ORIGINAL RESEARCH article

Front. Public Health

Sec. Public Mental Health

Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1535916

This article is part of the Research TopicMental Health Challenges in Long-term Pharmacotherapy for Patients with Chronic DiseasesView all 6 articles

Beyond the Liver: Well-Being as the Bridge Between Fatigue and Quality of Life in Chronic Hepatitis B Patients

Provisionally accepted
Chunxiu  ZhongChunxiu Zhong1*Qingyun  TangQingyun Tang1Hongyan  XieHongyan Xie1Xinrui  GaoXinrui Gao1Bing  LiBing Li1Junhua  YinJunhua Yin1Wei  LiWei Li2
  • 1Nanfang Hospital, Southern Medical University, Guangzhou, China
  • 2No.2 people hospital of Lanzhou, Lanzhou, China

The final, formatted version of the article will be published soon.

Background: Chronic hepatitis B (CHB) remains a significant public health challenge. Many CHB patients experience fatigue and impaired mental health, affecting their health-related quality of life (HRQoL). This study investigates the relationships between fatigue, well-being, and HRQoL, while identifying risk factors for poor well-being in CHB patients.Methods: A cross-sectional study was conducted with 428 CHB patients. HRQoL, fatigue, and well-being were evaluated using the 36-Item Short Form Health Survey (SF-36), fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), and well-being was evaluated using the WHO-Five Well-Being Index (WHO-5). Logistic regression was conducted to evaluate the independent risk factor, and structural equation modeling was performed to explore the relationship between fatigue, well-being and HRQoL.Results: A total of 315 CHB patients were classified as having high well-being, and 113 as having low well-being, based on WHO-5 scores. Patients in the low well-being group were more likely to be female (26.5% vs. 9.5%, P<0.001), had lower body weight (60.88 ± 9.19 kg vs. 64.47 ± 10.96 kg, P=0.002), and a higher prevalence of cirrhosis (35.4% vs. 21.6%, P=0.004). Well-being scores were positively correlated with all eight HRQoL dimensions, and patients with higher well-being had significantly better HRQoL scores. Conversely, well-being was negatively correlated with fatigue levels, with higher fatigue scores linked to lower well-being. Structural equation modeling showed that fatigue significantly reduced well-being, which in turn decreased HRQoL. Multivariable analysis indicated that independent factors of poor well-being included female gender (OR=2.692, P=0.004), lower weight (OR=0.971, P=0.038), lower education level (OR=0.642, P=0.028), lack of physical exercise (OR=0.541, P<0.001), and cirrhosis (OR=1.944, P=0.017). For patients with cirrhosis, only female gender (OR=5.884, P=0.007) and lack of exercise (OR=0.541, P=0.023) were significant factors.Conclusion: Well-being mediates the relationship between fatigue and HRQoL in CHB patients, underscoring its critical role in improving patient outcomes. Interventions targeting well-being, such as promoting physical activity, may enhance HRQoL and overall mental health in CHB patients.

Keywords: Chronic hepatitis B, Well-being, Fatigue, health-related quality of life, Mental Health

Received: 03 Dec 2024; Accepted: 29 May 2025.

Copyright: © 2025 Zhong, Tang, Xie, Gao, Li, Yin and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Chunxiu Zhong, Nanfang Hospital, Southern Medical University, Guangzhou, China

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