Academic journal article East Asian Archives of Psychiatry

Psychiatric Morbidity in Chinese Patients with Chronic Hepatitis B Infection in a Local Infectious Disease Clinic

Academic journal article East Asian Archives of Psychiatry

Psychiatric Morbidity in Chinese Patients with Chronic Hepatitis B Infection in a Local Infectious Disease Clinic

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Introduction

Hepatitis B virus (HBV) infection is a major global health problem, and is one of the commonest infections in the world. The virus can cause both acute and chronic infections in humans. Chronic hepatitis B (CHB) infection is defined as chronic necroinflammatory disease of the liver caused by persistent HBV infection for more than 6 months. Approximately 120 million people living in China have CHB. (1) The prevalence of CHB is more than 10% in South China, including Hong Kong. (2) Most patients with CHB in this region acquired the infection in the perinatal period or during childhood. (3) As newborns are considered to be 'immune tolerant', 90% of infected newborns will develop CHB, whereas less than 5% of infected adults will develop CHB. (4-7)

Patients with CHB have been found to have significant reductions in both physical and mental health-related functioning. (8) If CHB is not well treated, 15 to 40% of patients will develop serious sequelae. (9) Antiviral drugs are prescribed for suppression of HBV replication and remission of liver disease, with the ultimate goal of prevention of cirrhosis, liver failure, and hepatocellular carcinoma (HCC). (10)

There have been many studies of psychiatric morbidity in patients with hepatitis C infection in western countries, where it is far more prevalent than hepatitis B infection, while studies for CHB are relatively few. The prevalence rate for psychiatric morbidity is as high as 44.7% for patients with CHB. (8) Major depressive disorder is the commonest diagnosis among CHB patients, of which the point prevalence is up to 14%. (11) Psychiatric morbidity in CHB patients might encourage other behaviours hazardous to health such as smoking, which may further affect health functioning for these patients. (12) Moreover, it has been found that the anxiety state of patients with CHB is negatively correlated with CD4+ and CD4+/CD8+, which would affect the immune function of patients. (13)

Chronic hepatitis B is prevalent in Chinese societies, but the prevalence of associated psychiatric morbidity has not been adequately investigated. The study aimed to explore the prevalence of psychiatric morbidity in Chinese HBV-infected patients attending a local specialist infectious disease (ID) clinic. The correlates of current psychiatric disorders, current depressive disorders, and current anxiety disorders were also examined. This is also the first local study to examine the psychiatric morbidity of Chinese patients with CHB infection in Hong Kong.

Methods

Study Design

This was a cross-sectional study conducted in a public specialist outpatient ID clinic at the Princess Margaret Hospital (PMH) of the Hospital Authority in Hong Kong from October 2008 to June 2009. The clinic acts as a major local centre for the management and isolation of patients with ID. Providing treatment for patients with viral hepatitis is one of its major roles. Patients with complications of cirrhosis or HCC are referred to other hepatology clinics. Approval for conducting the present study was obtained from the hospital's Clinical Research Ethics Committee.

Patients

Patients who attended the ID clinic from September 2007 to September 2008 with a confirmed diagnosis of HBV infection, and without other viral hepatitis virus or human immunodeficiency virus co-infection were included in the randomised sampling. According to the prevalence rate for major depressive disorders found in a previous study, (11) 160 patients were needed for the study. Each patient was assigned a number, and a computerised random number generator was used to generate 160 samples out of 1144 patients. They were recruited on the day when they attended the ID clinic for routine clinical follow-up. Patients were excluded if they were not Chinese, unable to understand Cantonese, or illiterate. Patients with dementia, mental retardation, or communication difficulties who were unable to give informed consent were also excluded. …

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