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Health-promoting behaviors benefit the mental health of cirrhotic outpatients

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Abstract

Purpose

The objectives of this study were to survey the frequency of engaging in a health-promoting lifestyle in patients with liver cirrhosis, and examine the mediating effects of a health-promoting lifestyle on relationships of symptoms and psychological distress with the quality of life (QOL).

Methods

A cross-sectional study was conducted to recruit 148 cirrhotic outpatients from the gastroenterology outpatient department of one medical university hospital. All study participants completed self-administered questionnaires comprising a multidimensional symptoms scale, Hospital Anxiety and Depression Scale, short-form Chinese health-promoting lifestyle profile, and the Taiwanese version of the Short-Form 36. Hierarchical linear regression and mediation models were used to evaluate the effect of a health-promoting lifestyle on the QOL.

Results

Results showed these cirrhotic outpatients reported low frequencies of health-promoting behaviors in their daily activities and had poor mental health but superior physical health. The hierarchical linear regression model found that depression, anxiety, and a health-promoting lifestyle were significant determinants of mental health. The mediation analysis further identified that a health-promoting lifestyle acted as a significant mediator which ameliorated the effects of depression and anxiety on the mental health aspect of the QOL.

Conclusions

A health-promoting lifestyle can improve the mental health of the QOL. Healthcare professionals can develop effective health-promoting interventions to manage and improve the mental health of cirrhotic patients.

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References

  1. GBD 2013 Mortality and Causes of Death, C. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 385(9963), 117–171.

    Article  Google Scholar 

  2. Pinter, M., Trauner, M., Peck-Radosavljevic, M., & Sieghart, W. (2016). Cancer and liver cirrhosis: Implications on prognosis and management. ESMO Open, 1(2), e000042.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dong, M. H., & Saab, S. (2008). Complications of cirrhosis. Disease Month, 54(7), 445–456.

    Article  Google Scholar 

  4. Fowler, C. (2013). Management of patients with complications of cirrhosis. Nurse Practitioners, 38(4), 14–21. quiz 22 – 13.

    Article  Google Scholar 

  5. Mathews, R. E. Jr., McGuire, B. M., & Estrada, C. A. (2006). Outpatient management of cirrhosis: a narrative review. Southern Medical Journal, 99(6), 600–606.

    Article  PubMed  Google Scholar 

  6. Thiele, M., Askgaard, G., Timm, H. B., Hamberg, O., & Gluud, L. L. (2013). Predictors of health-related quality of life in outpatients with cirrhosis: results from a prospective cohort. Hepatitis Research and Treatment, 2013, 479639.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hauser, W., Holtmann, G., & Grandt, D. (2004). Determinants of health-related quality of life in patients with chronic liver diseases. Clinical Gastroenterology and Hepatology 2(2), 157–163.

    Article  PubMed  Google Scholar 

  8. Shek, D., & Lee, B. M. (2007). A comprehensive review of quality of life (QOL) research in Hong Kong. Scientific World Journal, 7, 1222–1229.

    Article  PubMed  Google Scholar 

  9. Kanwal, F., Gralnek, I. M., Hays, R. D., Zeringue, A., Durazo, F., Han, S. B., Saab, S., Bolus, R., & Spiegel, B. M. (2009). Health-related quality of life predicts mortality in patients with advanced chronic liver disease. Clinical Gastroenterology and Hepatology, 7(7), 793–799.

    Article  PubMed  Google Scholar 

  10. Gao, F., Gao, R., Li, G., Shang, Z. M., & Hao, J. Y. (2013). Health-related quality of life and survival in Chinese patients with chronic liver disease. Health Qual Life Outcomes, 11, 131.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Les, I., Doval, E., Flavia, M., Jacas, C., Cardenas, G., Esteban, R., Guardia, J., & Cordoba, J. (2010). Quality of life in cirrhosis is related to potentially treatable factors. European Journal of Gastroenterology & Hepatology, 22(2), 221–227.

