Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Thomas T. H. Wan


The goal of this dissertation is to better understand the complex relationship between the stresses encountered by US. service personnel during the Gulf War and eventual physical and psychological health outcomes among its veterans. By developing and validating a stress model using structural equation modeling techniques, it is hoped that knowledge regarding wartime stress and its potential impact on the health of veterans will be gained. This knowledge can be used to guide future policy decisions on how to minimize the deleterious health consequences associated with deployment and combat, as well as furnishing a basis for future studies that examine the link between stress and health outcomes.

A structural equation model is developed to test a number of hypotheses concerning the relationship between stress and eventual psychological health and physical health outcomes among Gulf War veterans. A core model is first created to test whether or not physical health is a function of psychological health without stress in the equation. This model then expands to test whether or not physical health is a function of psychological health in light of differences in stressful exposures/experiences encountered by Gulf War veterans. The model finally further expands to test whether or not physical health is a function of psychological health and stressful wartime experiences/exposures adjusting for differences in veterans’ age, gender, race, and marital status.

The models theoretical foundation centers on the “Stimulus-based Model of Stress,” developed by Drs. Thomas Holmes and Richard Rahe in the late 1960’s. Holmes and Rahe viewed stressful life events as additive in nature and that the more stress an individual experienced in a period of time, the more likely they were to suffer from a variety of physical and psychological illnesses. They developed a stress scale to measure the stressful life experience so as to predict health outcomes. This study likewise quantified stressful wartime exposures/experiences by creating a stress scale that could measure the stress level of individual veterans. This stress scale was then used to create stress scores of veterans based upon their wartime experiences/exposures. These stress scores were then incorporated into the above structural equation model to determine the effect of wartime stress on veterans’ physical and psychological health outcomes.

The dissertation has drawn upon prior research regarding stress and health outcomes in the creation of its stress model. Goodness-of-Fit tests were performed to determine whether the pattern of variances and covariances in the data is consistent with the structural (path) model specified. The model was respecified to obtain a better fit by adding correlated error terms based upon the modification indices and theoretical considerations.


Scanned, with permission from the author, from the original print version, which resides in University Archives.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission