 9 Alshelh, 2020 6 6 Anger, 1999 7 4 Arnetz, 2009 8 4 Barrett, 2002 9 6 Bell, 2005 10 6 Bell, 1997 11 4 Bierer, 2015 12 4 Bolton, 2006 13 4 Bonde, 2016 14 4 Born, 2019 15 4 Bourdette, 2001 16 4 Boyle, 1989 17 6 Brown Jr, 2007 18 6 Bullman, 1994 19 7 Bullman, 1991 20 4 Burr, 1988 21 8 Carney, 2003 22 3 Chao, 2016 23 4 Chao, 2016 24 6 Christova, 2017 25 1 Clouston, 2016 26 1 Colicino, 2017 27 5 Couzin, 2004 28 7 Daniele, 2015 29 4 David, 2002 30 4 Desai, 2019 31 6 Eum, 2013 32 4 Fiedler, 2000 33 3 Ford, 2004 34 1 Frost, 2000 35 6 Gray, 2002 36 3 Greenberg, 2004 37 6 Haines, 2017 38 6 Haley, 2003 39 6 Haley, 2013 40 6 Heaton, 2017 41 1 Ishøy, 2004 42 4 Ishøy, 2001 43 8 Ismail, 2011 44 3 Jakupcak, 2008 45 7 Janulewicz, 2018 46 6 Jones, 2008 47 1 Joyce, 2020 48 6 Juel, 1994 49 1 Kalinich, 2016 50 7 Kapreenko, 1992 51 8 Kelsall, 2004 52 3 Koenen, 2003 53 4 Korgeski, 1983 54 2 Kurt, 1998 55 6 LaRocca, 2020 56 4 Lee, 2022 57 4 Leiter, 1997 58 4 Levine, 1996 59 7 Levy, 1988 60 1 Lowe, 2007 61 7 Mansour Razavi, 2012 62 6 Martin, 2019 63 4 Maule, 2018 64 4 McAndrew, 2012 65 3 McCauley, 1999 66 4 McCauley, 2001 67 4 McDiarmid, 2006 68 1 Mehta, 2015 69 4 Mehta, 2015 70 4 Milner, 1999 71 8 Modi, 2014 72 6 Mousavi, 2009 73 6 Napryeyenko, 2018 74 4 Netudykhatka, 1999 75 8 Niu, 2004 76 5 Noble, 1994 77 7 Osman, 1997 78 6 Page, 2005 79 3 Parihar, 2013 80 1 Pierce, 1997 81 8 Pinchuk, 2020 82 5 Poisson, 2020 83 3 Powell, 2021 84 3 Proctor, 2003 85 4 Qiu, 2022 86 4 Rajan, 2007 87 4 Razavi, 2014 88 6 Reid, 2001 89 3 Rohrbeck, 2016 90 3 Sartin, 2000 91 7 Satkin, 2017 92 6 Scherrer, 2003 93 4 Schneiderman, 2018 94 4 Schulte, 1996 95 4 Smith, 2011 96 3 Southwick, 2010 97 8 Storzbach, 2000 98 4 Storzbach, 2001 99 4 Stuart, 1998 100 3 Stuart, 2002 101 3 Suadicani, 1999 102 3 Sullivan, 2018 103 4 Sundin, 2014 104 2 Thomas, 1990 105 1 Tu, 2004 106 1 Vasterling, 2003 107 1 Vogt, 2005 108 4 Weuve, 2006 109 4 White, 2016 110 6 Yates, 2022 111 3 Zundel, 2020 112 4 Notes . Exclusion reasons: 1 = Wrong population; 2 = Wrong comparator; 3 = Wrong outcomes; 4 = Wrong exposures; 5 = Wrong setting; 6 = Wrong study design; 7 = Wrong publication type; 8 = Cannot find full text; 9 = Did not evaluate association between exposure and outcome of interest. EXCLUDED STUDIES REFERENCES 1. Abdullah L, Nkiliza A, Niedospial D, et al. Genetic association between the APOE ε4 allele, toxicant exposures and Gulf war illness diagnosis. Environmental Health: A Global Access Science Source . 2023;22(1). [ PMC free article : PMC10324249 ] [ PubMed : 37415220 ] 2. Afkar A, Mahbobubi M, Shahri N, et al. Investigation of the relationship between illogical thoughts and dependence on others and marriage compatibility in the Iranian veterans exposed to chemicals in Iran-Iraq War. Global Journal of Health Science . 2014;6(5):38–45. [ PMC free article : PMC4825379 ] [ PubMed : 25168982 ] 3. Ahmadi K, Ranjebar-Shayan H, Rezazade M, et al. Sexual dysfunction among combat veterans injured by chemical warfare. International Journal of Sexual Health . 2014;26(2):93–99. 4. Alishev NV, Tsygan VN, Drabkin BA, et al. [Psychoemotional stress and somatic diseases in veterans of special risk units]. Adv Gerontol . 2008;21(2):276–85. [ PubMed : 18942374 ] 5. Allender S, Maconochie N, Keegan T, et al. Symptoms, ill-health and quality of life in a support group of Porton Down veterans. Occupational Medicine . 2006;56(5):329–337. [ PubMed : 16847038 ] 6. Alshelh Z, Albrecht DS, Bergan C, et al. In-vivo imaging of neuroinflammation in veterans with Gulf War illness. Brain, Behavior, and Immunity . 2020;87:498–507. [ PMC free article : PMC7864588 ] [ PubMed : 32027960 ] 7. Anger WK, Storzbach D, Binder LM, et al. Neurobehavioral deficits in Persian Gulf veterans: evidence from a population-based study. Portland Environmental Hazards Research Center. J Int Neuropsychol Soc . 1999;5(3):203–12. [ PubMed : 10217920 ] 8. Arnetz BB, Hamdan TA, Grzybowski M, et al. War-related mental health disorders among Iraqis 10 years after the 1991 Gulf War: a comparative study of soldiers and civilians living under sustained socio-environmental stress. New Iraqi Journal of Medicine . 2009;5(1):9–21. 9. Barrett DH, Gray GC, Doebbeling BN, et al. Prevalence of symptoms and symptom-based conditions among Gulf War veterans: Current status of research findings. Epidemiologic Reviews . 2002;24(2):218–227. [ PubMed : 12762094 ] 10. Bell IR, Brooks AJ, Baldwin CM, et al. JP-8 Jet Fuel Exposure and Divided Attention Test Performance in 1991 Gulf War Veterans. Aviation, Space, and Environmental Medicine . 2005;76(12):1136–1144. [ PubMed : 16385767 ] 11. Bell IR, Walsh ME, Goss A, et al. Cognitive dysfunction and disability in geriatric veterans with self-reported intolerance to environmental chemicals. Journal of Chronic Fatigue Syndrome . 1997;3(3):15–42. 12. Bierer LM, Ivanov I, Carpenter DM, et al. White matter abnormalities in Gulf War veterans with posttraumatic stress disorder: A pilot study. Psychoneuroendocrinology . 2015;51:567–576. [ PubMed : 25465169 ] 13. Bolton EE, Gray MJ, Litz BT. A cross-lagged analysis of the relationship between symptoms of PTSD and retrospective reports of exposure. J Anxiety Disord . 2006;20(7):877–95. [ PubMed : 16530379 ] 14. Bonde JP, Utzon-Frank N, Bertelsen M, et al. Risk of depressive disorder following disasters and military deployment: systematic review with meta-analysis. Br J Psychiatry . 2016;208(4):330–6. [ PubMed : 26892850 ] 15. Born JA, Zamorski MA. Contribution of traumatic deployment experiences to the burden of mental health problems in Canadian Armed Forces personnel: exploration of population attributable fractions. Social psychiatry and psychiatric epidemiology . 2019;54(2):145–156. [ PubMed : 30027449 ] 16. Bourdette DN, McCauley LA, Barkhuizen A, et al. Symptom factor analysis, clinical findings, and functional status in a population-based case control study of Gulf War unexplained illness. J Occup Environ Med . 2001;43(12):1026–40. [ PubMed : 11765674 ] 17. Boyle CA, Decoufle P, O’Brien TR. Long-term health consequences of military service in Vietnam. Epidemiologic Reviews . 1989;11:1–27. [ PubMed : 2680551 ] 18. Brown Jr JS. Psychiatric Issues in Toxic Exposures. Psychiatric Clinics of North America . 