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Katcher JG, Klassen AC, Hann HW, Chang M, Juon HS. Racial discrimination, knowledge, and health outcomes: The mediating role of hepatitis B-related stigma among patients with chronic hepatitis B. J Viral Hepat 2024; 31:248-254. [PMID: 38409935 PMCID: PMC11023788 DOI: 10.1111/jvh.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/16/2024] [Indexed: 02/28/2024]
Abstract
It is well described in current literature that Hepatitis B virus (HBV) affects Asian Americans more than any other racial group in the United States and that there is a stigma attached to this condition. The effects of stigma can be lasting, penetrating physiologically and psychologically, yet few studies have focused on the consequences of this phenomenon. The purpose of this study was to examine the mediating role of stigma in the effect of racial discrimination and knowledge (of HBV sequelae) on health status of Korean Americans with chronic hepatitis B (CHB). Three hundred sixty-five CHB patients were recruited and enrolled from two clinics in Philadelphia and Los Angeles. Depressive symptoms were measured using the Patient Health Question-9 (PHQ-9), physical health via self-rated health survey and stigma via hepatitis B quality of life (HBQOL)-stigma survey. Perceived racial discrimination and knowledge of CHB sequelae were independent variables. The cohort had an average age of 60.1 years (range 19-84, SD 10.7), 56% were male and 94% were born in South Korea. Mediational analysis found that stigma was a significant mediator between both racial discrimination (indirect effect = .037, Bootstrap 95% CI = [.010-.064]) and sequelae knowledge (indirect effect = .097, Bootstrap 95% CI = [.018-.176]) and depressive symptoms. Stigma also had a direct effect on depressive symptoms (β = .136, p < .01) and self-rated health (β = .018, p < .05). In addition, age, gender, education and employment were related to health outcomes. The findings of this study indicate that HBV-related stigma is an important mediator of mental health outcomes in this population. Future studies should identify other psychosocial factors to develop effective intervention programs to reduce stigma and improve quality of life among CHB patients.
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Affiliation(s)
- Julia G. Katcher
- Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA 19107
| | - Ann C. Klassen
- Dornsife School of Public Health, Drexel University, Philadelphia,
PA 19104
| | - Hie-Won Hann
- Liver Disease Prevention Center, Thomas Jefferson University
Hospital, Philadelphia, PA 19107
| | - Mimi Chang
- Asian Pacific Liver Center, Coalition of Inclusive Medicine, Los
Angeles, CA 90020
| | - Hee-Soon Juon
- Department of Medical Oncology, Thomas Jefferson University,
Philadelphia, PA 19107
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Wu C, Xie J, Liu F. Incidence and factors influencing sleep disorders in patients with chronic hepatitis B infection: A case-control study. J Viral Hepat 2023; 30:607-614. [PMID: 36922711 DOI: 10.1111/jvh.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/22/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
Chronic hepatitis B (HBV) infection is a disease that imposes a considerable financial burden on patients and can lead to sleep disorders (SDs), resulting in a serious deterioration to patient quality of life. This study aimed to determine the prevalence of SDs in patients with HBV and the correlated sociodemographic and clinical characteristics. A total of 747 patients with chronic HBV infection were recruited. All patients completed the Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 scale, Social Support Rating Scale, Short Form 36 Health Survey (SF-36), and Visual Analogue Scale (VAS). The total PSQI score of patients with each type of chronic HBV infection was significantly higher compared to healthy Chinese adults (p < .05). The incidence of SDs in HBV carriers and patients with mild HBV, moderate HBV, severe HBV, liver failure, compensated cirrhosis, and decompensated liver cirrhosis was 25%, 26%, 32%, 47%, 56%, 31%, and 49%, respectively. The incidence of SDs in all patients with chronic HBV infection was 30%. Binary logistic regression analysis revealed that the course of disease, aspartate aminotransferase levels, PHQ-9 scores, and VAS scores were independent risk factors for SDs, while the total SF-36 score was a protective factor for SDs (all p < .05). In conclusion, the prevalence of SDs was significantly higher in patients with chronic hepatitis B compared to healthy subjects. The independent risk factors for SDs included disease duration, aspartate aminotransferase levels, depression, and fatigue. Clinicians should pay more attention to SDs in patients with chronic HBV infection.
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Affiliation(s)
- Cichun Wu
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Jianping Xie
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Fei Liu
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
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Liu X, Chen C, Jiang D, Yan D, Zhou Y, Ding C, Lan L, Huang C, Zhang X, Li L, Yang S. Psychological stress; knowledge, attitude and practice and acceptance of antiviral therapy in pregnant women with hepatitis B in Zhejiang, China: a case comparison study. BMJ Open 2022; 12:e055642. [PMID: 35264360 PMCID: PMC8915272 DOI: 10.1136/bmjopen-2021-055642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine knowledge, attitude and practice (KAP) and antiviral therapy's acceptance during pregnancy of pregnant women with hepatitis B and influencing factors. DESIGN Case-comparison study. SETTING The study was conducted in Zhejiang province, China, from September 2019 to December 2020. PARTICIPANTS Pregnant and postpartum women with chronic hepatitis B. PRIMARY AND SECONDARY OUTCOME MEASURES The stress scores, self-assessed health score, KAP, antiviral therapy's acceptance rate during pregnancy and influencing factors were analysed. The Perceived Stress Scale-10 was used to assess stress. Logistic regression was used to analyse influencing factors on antiviral therapy. RESULTS The self-assessed health score of pregnant women without liver diseases (82.4±9.3) was significantly higher than that of pregnant women with chronic hepatitis B (75.5±9.5) and postpartum (75.1±14.1). Psychological stress of pregnant women with chronic hepatitis B was significantly high with a 14.9±3.6 score, but there was no significant difference between hepatitis B postpartum and non-liver disease women (12.7±3.5 vs 12.9±3.5, p=0.75). The acceptance rate of pregnant women with hepatitis B for antiviral therapy was 84.2%, while that of postpartum women was even higher. Logistic regression analysis showed that patients with positive hepatitis B e antigen (HBeAg) (OR, 3.35; 95% CI, 1.21 to 9.26) and higher scores on hepatitis B-related knowledge (OR, 3.52, 95% CI, 2.18 to 5.69) were more likely to accept antiviral therapy during pregnancy. CONCLUSIONS Pregnant women with hepatitis B in Zhejiang have heavy psychological stress and a high antiviral therapy acceptance rate during pregnancy. Acceptance is related to HBeAg status and level of understanding of hepatitis B during pregnancy. It is necessary to provide education on hepatitis B to reduce psychological stress and increase acceptance of antiviral therapy during pregnancy.
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Affiliation(s)
- Xiaoxiao Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Can Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Daixi Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Danying Yan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yuqing Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cheng Ding
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lei Lan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chenyang Huang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaobao Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shigui Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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