    Article  Google Scholar 

  12. Parkash, O., Iqbal, R., Jafri, F., Azam, I., & Jafri, W. (2012). Frequency of poor quality of life and predictors of health related quality of life in cirrhosis at a tertiary care hospital Pakistan. BMC Research Notes, 5, 446.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kim, S. H., Oh, E. G., & Lee, W. H. (2006). Symptom experience, psychological distress, and quality of life in Korean patients with liver cirrhosis: a cross-sectional survey. International Journal of Nursing Studies, 43(8), 1047–1056.

    Article  PubMed  Google Scholar 

  14. Bianchi, G., Marchesini, G., Nicolino, F., Graziani, R., Sgarbi, D., Loguercio, C., Abbiati, R., & Zoli, M. (2005). Psychological status and depression in patients with liver cirrhosis. Digestive and Liver Disease, 37(8), 593–600.

    Article  PubMed  CAS  Google Scholar 

  15. Shiraki, M., Nishiguchi, S., Saito, M., Fukuzawa, Y., Mizuta, T., Kaibori, M., Hanai, T., Nishimura, K., Shimizu, M., Tsurumi, H., & Moriwaki, H. (2013). Nutritional status and quality of life in current patients with liver cirrhosis as assessed in 2007–2011. Hepatology Research, 43(2), 106–112.

    Article  PubMed  Google Scholar 

  16. Youssef, N. F., Shepherd, A., & Evans, J. M. (2015). Factors associated with health-related quality of life among patients with liver cirrhosis in Egypt. The Journal of the Egyptian Public Health Association, 90(1), 14–19.

    Article  PubMed  Google Scholar 

  17. John, U., & Hanke, M. (2015). Liver cirrhosis mortality, alcohol consumption and tobacco consumption over a 62 year period in a high alcohol consumption country: A trend analysis. BMC Research Notes, 8, 822.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Jones, J. C., Coombes, J. S., & Macdonald, G. A. (2012). Exercise capacity and muscle strength in patients with cirrhosis. Liver Transplantation, 18(2), 146–151.

    Article  PubMed  Google Scholar 

  19. Ney, M., Vandermeer, B., van Zanten, S. J., Ma, M. M., Gramlich, L., & Tandon, P. (2013). Meta-analysis: oral or enteral nutritional supplementation in cirrhosis. Alimentary Pharmacology & Therapeutics, 37(7), 672–679.

    Article  CAS  Google Scholar 

  20. Valery, P. C., Clark, P. J., McPhail, S. M., Rahman, T., Hayward, K., Martin, J., Horsfall, L., Volk, M. L., Skoien, R., & Powell, E. (2017). Exploratory study into the unmet supportive needs of people diagnosed with cirrhosis in Queensland, Australia. Journal of Internal Medicine, 47(4), 429–435.

    Article  Google Scholar 

  21. Hilscher, M. B., Odell, L. J., Myhre, L. J., Prokop, L., & Talwalkar, J. (2016). The pharmacotherapy of cirrhosis: concerns and proposed investigations and solutions. Journal of Clinical Pharmacy and Therapeutics, 41(6), 587–591.

    Article  PubMed  CAS  Google Scholar 

  22. Barr, V. J., Robinson, S., Marin-Link, B., Underhill, L., Dotts, A., Ravensdale, D., & Salivaras, S. (2003). The expanded Chronic Care Model: an integration of concepts and strategies from population health promotion and the Chronic Care Model. Hospital Quarterly, 7(1), 73–82.

    PubMed  Google Scholar 

  23. Pender, N. J. (1984). Health promotion and illness prevention. Annual Review of Nursing Research, 2, 83–105.

    Article  PubMed  CAS  Google Scholar 

  24. Walker, S. N., Sechrist, K. R., & Pender, N. J. (1987). The Health-Promoting Lifestyle Profile: development and psychometric characteristics. Nursing Research, 36(2), 76–81.

    Article  PubMed  CAS  Google Scholar 

  25. Stuifbergen, A. K., Seraphine, A., & Roberts, G. (2000). An explanatory model of health promotion and quality of life in chronic disabling conditions. Nursing Research, 49(3), 122–129.