2007;30(4):837–854. [ PubMed : 17938048 ] 19. Bullman TA, Kang HK. The effects of mustard gas, ionizing radiation, herbicides, trauma, and oil smoke on US military personnel: the results of veteran studies. Annual Review of Public Health . 1994;15:69–90. [ PubMed : 8054100 ] 20. Bullman TA, Kang HK, Thomas TL. Posttraumatic stress disorder among Vietnam veterans on the Agent Orange Registry. A case-control analysis. Ann Epidemiol . 1991;1(6):505–12. [ PubMed : 1669530 ] 21. Burr RG, Hoiberg A. Health profile of U.S. Navy pilots of electronically modified aircraft. Aviat Space Environ Med . 1988;59(2):168–71. [ PubMed : 3345179 ] 22. Carney CP, Sampson TR, Voelker M, et al. Women in the gulf war: Combat experience, exposures, and subsequent health care use. Military Medicine . 2003;168(8):654–661. [ PubMed : 12943043 ] 23. Chao LL. Associations between the self-reported frequency of hearing chemical alarms in theater and visuospatial function in Gulf War veterans. Journal of Occupational and Environmental Medicine . 2016;58(10):1014–1020. [ PubMed : 27513172 ] 24. Chao LL, Reeb R, Esparza IL, et al. Associations between the self-reported frequency of hearing chemical alarms in theater and regional brain volume in Gulf War Veterans. Neurotoxicology . 2016;53:246–256. [ PMC free article : PMC5459360 ] [ PubMed : 26920621 ] 25. Christova P, James LM, Engdahl BE, et al. Subcortical brain atrophy in Gulf War Illness. Experimental Brain Research . 2017;235(9):2777–2786. [ PubMed : 28634886 ] 26. Clouston SA, Kotov R, Pietrzak RH, et al. Cognitive impairment among World Trade Center responders: Long-term implications of re-experiencing the 9/11 terrorist attacks. Alzheimers Dement (Amst) . 2016;4:67–75. [ PMC free article : PMC5011166 ] [ PubMed : 27626057 ] 27. Colicino E, Wilson A, Frisardi MC, et al. Telomere Length, Long-Term Black Carbon Exposure, and Cognitive Function in a Cohort of Older Men: The VA Normative Aging Study. Environ Health Perspect . 2017;125(1):76–81. [ PMC free article : PMC5226701 ] [ PubMed : 27259001 ] 28. Couzin J. Epidemiology. VA advisers link Gulf War illnesses to neurotoxins. Science . 2004;306(5693):26–7. [ PubMed : 15459349 ] 29. Daniele DO, Clark LL. Morbidity burdens attributable to various illnesses and injuries in deployed (per Theater Medical Data Store [TMDS]) active and reserve component service members, U.S. Armed Forces, 2008-2014. MSMR . 2015;22(8):17–22. [ PubMed : 26295977 ] 30. David AS, Farrin L, Hull L, et al. Cognitive functioning and disturbances of mood in UK veterans of the Persian Gulf War: A comparative study. Psychological Medicine . 2002;32(8):1357–1370. [ PubMed : 12455934 ] 31. Desai MU, Pavlo AJ, Davidson L, et al. Context matters: Social, cultural, and political dimensions of PTSD among Vietnam veterans. Ethical Human Psychology and Psychiatry . 2019;20(2):113–119. 32. Eum KD, Wang FT, Schwartz J, et al. Modifying roles of glutathione S-transferase polymorphisms on the association between cumulative lead exposure and cognitive function. Neurotoxicology . 2013;39:65–71. [ PMC free article : PMC3844089 ] [ PubMed : 23958642 ] 33. Fiedler N, Lange G, Tiersky L, et al. Stressors, personality traits, and coping of Gulf War veterans with chronic fatigue. Journal of Psychosomatic Research . 2000;48(6):525–535. [ PubMed : 11033371 ] 34. Ford JD, Schnurr PP, Friedman MJ, et al. Posttraumatic stress disorder symptoms, physical health, and health care utilization 50 years after repeated exposure to a toxic gas. Journal of Traumatic Stress . 2004;17(3):185–194. [ PubMed : 15253090 ] 35. Frost SD. Gulf War syndrome: proposed causes. Cleve Clin J Med . 2000;67(1):17–20. [ PubMed : 10645673 ] 36. Gray GC, Reed RJ, Kaiser KS, et al. Self-reported symptoms and medical conditions among 11,868 Gulf War-era veterans: the Seabee Health Study. Am J Epidemiol . 2002;155(11):1033–44. [ PubMed : 12034582 ] 37. Greenberg N, Iversen AC, Unwin C, et al. Screening for depleted uranium in the United Kingdom armed forces: who wants it and why? J Epidemiol Community Health . 2004;58(7):558–61. [ PMC free article : PMC1732813 ] [ PubMed : 15194715 ] 38. Haines DD, Ottenweller JE, Dickens BF, et al. Activity of paraoxonase/arylesterase and butyrylcholinesterase in peripheral blood of Gulf War era veterans with neurologic symptom complexes or post-traumatic stress disorder. Journal of Occupational and Environmental Medicine . 2017;59(10):1000–1006. [ PMC free article : PMC5679307 ] [ PubMed : 28991135 ] 39. Haley RW. Excess incidence of ALS in young Gulf War veterans. Neurology . 2003;61(6):750–6. [ PubMed : 14504316 ] 40. Haley RW, Tuite JJ. Epidemiologic evidence of health effects from long-distance transit of chemical weapons fallout from bombing early in the 1991 Persian Gulf War. Neuroepidemiology . 2013;40(3):178–189. [ PubMed : 23258108 ] 41. Heaton KJ, Maule AL, Smith KW, et al. JP8 exposure and neurocognitive performance among US Air Force personnel. Neurotoxicology . 2017;62:170–180. [ PubMed : 28687449 ] 42. Ishøy T, Knop J, Suadicani P, et al. Increased psychological distress among Danish gulf war veterans - Without evidence for a neurotoxic background. A Danish Gulf War Study. Danish Medical Bulletin . 2004;51(1):108–113. [ PubMed : 16009075 ] 43. Ishøy T, Suadicani P, Andersson AM, et al. Prevalence of male sexual problems in the Danish Gulf War Study. Scandinavian Journal of Sexology . 2001;4(1):43–55. 44. Ismail K, Fear N, Flanagan M, et al. A US-UK comparison of health in 1990-1991 Gulf War veterans. Occup Med (Oxf) . 2011;61(7):483–9. [ PubMed : 21865220 ] 45. Jakupcak M, Luterek J, Hunt S, et al. Posttraumatic stress and its relationship to physical health functioning in a sample of Iraq and Afghanistan war veterans seeking postdeployment VA health care. Journal of Nervous and Mental Disease . 2008;196(5):425–428. [ PubMed : 18477887 ] 46. Janulewicz P, Krengel M, Quinn E, et al. The Multiple Hit Hypothesis for Gulf War Illness: Self-Reported Chemical/Biological Weapons Exposure and Mild Traumatic Brain Injury. Brain sci . 2018;8(11):13. [ PMC free article : PMC6266762 ] [ PubMed : 30428552 ] 47. Jones E, Everitt B, Ironside S, et al. Psychological effects of chemical weapons: A follow-up study of First World War veterans. Psychological Medicine . 