A recent study published in the Journal of Psychiatric Research revealed a concerning link between Gulf War Illness (GWI) and suicidal thoughts and behaviors (STBs) among veterans who served in the Persian Gulf War. Researchers found that Gulf War veterans experiencing GWI are significantly more likely to report suicidal ideation and behaviors than those who don’t have GWI.
Of note, deployment to the Persian Gulf alone was not found to be strongly associated with any suicide-related outcome. Rather, the presence of GWI symptoms emerged as the most significant indicator of suicide risk.
Rachele Lipsky, PhD, a postdoctoral fellow at Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center in Houston, led the study; Nathan Kimbrel, PhD, an associate professor of psychiatry and behavioral sciences at Duke University and the Durham Veterans Affairs Health Care System, was the senior author.
Understanding Gulf War Illness
Around 25% of veterans who were deployed to the Persian Gulf between 1990 and 1991 remain affected by GWI. Experts suggest that GWI stems from exposure to neurotoxic chemicals during deployment as well as extreme physical and psychological stress. The condition includes symptoms of fatigue, joint pain, headaches, indigestion, insomnia, dizziness, respiratory issues, and memory problems. Although previous research has found some of these symptoms to be independently associated with increased suicide risk, this study is unique in its comprehensive approach to examining the impact of GWI as a whole on suicidal ideation.
The researchers—including Jean Beckham, PhD, and Patrick Calhoun, PhD, from Duke’s Department of Psychiatry & Behavioral Sciences—surveyed a sample of 1,142 Gulf War veterans who served in active duty between May 1, 1990, and February 28, 1991. The sample was recruited as a part of a larger study, Project Gulf War Research and Individual Testimony (GRIT).
Participants provided information about demographics, deployment history, combat exposure, mental health issues (e.g., depression and alcohol use disorders), and GWI. STBs were identified using a standard suicide risk assessment, Suicidal Behaviors Questionnaire-Revised (SBQ-R).
Effect of Illness Severity on Suicidal Thoughts & Behaviors
Participants were categorized into three groups: no GWI, moderate GWI, and severe GWI. Both moderate and severe GWI were found to be strongly associated with past-year suicidal ideation in Gulf War veterans—almost four times more likely than among veterans without GWI. While Gulf War veterans with more severe symptoms reported higher rates of STBs, simply having GWI itself had a greater influence on suicide risk than differences between symptom severity. This finding suggests that the presence of GWI symptoms, even at a moderate level, substantially elevates suicide risk.
Both moderate and severe Gulf War Illness were found to be strongly associated with past-year suicidal ideation in Gulf War veterans—almost four times more likely than among veterans without Gulf War Illness.
The study also found that certain GWI symptoms were more significantly associated than others with past-year suicidal ideation depending on severity. For instance, “feeling down and depressed” was linked to past-year suicidal ideation in both moderate and severe GWI groups. However, “pain in your joints” was significant only for moderate GWI, whereas “fatigue” emerged as significant only for severe GWI.
These results highlight the complexity of GWI, emphasizing that symptoms manifest differently for every individual. Therefore, future research analyzing specific symptom clusters of GWI in association with STBs may further contribute to our understanding of such complexities.
Study Insights Can Inform Clinical Care
The impact of this study is far-reaching, given that veterans are among the populations who are most vulnerable to death by suicide. Between 2010 and 2021, more than 78,000 U.S. veterans died by suicide—more than the total number of combat deaths suffered by U.S. service members. While many factors contribute to these elevated statistics, this study provides compelling evidence that GWI should be considered a significant factor for suicide risk among Gulf War veterans.
“In my opinion, there has not been enough research on suicidal thoughts and behaviors among Gulf War veterans, so we were grateful for the opportunity to conduct this important study,” said Kimbrel.
Kimbrel noted that nearly 2 out of 5 (39%) of the Gulf War veterans the team assessed endorsed a lifetime history of suicidal thinking, and nearly 1 out of 5 (19.3%) reported experiencing suicidal ideation in the past year.
“These findings suggest to me that suicidal ideation is quite common among this cohort of veterans and that clinicians working with Gulf War veterans—particularly those reporting symptoms of GWI—should routinely screen them for suicidal ideation and provide appropriate treatment and referrals for any veterans who screen positive,” Kimbrel reflected.
“These findings suggest to me that suicidal ideation is quite common among this cohort of veterans and that clinicians working with Gulf War veterans—particularly those reporting symptoms of GWI—should routinely screen them for suicidal ideation and provide appropriate treatment and referrals for any veterans who screen positive.”
— Nathan Kimbrel, PhD
In addition to Lipsky, Kimbrel, Beckham, and Calhoun, study authors include Drew A. Helmer and Mary Jo Pugh. The study was funded by the United States Department of Veterans Affairs.
Citation: Lipsky, R. K., Helmer, D. A., Beckham, J. C., Calhoun, P. S., Pugh, M. J., & Kimbrel, N. A. (2025). Associations between Gulf War Illness and Suicidal Thoughts and Behaviors Among Gulf War Veterans. Journal of Psychiatric Research, 183, 72-78. https://doi.org/10.1016/j.jpsychires.2025.02.039