    Article  PubMed  CAS  Google Scholar 

  26. Kemppainen, J., Bomar, P. J., Kikuchi, K., Kanematsu, Y., Ambo, H., & Noguchi, K. (2011). Health promotion behaviors of residents with hypertension in Iwate, Japan and North Carolina, USA. Japan Journal of Nursing Science, 8(1), 20–32.

    Article  PubMed  Google Scholar 

  27. Smith-Miller, C. A., Berry, D. C., DeWalt, D., & Miller, C. T. (2016). Type 2 Diabetes Self-management Among Spanish-Speaking Hispanic Immigrants. Journal of Immigrant and Minority Health, 18(6), 1392–1403.

    Article  PubMed  Google Scholar 

  28. Toshikuni, N., Arisawa, T., & Tsutsumi, M. (2014). Nutrition and exercise in the management of liver cirrhosis. World Journal of Gastroenterology, 20(23), 7286–7297.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Sargent, S. (2006). Management of patients with advanced liver cirrhosis. Nursing Standard, 21(11), 48–56; quiz 58.

    Article  PubMed  Google Scholar 

  30. Orr, J. G., Homer, T., Ternent, L., Newton, J., McNeil, C. J., Hudson, M., & Jones, D. E. (2014). Health related quality of life in people with advanced chronic liver disease. Journal of Hepatology, 61(5), 1158–1165.

    Article  PubMed  Google Scholar 

  31. Lenz, E. R., Pugh, L. C., Milligan, R. A., Gift, A., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: an update. Advances in Nursing Science, 19(3), 14–27.

    Article  PubMed  CAS  Google Scholar 

  32. Snaith, R. P., & Zigmond, A. S. (1986). The hospital anxiety and depression scale. British Medical Journal (Clinical Research Ed.), 292(6516), 344.

    Article  CAS  Google Scholar 

  33. Li, Q., Lin, Y., Hu, C., Xu, Y., Zhou, H., Yang, L., & Xu, Y. (2016). The Chinese version of hospital anxiety and depression scale: Psychometric properties in Chinese cancer patients and their family caregivers. European Journal of Oncology Nursing, 25, 16–23.

    Article  PubMed  Google Scholar 

  34. Wei, M., & Lu, C. (2005). Development of the Short-Form Chinese Health-Promoting Lifestyle Profile. Journal of Health Education,24, 25–45.http://rportal.lib.ntnu.edu.tw/bitstream/77345300/17996/1/ntnulib_ja_A0601_0024_025.pdf.

  35. Tseng, H., Lu, J., & Tsai, Y. (2003). Assessment of health-related quality of life in Taiwan (II): Norming and validation of SF-36 Taiwan Version Taiwan. Journal of Public Health, 22(6), 512–518.

    Google Scholar 

  36. Mickey, R. M., & Greenland, S. (1989). The impact of confounder selection criteria on effect estimation. American Journal of Epidemiology, 129(1), 125–137.

    Article  PubMed  CAS  Google Scholar 

  37. Hayes, A. F., & Rockwood, N. J. (2017). Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. Behaviour Research and Therapy, 98, 39–57.

    Article  PubMed  Google Scholar 

  38. Taylor, G., McNeill, A., Girling, A., Farley, A., Lindson-Hawley, N., & Aveyard, P. (2014). Change in mental health after smoking cessation: systematic review and meta-analysis. British Medical Journal, 348, g1151.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Daulaire, N. (2012). The importance of the global health strategy from the U.S. Department of Health and Human Services. American Journal of Tropical Medicine and Hygiene, 87(3), 382–384.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Services, U. S. D. o. H. a. H. (2000). U.S. Department of Health and human services: Office of disease prevention and health promotion–healthy people 2010. Nasnewsletter, 15(3), 3.

    Google Scholar 

  41. Kreider, R. B., Wilborn, C. D., Taylor, L., Campbell, B., Almada, A. L., Collins, R., Cooke, M., Earnest, C. P., Greenwood, M., Kalman, D. S., Kerksick, C. M., Kleiner, S. M., Leutholtz, B., Lopez, H., Lowery, L. M., Mendel, R., Smith, A., Spano, M., Wildman, R., Willoughby, D. S., Ziegenfuss, T. N., & Antonio, J. (2010). ISSN exercise & sport nutrition review: research & recommendations. Journal of the International Society of Sports Nutrition, 7, 7.