2008;38(10):1419–1426. [ PubMed : 18237455 ] 48. Joyce MR, Holton KF. Neurotoxicity in Gulf War Illness and the potential role of glutamate. Neurotoxicology . 2020;80:60–70. [ PubMed : 32585289 ] 49. Juel K. High mortality in the Thule cohort: An unhealthy worker effect. International Journal of Epidemiology . 1994;23(6):1174–1178. [ PubMed : 7721519 ] 50. Kalinich JF, Kasper CE. Are internalized metals a long-term health hazard for military veterans? Public Health Reports . 2016;131(6):831–833. [ PMC free article : PMC5230833 ] [ PubMed : 28123230 ] 51. Kapreenko AK, Loganovskii KN. [Borderline neuropsychic disorders in persons subjected to ionizing radiation exposure]. Lik Sprava . 1992(6):48–52. [ PubMed : 1455828 ] 52. Kelsall HL, Sim MR, Forbes AB, et al. Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: relation to immunisations and other Gulf War exposures. Occup Environ Med . 2004;61(12):1006–13. [ PMC free article : PMC1740679 ] [ PubMed : 15550607 ] 53. Koenen KC, Stellman JM, Stellman SD, et al. Risk Factors for Course of Posttraumatic Stress Disorder Among Vietnam Veterans: A 14-Year Follow-Up of American Legionnaires. Journal of Consulting and Clinical Psychology . 2003;71(6):980–986. [ PubMed : 14622073 ] 54. Korgeski GP, Leon GR. Correlates of self-reported and objectively determined exposure to Agent Orange. The American Journal of Psychiatry . 1983;140(11):1443–1449. [ PubMed : 6624989 ] 55. Kurt TL. Epidemiological association in US veterans between Gulf War illness and exposures to anticholinesterases. Toxicol Lett . 1998;102–103:523–6. [ PubMed : 10022306 ] 56. LaRocca M, Ashford J, Katz R, et al. Military environmental exposure concerns, posttraumatic stress disorder, and somatic symptoms: their interrelation among treatment-seeking veterans. Journal of Occupational and Environmental Medicine . 2020;62(1):74–79. [ PubMed : 31743303 ] 57. Lee H, Aldwin CM, Kang S. Do different types of war stressors have independent relations with mental health? Findings from the Korean Vietnam Veterans Study. Psychological Trauma: Theory, Research, Practice, and Policy . 2022;14(5):840–848. [ PubMed : 32105130 ] 58. Leiter MP, Robichaud L. Relationships of occupational hazards with burnout: an assessment of measures and models. J Occup Health Psychol . 1997;2(1):35–44. [ PubMed : 9552278 ] 59. Levine PH. The elusive Gulf War syndrome. Journal of Chronic Fatigue Syndrome . 1996;2(2–3):55–63. 60. Levy CJ. Agent Orange exposure and posttraumatic stress disorder. Journal of Nervous and Mental Disease . 1988;176(4):242–245. [ PubMed : 2965215 ] 61. Lowe M, Harris W, Kane RL, et al. Neuropsychological assessment in extreme environments. Archives of Clinical Neuropsychology . 2007;22(SUPPL. 1):89–99. [ PubMed : 17147982 ] 62. Mansour Razavi S, Salamati P, Saghafinia M, et al. A review on delayed toxic effects of sulfur mustard in Iranian veterans. DARU, Journal of Pharmaceutical Sciences . 2012;20(1). [ PMC free article : PMC3555992 ] [ PubMed : 23351810 ] 63. Martin K, McLeod E, Periard J, et al. The impact of environmental stress on cognitive performance: A systematic review. Human Factors . 2019;61(8):1205–1246. [ PubMed : 31002273 ] 64. Maule AL, Janulewicz PA, Sullivan KA, et al. Meta-analysis of self-reported health symptoms in 1990-1991 Gulf War and Gulf War-era veterans. BMJ Open . 2018;8(2). [ PMC free article : PMC5829661 ] [ PubMed : 29440208 ] 65. McAndrew LM, Teichman RF, Osinubi OY, et al. Environmental exposure and health of Operation Enduring Freedom/Operation Iraqi Freedom veterans. J Occup Environ Med . 2012;54(6):665–9. [ PubMed : 22684317 ] 66. McCauley LA, Joos SK, Lasarev MR, et al. Gulf War unexplained illnesses: persistence and unexplained nature of self-reported symptoms. Environ Res . 1999;81(3):215–23. [ PubMed : 10585017 ] 67. McCauley LA, Rischitelli G, Lambert WE, et al. Symptoms of Gulf War veterans possibly exposed to organophosphate chemical warfare agents at Khamisiyah, Iraq. Int J Occup Environ Health . 2001;7(2):79–89. [ PubMed : 11373050 ] 68. McDiarmid MA, Engelhardt SM, Oliver M, et al. Biological monitoring and surveillance results of Gulf War I veterans exposed to depleted uranium. International Archives of Occupational and Environmental Health . 2006;79(1):11–21. [ PubMed : 16075297 ] 69. Mehta AJ, Kubzansky LD, Coull BA, et al. Associations between air pollution and perceived stress: the Veterans Administration Normative Aging Study. Environ Health . 2015;14:10. [ PMC free article : PMC4417295 ] [ PubMed : 25627872 ] 70. Mehta AJ, Kubzansky LD, Coull BA, et al. Associations between air pollution and perceived stress: The Veterans Administration Normative Aging Study -No section. Environmental Health: A Global Access Science Source . 2015;14(1). [ PMC free article : PMC4417295 ] [ PubMed : 25627872 ] 71. Milner IB, Axelrod BN. Illnesses in Gulf War veterans: Review and update. Public Health Reviews . 1999;27(4):263–277. [ PubMed : 11081353 ] 72. Modi YS, Qurban Q, Zlotcavitch L, et al. Ocular surface symptoms in veterans returning from operation Iraqi freedom and operation enduring freedom. Invest Ophthalmol Vis Sci . 2014;55(2):650–3. [ PMC free article : PMC3912909 ] [ PubMed : 24408975 ] 73. Mousavi B, Soroush MR, Montazeri A. Quality of life in chemical warfare survivors with ophthalmologic injuries: the first results form Iran Chemical Warfare Victims Health Assessment Study. Health Qual Life Outcomes . 2009;7:2. [ PMC free article : PMC2647906 ] [ PubMed : 19152700 ] 74. Napryeyenko OK, Loganovsky KM, Napryeyenko NY, et al. Comparative Characteristic of <<Alcohol Depression>> in Persons Who Participated in Combat Operations (Combatans) and Affected by Radiation Catastrop. Probl . 2018;23:423–441. [ PubMed : 30582860 ] 75. Netudykhatka OI. The age-related characteristics of the psychophysiological indices of sailors. Likars’ka sprava / Ministerstvo okhorony zdorov’ia Ukraïny . 1999(1):131–134. [ PubMed : 10424026 ] 76. Niu FS, Xie HG, Wang LN, et al. Relationship between electromagnetic field exposure and dementia: A population-based case-control study. Chinese Journal of Clinical Rehabilitation . 