Predictors of mental and physical health in non-cirrhotic patients with viral hepatitis: a case control study.

OBJECTIVE: To identify independent predictors of mental and physical health in patients with viral hepatitis. METHODS: Hepatitis C (HCV) and hepatitis B (HBV) infected patients, and community control subjects with equal age and sex distribution were recruited. All subjects filled in personal characteristics questionnaire, Hospital Anxiety and Depression Scale (HADS), Iowa Fatigue Scale (IFS), and Medical Outcomes Survey Short Form-12 (SF-12). All patients had measurement of routine laboratory values, and some had recent liver biopsy. Regression analyses were used to identify predictors of physical and mental health. RESULTS: One hundred eighty nine subjects (162 males, 27 females, for each group N=63) with mean (±SD) age of 39±11years were included. Anxiety and depression were important predictors of SF-12 (and its subscales MCS and PCS) and IFS scores, whereas IFS scores independently predicted HADS, PCS, MCS, and SF-12 scores. After controlling for confounders, HCV infection was independently associated with impairment of physical health. Moreover, creatinine showed an inverse strong relation with fatigue. Genotype 3a of HCV was independently associated with depressed and anxious states, whereas higher inflammation grade was significantly related to depression. Marital status, non-psychiatric comorbidities, and history of alcohol abuse also predicted health scores in the patients. Adjusted R(2)s for linear models were 0.571 to 0.709, whereas areas under the receiver operating characteristic (ROC) curve for logistic models were 0.90 to 0.93. CONCLUSION: In viral hepatitis patients, besides mental and medical comorbidities, marital status, and alcohol abuse, HCV infection itself is associated with impaired physical and possibly mental health.

Validity, reliability and factor structure of Hepatitis B Quality of Life Questionnaire version 1.0: findings in a large sample of 320 patients.

BACKGROUND: Quality of life is of significant importance in chronic hepatitis B (CHBV). We aimed to assess the psychometric properties of the Hepatitis B Quality of Life Questionnaire v1.0 (HBQOL) in a large sample of 320 Iranian patients with CHBV. METHODS: After adapting the Iranian version through forward-backward translation and expert panel discussion, we administered HBQOL together with Short-Form 36 (SF-36), Medical Outcome Study Social Support Questionnaire (MOS-SS), Hospital Anxiety and Depression Scale (HADS), and the Iowa Fatigue Scale (IFS) to 320 non-cirrhotic Iranian patients. We used principal component analysis with Varimax rotation to determine the factor structure. To evaluate the psychometric properties of HBQOL, test-retest and internal consistency reliabilities, divergent and convergent validity with other instruments, and discriminatory power were calculated. RESULTS: Thirty-one questions loaded on to six factors (Anticipation anxiety, Stigma, Psychological well-being, Vitality, Transmissibility and Vulnerability) which explained 63.6% of total variance. Test-retest reliability was 0.66. Cronbach's α was 0.94 for the overall scale and between 0.7 and 0.9 for subscales, with the exception of the Vulnerability subscale. HBQOL and its subscales showed acceptable convergent and divergent validity with other instruments. Furthermore, Vulnerability subscale of HBQOL discriminated between patients with chronic active and chronic inactive hepatitis. CONCLUSION: The Iranian version of HBQOL is reliable, valid, and sensitive to the clinical conditions of the patients. This instrument has acceptable factor structure to measure several aspects of quality of life in patients with chronic HBV.