DECLARATION UNDER SUBSECTION 196B(9)
OF THE VETERANS’ ENTITLEMENTS ACT 1986
The Repatriation Medical Authority (the Authority), under subsection 196B(9) of the Veterans’ Entitlements Act 1986 (the Act), makes the following declaration in respect of the review of the contents of the Statements of Principles in force under the Act concerning bipolar disorder, Instrument Nos. 27 and 28 of 2009.
The investigation related to "a threatening, hostile, hazardous and/or menacing situation and/or environment". The Notice of Investigation was published in the Government Notices Gazette of 26 March 2014.
The Authority declares that it does not propose to amend Statements of Principles, Instrument Nos. 27 and 28 of 2009, concerning bipolar disorder for the reason that the new sound medical-scientific evidence available is not sufficient to justify an amendment to the Statements of Principles already determined in respect of bipolar disorder.
A cross-sectional Vietnam veteran study reported some significant associations between manic episode and malevolent environment and perceived threat. A cross-sectional Australian Gulf War Veterans' Health Study reported on bipolar depressed and bipolar manic diagnoses combined and found that when compared with the control group, Australian Gulf War Veterans were significantly more likely to present with a bipolar disorder diagnosis. However, a non-significant increased risk for bipolar disorder in the previous 12-months was reported. A retrospective database study of veterans of the recent Afghanistan and Iraq conflicts reported that greater perceived threat during deployment was significantly associated with mood disorders, but no findings for bipolar disorder specifically were reported.
Overall, the evidence was limited in quality and quantity and all studies did not report specifically on bipolar disorder as an outcome. An association was demonstrated in some of the studies, but the findings are limited by the cross-sectional design, retrospective data collection, lack of independent validation of some measures and possible confounding by other lifestyle factors and pre-deployment factors. Studies with prospective design and clinical measurement of psychiatric diagnosis are required to confirm these associations are causal.
The Authority concluded that the sound medical-scientific evidence available is inadequate to raise a reasonable hypothesis concerning a causal relationship between exposure to a threatening, hostile, hazardous and/or menacing situation and/or environment and bipolar disorder.
The Common Seal of the )
Repatriation Medical Authority )
was affixed at the direction of: )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON 17 / 10 /2014