2004;8(10):1806–1807. 77. Noble D. Back into the storm. Reanalyzing health effects of the Gulf War. Anal Chem . 1994;66(15):805A–808A. [ PubMed : 8092489 ] 78. Osman Y. Environmental surveys conducted in the Gulf region following the Gulf War to identify possible neurobehavioral consequences. Environ Res . 1997;73(1–2):207–10. [ PubMed : 9311549 ] 79. Page WF, Mahan CM, Kang HK, et al. Health effects in Army Gulf War veterans possibly exposed to chemical munitions destruction at Khamisiyah, Iraq: Part II, morbidity associated with notification of potential exposure. Military Medicine . 2005;170(11):945–951. [ PubMed : 16450822 ] 80. Parihar VK, Hattiangady B, Shuai B, et al. Mood and memory deficits in a model of Gulf War illness are linked with reduced neurogenesis, partial neuron loss, and mild inflammation in the hippocampus. Neuropsychopharmacology . 2013;38(12):2348–2362. [ PMC free article : PMC3799073 ] [ PubMed : 23807240 ] 81. Pierce PF. Physical and emotional health of Gulf War veteran women. Aviation Space and Environmental Medicine . 1997;68(4):317–321. [ PubMed : 9096828 ] 82. Pinchuk IY, Boltonosov SV, Atamanchuk NV, et al. Study of Suicide Behavior in Joint Force Operation Veterans in Eastern Ukraine and in Liquidators of the Consequences of the Chornobyl Accident. Probl . 2020;25:230–248. [ PubMed : 33361838 ] 83. Poisson C, Boucher S, Selby D, et al. A Pilot Study of Airborne Hazards and Other Toxic Exposures in Iraq War Veterans. Int J Environ Res Public Health . 2020;17(9):09. [ PMC free article : PMC7246947 ] [ PubMed : 32397395 ] 84. Powell TA, Mysliwiec V, Aden JK, et al. Burn pit exposure in military personnel: is there an effect on sleep-disordered breathing? Sleep Breath . 2021;25(1):479–485. [ PubMed : 32185632 ] 85. Proctor SP, White RF, Heeren T, et al. Neuropsychological functioning in Danish Gulf War veterans. Journal of Psychopathology and Behavioral Assessment . 2003;25(2):85–93. 86. Qiu X, Danesh-Yazdi M, Weisskopf M, et al. Associations between Air Pollution and Psychiatric Symptoms in The Normative Aging Study. Environ Res Lett . 2022;17(3). [ PMC free article : PMC8903151 ] [ PubMed : 35273649 ] 87. Rajan P, Kelsey KT, Schwartz JD, et al. Lead burden and psychiatric symptoms and the modifying influence of the delta-aminolevulinic acid dehydratase (ALAD) polymorphism: the VA Normative Aging Study. Am J Epidemiol . 2007;166(12):1400–8. [ PMC free article : PMC2632805 ] [ PubMed : 17823382 ] 88. Razavi SM, Negahban Z, Pirhosseinloo M, et al. Sulfur Mustard Effects on Mental Health and Quality-of-Life: A Review. Iran . 2014;8(3):11–21. [ PMC free article : PMC4359720 ] [ PubMed : 25780370 ] 89. Reid S, Hotopf M, Hull L, et al. Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans. Am J Epidemiol . 2001;153(6):604–9. [ PubMed : 11257069 ] 90. Rohrbeck P, Hu Z, Mallon TM. Assessing health outcomes after environmental exposures associated with open pit burning in deployed US service members. Journal of Occupational and Environmental Medicine . 2016;58(8):S104S–110. [ PMC free article : PMC5880283 ] [ PubMed : 27501097 ] 91. Sartin JS. Gulf War illnesses: causes and controversies. Mayo Clin Proc . 2000;75(8):811–9. [ PubMed : 10943235 ] 92. Satkin M, Ghanei M, Ebadi A, et al. The Quality of Life of Mustard Gas Victims: A Systematic Review. Tanaffos . 2017;16(2):115–126. [ PMC free article : PMC5749324 ] [ PubMed : 29308076 ] 93. Scherrer JF, Xian H, Bucholz KK, et al. A twin study of depression symptoms, hypertension, and heart disease in middle-aged men. Psychosom Med . 2003;65(4):548–57. [ PubMed : 12883104 ] 94. Schneiderman AI, Cypel YS, Dursa EK, et al. Associations between use of antimalarial medications and health among U.S. Veterans of the wars in Iraq and Afghanistan. American Journal of Tropical Medicine and Hygiene . 2018;99(3):638–648. [ PMC free article : PMC6169191 ] [ PubMed : 29943726 ] 95. Schulte PA, Bumett CA, Boeniger M, et al. Neurodegenerative diseases: Occupational occurrence and potential risk factors, 1982 through 1991. American Journal of Public Health . 1996;86(9):1281–1288. [ PMC free article : PMC1380592 ] [ PubMed : 8806381 ] 96. Smith TC. Linking exposures and health outcomes to a large population-based longitudinal study: the Millennium Cohort Study. Mil Med . 2011;176(7 Suppl):56–63. [ PubMed : 21916332 ] 97. Southwick SM, Vojvoda D, Morgan CA, III, et al. Persian Gulf War, stress effects of. San Diego, CA: Elsevier Academic Press; US; 2010:335–340. 98. Storzbach D, Campbell KA, Binder LM, et al. Psychological differences between veterans with and without Gulf War unexplained symptoms. Portland Environmental Hazards Research Center. Psychosom Med . 2000;62(5):726–35. [ PubMed : 11020103 ] 99. Storzbach D, Rohlman DS, Anger WK, et al. Neurobehavioral deficits in Persian Gulf veterans: additional evidence from a population-based study. Environ Res . 2001;85(1):1–13. [ PubMed : 11161646 ] 100. Stuart JA, Bliese PD. The long-term effects of Operation Desert Storm on the psychological distress of U. S. Army Reserve and National Guard veterans. Journal of Applied Social Psychology . 1998;28(1):1–22. 101. Stuart JA, Murray KM, Ursano RJ, et al. The Department of Defense’s Persian Gulf War registry year 2000: an examination of veterans’ health status. Mil Med . 2002;167(2):121–8. [ PubMed : 11873533 ] 102. Suadicani P, Ishøy T, Guldager B, et al. Determinants of long-term neuropsychological symptoms. Danish Medical Bulletin . 1999;46(5):423–427. [ PubMed : 10605622 ] 103. Sullivan K, Krengel M, Bradford W, et al. Neuropsychological functioning in military pesticide applicators from the Gulf War: Effects on information processing speed, attention and visual memory. Neurotoxicology and Teratology . 2018;65:1–13. [ PubMed : 29126934 ] 104. Sundin J, Herrell RK, Hoge CW, et al. Mental health outcomes in US and UK military personnel returning from Iraq. The British Journal of Psychiatry . 2014;204(3):200–207. [ PubMed : 24434071 ] 105. Thomas TL, Kang HK. Mortality and morbidity among Army Chemical Corps Vietnam veterans: a preliminary report. American Journal of Industrial Medicine . 1990;18(6):665–673. [ PubMed : 2264565 ] 106. Tu RH, Mitchell CS, Kay GG, et al. Human exposure to the jet fuel, JP-8. Aviat Space Environ Med . 