    Article  PubMed Central  CAS  Google Scholar 

  42. Kino, S., Bernabe, E., & Sabbah, W. (2017). Socioeconomic inequality in clusters of health-related behaviours in Europe: latent class analysis of a cross-sectional European survey. BMC Public Health, 17(1), 497.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Park, C. L., & Iacocca, M. O. (2014). A stress and coping perspective on health behaviors: theoretical and methodological considerations. Anxiety Stress and Coping, 27(2), 123–137.

    Article  Google Scholar 

  44. Naslund, G. K. (1997). Relationships between health behavior, knowledge, and beliefs among Swedish blue-collar workers. Scandinavian Journal of Social Medicine, 25(2), 100–110.

    Article  PubMed  CAS  Google Scholar 

  45. Kumar, S., & Preetha, G. (2012). Health promotion: an effective tool for global health. Indian Journal of Community Medicine, 37(1), 5–12.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ko, F. Y., Yang, A. C., Tsai, S. J., Zhou, Y., & Xu, L. M. (2013). Physiologic and laboratory correlates of depression, anxiety, and poor sleep in liver cirrhosis. BMC Gastroenterology, 13, 18.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Baumeister, D., Ciufolini, S., & Mondelli, V. (2016). Effects of psychotropic drugs on inflammation: consequence or mediator of therapeutic effects in psychiatric treatment? Psychopharmacology (Berl), 233(9), 1575–1589.

    Article  CAS  Google Scholar 

  48. Kim, G. A., Han, S., Kim, H. D., An, J., & Lim, Y. S. (2017). Higher risk of hepatocellular carcinoma in chronic hepatitis B vs chronic hepatitis C after achievement of virologic response. Journal of Viral Hepatitis, 24(11), 990–997

    Article  PubMed  CAS  Google Scholar 

  49. Evon, D. M., Wahed, A. S., Johnson, G., Khalili, M., Lisker-Melman, M., Fontana, R. J., Sarkar, S., Reeve, B. B., & Hoofnagle, J. H. (2016). Fatigue in patients with chronic hepatitis B living in North America: results from the hepatitis B research network (HBRN). Digestive Diseases and Sciences, 61(4), 1186–1196.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Guy, J., & Peters, M. G. (2013). Liver disease in women: the influence of gender on epidemiology, natural history, and patient outcomes. Gastroenterology & Hepatology, 9(10), 633–639.

    Google Scholar 

  51. Scaglione, S., Kliethermes, S., Cao, G., Shoham, D., Durazo, R., Luke, A., & Volk, M. L. (2015). The Epidemiology of Cirrhosis in the United States: A Population-based Study. Journal of Clinical Gastroenterology, 49(8), 690–696.

    Article  PubMed  Google Scholar 

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Funding

This study was funded by a grant from the Taipei Medical University (TMU104-AE1-B18).

Author information

Authors and Affiliations

  1. School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China

    Hui-Chuan Huang

  2. Institute of Hospital and Health Care Administration, Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan, Republic of China

    Kuan-Chia Lin

  3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan, Republic of China

    Chia-Shin Wu & Ming-Yao Chen

  4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan, Republic of China

    Chia-Shin Wu & Ming-Yao Chen

  5. Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China

    Nae-Fang Miao

Authors
  1. Hui-Chuan Huang
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  2. Kuan-Chia Lin
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Correspondence to Ming-Yao Chen.

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Conflict of interest

The authors report no conflicts of interest. Ethical approval: The study was approved by the joint institutional review broad of the university medical hospital (TMU-JIRB no.: N201603024).

Ethical approval

The study was approved by the joint institutional review broad of the university medical hospital (TMU-JIRB no.: N201603024).

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Huang, HC., Lin, KC., Wu, CS. et al. Health-promoting behaviors benefit the mental health of cirrhotic outpatients. Qual Life Res 27, 1521–1532 (2018). https://doi.org/10.1007/s11136-018-1818-3

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  • DOI: https://doi.org/10.1007/s11136-018-1818-3

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