title: The importance of fatigue cognitions in chronic hepatitis C infection.
abstract: Chronic Hepatitis C virus (HCV) infection is a source of significant public health burden worldwide. Fatigue is a cardinal patient reported consequence of the disease. HCV infection associated fatigue leads to significant impairment in the quality of life and day-to-day functioning. Despite its clinical significance, the factors that contribute to adverse impact of fatigue in HCV infection are largely unknown.
  
  
  OBJECTIVE
  This study evaluated the contributions of insomnia, depression symptoms, and fatigue-specific cognitions to fatigue-related functional impairment.
  
  
  METHODS
  Fatigue, insomnia, depression symptoms, as well as fatigue cognitions were assessed in participants (36% females; age>18 years, N=115) with chronic HCV infection at a tertiary hepatitis clinic.
  
  
  RESULTS
  Sixty percent of participants reported clinically significant fatigue (Fatigue Severity Index FSS ≥ 4). Comorbidities and fatigue perceptions accounted for 61% of the variation of fatigue. Fatigue perceptions were the main predictors of adverse fatigue outcomes (B=.114, 95% CI=.054-.154). Patients with clinically significant fatigue were four-times more likely than less fatigued patients to believe that the main cause of their fatigue was the infection.
  
  
  CONCLUSIONS
  Patients' beliefs about their fatigue were the main predictors of adverse fatigue outcomes. These results suggest that fatigue associated with chronic hepatitis C infection can be conceptualized using a cognitive behavioral approach. This was the first study to evaluate the role of both comorbid mood/sleep and cognitive predictors of fatigue in a single model. Integrating the findings into existing treatment strategies could improve patient reported outcomes in chronic hepatitis C infection.
authors.affiliation: Dept. of Psychology, Ryerson University, Toronto, Canada. Electronic address: dora.zalai@psych.ryerson.ca.
authors.forename: Dora
authors.initials: D
authors.lastname: Zalai
authors.affiliation: Dept. of Gastroenterology, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Morris
authors.initials: M
authors.lastname: Sherman
authors.affiliation: Dept. of Psychology, Ryerson University, Toronto, Canada.
authors.forename: Kelly
authors.initials: K
authors.lastname: McShane
authors.affiliation: Dept. of Psychiatry, University Health Network, University of Toronto, Toronto, Canada; Dept. of Ophthalmology, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
authors.affiliation: Dept. of Psychology, Ryerson University, Toronto, Canada.
authors.forename: Colleen E
authors.initials: CE
authors.lastname: Carney
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D003071:Cognition; D003863:Depression; D005221:Fatigue / Q000209:etiology* / Q000523:psychology; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life
keywords: Chronic hepatitis C infection; Cognition; Depression; Fatigue; Illness perception; Insomnia