2004;75(1):49–59. [ PubMed : 14736133 ] 107. Vasterling JJ, Brailey K, Tomlin H, et al. Olfactory functioning in Gulf War-era veterans: Relationships to war-zone duty, self-reported hazards exposures, and psychological distress. Journal of the International Neuropsychological Society . 2003;9(3):407–418. [ PubMed : 12666765 ] 108. Vogt DS, Pless AP, King LA, et al. Deployment stressors, gender, and mental health outcomes among Gulf War I veterans. J Trauma Stress . 2005;18(3):272–84. [ PubMed : 16281224 ] 109. Weuve J, Kelsey KT, Schwartz J, et al. Delta-aminolevulinic acid dehydratase polymorphism and the relation between low level lead exposure and the Mini-Mental Status Examination in older men: the Normative Aging Study. Occup Environ Med . 2006;63(11):746–53. [ PMC free article : PMC2077996 ] [ PubMed : 16757504 ] 110. White RF, Steele L, O’Callaghan JP, et al. Recent research on Gulf War illness and other health problems in veterans of the 1991 Gulf War: Effects of toxicant exposures during deployment. Cortex: A Journal Devoted to the Study of the Nervous System and Behavior . 2016;74:449–475. [ PMC free article : PMC4724528 ] [ PubMed : 26493934 ] 111. Yates PL, Case K, Sun X, et al. Veteran-derived cerebral organoids display multifaceted pathological defects in studies on Gulf War Illness. Front Cell Neurosci . 2022;16:979652. [ PMC free article : PMC9816432 ] [ PubMed : 36619675 ] 112. Zundel CG, Heeren T, Grasso CM, et al. Changes in Health Status in the Ft. Devens Gulf War Veterans Cohort: 1997-2017. Neurosci . 2020;15:2633105520952675. [ PMC free article : PMC7444112 ] [ PubMed : 32914090 ] STUDY CHARACTERISTICS Download PDF (289K) OUTCOME CATEGORIES View in own window Diagnosis Code Options Depressive Disorders, Major Depressive Disorder (MDD), Anxiety Disorders, GAD, Social Phobia, Major Neurocognitive Disorder (Dementia), Mild Neurocognitive Disorder (Mild Cognitive Impairment), PTSD, Adjustment Disorder, Somatic Symptom Disorders, Hypochondriasis, Schizophrenia and Psychotic Disorders, Obsessive Compulsive Disorder (OCD), Bipolar and related disorders, Sleep-wake Disorders, Substance Related and Addictive Disorders (exclude tobacco), Other_multiple, Other_single Symptom Code Options Paranoia, Self-injury/self-harm, Nightmares, Hypersomnolence/trouble sleeping, Crying easily, Nervous/tense, Depressed mood, Guilt, Grief, Substance Use, Suicide, Anxiety symptoms, PTSD symptoms, Suicidality or Non-Suicidal Self-Injury (NSSI), Psychosis related symptoms, Other_multiple, Other_single Neurocognitive Code Options Memory/Learning ( eg , short and long term recall and recognition), Attention/Concentration (e g , sustained attention, processing speed), Executive functioning (e g , planning, organizing, decision-making, working memory, mental flexibility), Perceptual-motor functioning ( eg , visuospatial, constructional praxis), Language (e g , expressive, receptive), Other_multiple, Other_single PEER REVIEW COMMENTS AND RESPONSES View in own window Comment # Reviewer # Comment Author Response Are the objectives, scope, and methods for this review clearly described? 1 1 Yes Acknowledged 2 2 Yes Acknowledged 3 3 Yes Acknowledged 4 4 Yes Acknowledged 5 5 Yes Acknowledged 6 7 Yes Acknowledged Is there any indication of bias in our synthesis of the evidence? 7 1 No Acknowledged 8 2 No Acknowledged 9 3 No Acknowledged 10 4 No Acknowledged 11 5 No Acknowledged 12 7 No Acknowledged Are there any published or unpublished studies that we may have overlooked? 13 1 No Acknowledged 14 2 No Acknowledged 15 3 No Acknowledged 16 4 No Acknowledged 17 5 No Acknowledged 18 7 No Acknowledged Additional suggestions or comments can be provided below . 19 1 There is a manuscript by Dr. Kyle Bourassa that was recently accepted for publication. As such, it is unclear whether this was included in the review. The current in press version of the article can be found under the title Deployment Related Toxic Exposures are Associated with Worsening Mental and Physical Health After Military Services; Results from a Self-Report Screening of Veterans Deployed After 9/11 (Science Direct). We appreciate Reviewer 1 mentioning this study by Dr. Bourassa. The study search and selection process used articles that were published and included in the MEDLINE, Embase, APA PsycINFO, and PTSDpubs databases through July 27, 2023. As such, the article by Dr. Bourassa was not included in the studies selected for review, since it was published on April 23, 2024. We acknowledge that this article might be relevant to the interpretation of the findings, particularly as they show an increasing interest in the study of toxic exposure and mental health among veterans. We have added text to the “Areas of Future Research” section of the Discussion describing this possibility and citing the recent Bourassa et al., 2024 publication. 20 2 The complex nature of toxic exposure experiences that occur in environments or circumstance involving concurrent threats (psychological trauma, physical injury, TBI/recurrent concussive injury, moral injuries, existential threat, etc) makes it difficult to parse out toxic environmental exposures from other relevant variables. It is not clear that this is taken fully into account in this examination of potential relationships between “toxic exposure during military service and mental health outcomes.” We agree with Reviewer 2 that there are several concurrent threats and exposures that face military service members beyond toxic exposures. It is possible that these exposures interact with or better explain associations with mental health outcomes, though it is challenging to draw strong conclusions given the limitations of the current literature (as highlighted by our review). As a result, we have emphasized that the results of this review provide initial evidence about the prevalence of psychiatric and neurocognitive outcomes among Veterans reporting military toxic exposure (in contrast to drawing definitive causal conclusions). We have added text to the Discussion to further highlight and clarify the extent to which we can draw conclusions from the existing literature and the limitations of the current literature. We also added text specifically mentioning the alternative exposures highlighted by Reviewer 2. 