| ObjectivesTo assess the overall quality of life(QOL)of patients with chronic hepatitis B(CHB)in Zhejiang Province,and to analyze the key influencing factors in order to better understand patients' QOL and provide advice for clinical treatment,nursing and post-intervention of CHB.Methods1.Subjects:This study selected Zhejiang Province as the survey site,using multi-stage stratified sampling method.From June 2017 to February 2018,584 CHB patients from 6 hospitals(Zhejiang First Hospital,Ningbo Second Hospital,Yiwu Central Hospital,Huzhou Central Hospital,Taizhou Hospital and Quzhou People's Hospital)were recruited.2.Contents:(1)The SF-36 instrument was used to evaluate the QOL of patients with CHB in six cities of Zhejiang Province.The QOL scores of patients with CHB was compared with the general population,considering the effect of age and gender.(2)We investigated the relationships between demographics,self-assessment of physiological status,psychological status,social and environmental conditions,disease treatment and cognitive status and QOL,and explore the influencing factors.(3)The relationships between social support,depression and QOL were further explored by constructing a structural equation model for social support,depression and QOL.The path of social support and depression on QOL was analyzed and verify the mediating effects of depression in social support and qol was verified.3.Statistical analysis of data:(1)Using two independent sample t-tests and analysis of variance to compare patients' QOL scores among different demographic characteristics groups;(2)After matching age and gender,a single-sample t-test was used to compare the QOL of patients with those of a large Hangzhou general population;(3)Single factor logistic regression and multivariable logistic regression analysis were used to analyze factors affecting the qol of patients with hepatitis B.The inclusion level and rejection level of variables were a=0.05 and a=0.10,respectively.(4)Structural equation model was used to explore the relationship between social support,depression and QOL of patients with hepatitis B.All statistical analyses were performed using SPSS 21.0 and Amos 21.0 software and a p-value of<0.05 was considered statistically significant.Results1.A total of 584 questionnaires were distributed and collected.After removing those with missing key variables,a total of 571 questionnaires were included in the final analysis.Among them,137 people(24.0%)were recruited from Hangzhou,77(13.5%)were recruited from Ningbo,99(17.3%)were recruited from Yiwu,90(15.8%)were recruited from Huzhou,95(16.6%)were recruited from Taizhou,and 73(12.8%)were recruited from Quzhou.Among the participants,four hundred and twenty-one were males(73.7%),372(65.1%)patients aged<45 years old,159(27.8%)aged 45-59 years old,and 40(7.0%)aged?60 years old.2.The QOL of patients with hepatitis B was low in general.The mean PCS score was 48.58(SD=11.21),and the mean MCS score was 47.18(SD=9.70).Among the eight dimensions,the mean scores varied from 91.36 for the PF dimension to 55.36 points for the GH and VT dimensions.Patients with different genders,ages,education levels,occupations,regions,and per capita annual household income reported different QOL.3.After matching by age and gender,the QOL scores of patients with hepatitis B were compared with those of a large Hangzhou general population.It was found that there were statistical differences in the scores of QOL between patients and age-and gender-matched reference population(p<0.05).4.Multivariable logistic analysis showed that,age,employment,fatigue,irritability,years since diagnosis,number of hospitalizations due to hepatitis B complications in the past year,and illegal hospitals consultation were factors influencing PCS scores(p<0.05).Gender,fatigue,abdominal pain,comorbidity of other chronic diseases,total score of BDI,grief,lacking of hope in life,total score of PSSS,years since diagnosis,and knowledge of hepatitis B through health education lectures were the influencing factors of MCS scores(p<0.05).5.This study showed that according to the criteria for social support,there were 12 patients(2.1%)in low support status,161(28.2%)in intermediate support status,and 398(69.7%)in high support status.According to the classification criteria of the BDI scale,182(31.9%)had depression characteristics,including 99(17.3%)with mild depression,65(11.4%)with moderate depression,and 18(3.2%)with severe depression).Structural equation model was constructed to explore the relationship between social support,depression and QOL in patients with hepatitis B.The social support of hepatitis B patients had a negative predictive effect on depression,and depression had a negative prediction of QOL.However,social support has a positive predictive effect on the QOL of patients.The direct effect of social support on the QOL of hepatitis B patients and the mediating effect of depression on the relationship between social support and QOL are significant.The direct effect of social support on the QOL of patients with hepatitis B is 0.14,while the mediating effect of depression between social support and QOL was 0.28.Conclusions1.The study found that the QOL scores of chronic hepatitis B patients in Zhejiang Province were low,and the scores of each dimension were significantly lower than the general population,especially the scores of dimensions in the psychological domain.2.The QOL was affected by patients' demographic,physiological,psychological,social and environmental conditions,disease treatment and cognitive status.It is necessary to pay attention to clinical treatment and psychological intervention of patients,and to improve the society's awareness of hepatitis B and enhance the social support of patients.3.Social support had direct and indirect effects on QOL.Depression worked as a mediator to regulate the relationship between social support and QOL.Therefore,we need to pay attention to the construction of social support system for hepatitis B patients,for providing robust social support and mediating the effect of depression. |
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