21 3 1) on the study sample - I would be concerned as a limitation selection bias or convenience sample of observational studies. this limitation beyond “observational” studies being included was not specifically addressed. We included all studies that examined associations between environmental exposures occurring during military service and psychiatric or neurocognitive diagnoses or symptoms, which included cohort, case-control, and cross-sectional studies. Our excluded studies primarily included modeling studies, case reports, case series, qualitative studies, conference abstracts, and studies with small sample sizes (<100). We have clarified this point in the executive summary and Method sections outlining our study selection process. 22 3 2) in future opportunities - studies using GIS analyses combined with modern detailed deployment patterns will be invaluable. We agree with Reviewer 3 and highlight GIS/GPS as opportunities in the “Future Areas for Research.” 23 4 My only suggestion is that I find the categorization of no association, moderate, etc based on the measures a little problemmatic as it’s unclear to me how it incorporates statistical significance. For example a RR of 1.2 could be a statistically significant association and would be in fact a 20% increase in risk of an event however this would fall into the no association category. On the other hand a larger association like 2 could not be statistically significant and fall into the large association category. The naming of the categories seems to indicate importance of the results but I’m unsure if it’s really accurate if it’s only based on magnitude and not also on some significance or confidence interval criteria. Reviewer 4 highlights an important point, which is that our review, as an evidence map, does not specifically categorize studies using both effect size and significance ( ie , error terms). We sought to balance the need to effectively summarize the extant literature while also contending with heterogeneity in the measurement of exposures and outcomes, as well as variations in how associations were reported ( eg , no comparator group, p values only, etc.). We found approaching the question of counting effect size estimates to best balance these goals but acknowledge that it leaves questions of significance less well characterized. We do note, however, that counting instances of effect size is suggested as preferable to other synthesis methods ( eg , vote counting based on statistical significance) in the Cochrane methods for data synthesis when presenting systematic review results without meta-analysis (see Chapter 12, https://training ​.cochrane ​.org/handbook/current ​/chapter-12#section-12-2 ). We have added text to help emphasize our approach balancing these two goals and clarify the focus of the current manuscript on broad patterns within the current literature. 24 5 This manuscript describes the work that went into establishing a systematic evidence map of the human literature that addresses the association between toxic exposures during military service and mental health outcomes. It was an ambitious undertaking to synthesize and summarize this important literature. The authors identify the notable patterns and important gaps in the evidence that will hopefully serve as the impetus to more focused research and funding for research in this area. However, some of the methods and results could be presented more clearly and transparently. Comments are below. Acknowledged 25 5 Major comments Page 6, Lines 36-42: “When a single study reported more than 1 measured association between the same exposure and outcome, we prioritized 1 effect size using the following process. We counted the effect sizes within exposure categories and prioritized the most common effect size. If there was more than one exposure level (eg, highest days or dose of exposure), we vote-counted effect sizes within the most extreme exposure level and used the most common association as the strength of the effect estimate. Each route of toxic exposure was considered a unique toxic exposure.” Comment: I have having trouble following what was done in this description. It is unclear what the authors mean when they describe “counting effect sizes”, the “most common effect size”, and “vote-counting effect sizes”. More detail on these methods and what they mean is needed. In addition, the actual data (i.e., the values of the effect sizes and measure of variance, such as a confidence intervals) are not provided in this document. It is unclear if the authors extracted the actual values during data extraction before categorizing them into “no association, small, moderate, or large”?. If so, are these values available to the reader? This should be clarified in the methods describing the data extraction. We appreciate this comment from Reviewer 5, and we have taken multiple steps to clarify our approach to categorizing effects in the report. First, we edited the “Synthesis” section to make it clearer how we were selecting and counting the various effect sizes. Second, we have added a citation to the “Cochrane Handbook for Systematic Reviews of Interventions” that guided our decisions as to which methods for synthesizing evidence from the selected studies might best balance the goals of our final report. Third, we have added a citation to the report that we used to determine our effect size coding schema (see Table 1; Sullivan et al., 2012). We categorized the effect sizes during data extraction; these categories (and not point estimates) were used to generate the resulting counting values presented in the various figures in the report. We did not extract and clean actual effect size values during this process; thus, we are not able to make these values available to readers. We agree that such methods would be valuable in the future, however, as we describe in the Discussion and Future Directions. 26 5 Page 6, Table 1: What was the basis for assigning the effect size names (small, moderate, large) to the different effect estimate values? Was this expert consensus? Based on the literature? The rationale here needs to be clarified, especially the decision to label any OR <1.2 as “no association”. Why was this cut off chosen as opposed to categorizing ORs>1.0 to 1.5 as “small” (same comment for the other types of effect estimates)? We determined the categories for effects sizes in Table 1. We have added a citation to the report that we used to determine our effect size coding schema (see Table 1; Sullivan et al., 2012). 27 5 Page x, Figure. This figure is almost impossible to interpret as it does not have a key or a description of how to read what it displays. It is also difficult to understand or discern what patterns the reader should notice. More context is needed. Also, the font is very small on the x-axis. We have added more detail to help readers interpret Figure 4. This includes placing the figure in a landscape page to increase the size of the font of the x-axis, adding bubble sizes examples to clarify the number of studies, and adding more detail to the note for the figure. 28 5 Page 22, Figure 4. As noted in the comment above, this figure is not easy to interpret. However, the footnote at the bottom does clarify what the size of the circles means (which is missing when the figure is shown the first time in the executive summary). The figure indicates to the reader that Depressed symptoms or diagnoses, and Anxiety symptoms or diagnoses have patterns similar to PTSD. It would be helpful to the reader for more information to be included in the note about the Depressed symptoms or diagnoses having heterogeneous measures of depression that cannot be grouped together for the purposes of identifying a pattern. It is unclear to me why Anxiety was not identified as having a notable pattern with herbicides and pesticides. We have added the footnote for Figure 4 to the figure in the Executive Summary and appreciate the reviewer bringing this oversight to our attention. We have also added that there is a pattern, albeit slightly less strong than PTSD, between the broad chemical category with Depressive Symptoms and Diagnoses as well as Anxiety Symptoms and Diagnoses. 29 5 Page 26, Figure 6 appears to show that there is a pattern of large associations between herbicides, pesticides and anxiety and anxiety symptoms. The text on page 25 does not make a convincing case for why herbicides/pesticides and anxiety did not have sufficient information to establish this as a notable pattern. How is this different from Agent Orange exposure and psychotic disorders/psychosis symptoms which were identified as a notable pattern Thank you for bringing this to our attention, we have now acknowledged the pattern between herbicides/pesticides and anxiety. 30 5 Page 35, line 44: “Nearly half the studies were cross-sectional designs (n = 23); as such, causality of these associations cannot be inferred.” Comment: Although I agree that causality of these associations cannot be inferred, this sentence is an oversimplification of cross-sectional study design and does not seem to fit with the rest of the paragraph. Although cross-sectional studies are less likely than prospective cohorts to establish temporality of exposure, some can provide information or context that establishes that exposure occurred before the outcome. In the same vein, there are badly designed cohort studies. This is all to say that the presence of factors that serve to infer causality should not be assumed based on study design name but should be evaluated based on the methods that are reported in the individual study. In addition to evidence of temporality, confidence in the association can be strengthened if other various factors that describe causal inference are established (e.g., large effect sizes, consistency in the direction of the association across study designs/populations, dose-response relationships, etc.) We agree with Reviewer 5 that this statement might have been too strongly worded. We have revised this line to more accurately describe the limitations of the cross-sectional designs, largely focused on an inability to establish temporal precedence. 31 5 Minor comments Please run spell check throughout this document. There are several spelling errors. We have worked to edit the new version of the report to address spelling and grammatical errors in the text. 32 5 Page vi, Line 34: “While there were few patterns in the strength of associations between military toxic exposures and psychological diagnoses, we observed a few notable findings.” This may be more effectively framed as “There were a few notable patterns in the strength of associations between military toxic exposures and psychological diagnoses.” We appreciate this helpful suggestion from Reviewer 5 and have made the requested change to the text in the Executive Summary. 33 5 Page viii, line 32: Add subheading for KQ1 results (similar to page viv line 27 “KQ2: Evidence Mapping of Prevalence, Incidence, and Association”. We have made this change suggested by Reviewer 5. 34 5 Page ix, line 38: There is a disconnect for the reader when this bullet, that is meant to describe the patterns that were identified, starts with “There were few patterns…”. It would make more sense if it started with “There were a few patterns…”. We have made this change suggested by Reviewer 5. 35 5 Page x, line 48: Should be spelled “unknown” This line has been changed and is no longer present in the current draft. 36 5 Page 5, line 53: The heading includes “Risk of Bias Assessment”; however, this is not mentioned anywhere in the following text. Authors should either add a sentence to this paragraph saying that RoB was not assessed in this systematic evidence map or remove mention of RoB from the heading. We added “Risk of Bias” text to the section heading of the Method that describes that we did not conduct a risk of bias assessment, due to the current report being an evidence map. 37 5 Page 9, Literature flow diagram. This is a nice diagram We appreciate the positive feedback from Reviewer 5 38 5 Page 9, line 40: The “cohort with control group” and “cohort without control group” designations are an unusual way present cohort study design. What is a cohort with a control group? Is it the same as a nested case-control study? The authors should identify how many cohort studies were prospective or retrospective in design. We now clarify that the cohorts with and without controls refers to whether there was a non-toxic exposure comparison group assessed in the study. We have added this text to the Table 4 notes. 39 5 Page 10, Table 4 says the mean sample size was 69,627. But line 39 says this is the median sample size. One of these should be corrected. We have made this change suggested by Reviewer 5. 40 5 Page 11, line 4 (Table 4) Country of origin: Clarify if this is where the exposure occurred or something else. We have made this change suggested by Reviewer 5 and specified that this referred to the country of origin for the participants in the study. 41 5 Page 25, line 38-42 “Most of the studies that assessed global anxiety symptoms investigated exposure to various chemicals. Within the subcategories of chemicals, 3 analyses across 2 studies examined exposure to the herbicide Agent Orange.28 Two reported a large effect size and 1 reported a small effect of the associations between Agent Orange and anxiety symptoms.19” Comment: The citations here are confusing. There should be two citations after “the herbicide Agent Orange.” We have made this change suggested by Reviewer 5. 42 5 Page 35, line 14: misspelling of “unknown” We have made this change suggested by Reviewer 5. 43 5 Page 35, line 20: misspelling of “synthesize” We have made this change suggested by Reviewer 5. 44 5 Page 35, line 23: “As such, we conducted an evidence mapping to describe and characterize (1) where these associations have been explored and (2) where there are gaps in the literature on these associations.” Comment: Why don’t these goals include KQ2 which was “the range of prevalence, incidence or association of co-occurring psychiatric conditions or symptoms among individuals with a history of military service-related environmental and/or chemical toxic exposures”? We have made this change suggested by Reviewer 5 and added a reference to KQ2 as an item in this sentence. 45 5 Page 35, line 27: should be a space after “41” We have made this change suggested by Reviewer 5. 46 5 Page 35, lines 34-35 “which is surprising as this is a major health concern among Veterans cared for though the VHA.” Comments: Add citation for this. We have made this change suggested by Reviewer 5. 47 7 Other “gaps in literature” and/or in framework for understanding and for future analysis: 1a) Exposures “Experimental” vaccinations “Unknown” We have added these items as potential areas for future study in the text. 48 7 1b) Related issues to “Mental Health” beyond lumped categories of psychiatric diagnoses, psychiatric symptoms, and neurocognitive functioning: 1bi) Moral Injury, including Betrayal of trust by, and lack of trust in authorities… for allowing and/or “covering up” exposures to military members; could recommend using this or shorter form of Moral Injury Outcomes Scale file:///C:/Users/VHAATGSaengM/OneDrive%20-%20Department%20of%20Veterans%20Affairs/3.1%20Outcome%20Domains%20of%20QI%20Clinical%20Measurement%20of%20TelePain-EVP/Moral%20Injury/Moral%20Injury%20Outcome%20Scale%20MIOS%20Litz.pdf Issue of distinguishing PSTD from Moral Injury is important for several reasons including Is “large association” with PTSD and Chemical Weapons exposure, actually Moral Injury Moral Injury interventions are often quite different from PTSD interventions based on theory… We have added these items as potential areas for future study in the text. 49 7 1bii) Well-being (in contrast to bio-medical, disease focused categorization and analysis); note could recommend use in future studies the Well-Being Signs https://dvagov ​.sharepoint ​.com/sites/VHAOPCC ​/WH-Implementation ​/SitePages/Well-Being-Signs ​.aspx?xsdata ​=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 ​%3D&sdata ​=TkkwSWszSEdvS0hKTTVTVHhuN0k4ZmR3QWVXTllEeGNkYTk0NmMrNlJ0dz0 ​%3D&ovuser ​=e95f1b23-abaf-45ee-821d-b7ab251ab3bf%2CEdward ​.Lee6%40va ​.gov&OR ​=Teams-HL&CT ​=1708548300069&clickparams ​=eyJBcHBOYW1lIjoiVGVhbXMtRGVza3RvcCIsIkFwcFZlcnNpb24iOiIyNy8yNDAxMDQxNzUwMyIsIkhhc0ZlZGVyYXRlZFVzZXIiOmZhbHNlfQ%3D%3D We have added wellbeing as potential areas for future study in the text. 50 7 - On related note, can you list in appendices the exposures noted of those 38 studies excluded on basis of “ineligible exposure”? The full list of ineligible exposures can be found in the Eligibility Criteria table. Specific examples including Pyridostigmine bromide pills and vaccines have been added to the executive summary. 51 7 Consider labeling “Sleep Disorders” as such rather than “Hypersomnia…” as many Veterans complain on difficulty with sleep more than daytime drowsiness/hypersomnia… We appreciate this comment from Reviewer 7 and acknowledge that “sleep disorders” would be the more current term for the sleep/wake disorders from the DSM-5. We note that we did have sections on “Sleep Disorders,” but included a specific “hypersomnia” section due to the prevalence of this term in the literature we reviewed. We have clarified in the text when we are discussing hypersomnia specifically, as compared to sleep disorders more generally. Copyright Notice This publication is in the public domain and is therefore without copyright. All text from this work may be reprinted freely. Use of these materials should be acknowledged. Bookshelf ID: NBK619876 Contents < Prev Next > Share Views PubReader Print View Cite this Page Nugent SM, Magnante AT, Leflore-Lloyd N, et al. Occurrence of Psychiatric Conditions or Symptoms After Military Service-Related Environmental and Chemical Toxic Exposures. Washington (DC): Department of Veterans Affairs (US); 2024 Jun. Appendix. PDF version of this title (1.4M) In this Page SEARCH STRATEGIES STUDIES EXCLUDED DURING FULL-TEXT SCREENING STUDY CHARACTERISTICS OUTCOME CATEGORIES PEER REVIEW COMMENTS AND RESPONSES Other titles in this collection VA Evidence Synthesis Program Reports Related information PMC PubMed Central citations PubMed Links to PubMed Recent Activity Clear Turn Off Turn On Appendix - Occurrence of Psychiatric Conditions or Symptoms After Military Servi... 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