{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:32:36Z","timestamp":1789605156033,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic hepatitis B (CHB) remains a significant public health challenge. Many CHB patients experience fatigue and impaired mental health, affecting their health-related quality of life (HRQoL). This study investigates the relationships between fatigue, well-being, and HRQoL, while identifying risk factors for poor well-being in CHB patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional study was conducted with 428 CHB patients. HRQoL, fatigue, and well-being were evaluated using the 36-Item Short Form Health Survey (SF-36), fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), and well-being was evaluated using the WHO-Five Well-Being Index (WHO-5). Logistic regression was conducted to evaluate the independent risk factor, and structural equation modeling was performed to explore the relationship between fatigue, well-being and HRQoL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 315 CHB patients were classified as having high well-being, and 113 as having low well-being, based on WHO-5 scores. Patients in the low well-being group were more likely to be female (26.5% vs. 9.5%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), had lower body weight (60.88\u202f\u00b1\u202f9.19\u202fkg vs. 64.47\u202f\u00b1\u202f10.96\u202fkg, <jats:italic>p<\/jats:italic>\u202f=\u202f0.002), and a higher prevalence of cirrhosis (35.4% vs. 21.6%, <jats:italic>p<\/jats:italic>\u202f=\u202f0.004). Well-being scores were positively correlated with all eight HRQoL dimensions, and patients with higher well-being had significantly better HRQoL scores. Conversely, well-being was negatively correlated with fatigue levels, with higher fatigue scores linked to lower well-being. Structural equation modeling showed that fatigue significantly reduced well-being, which in turn decreased HRQoL. Multivariable analysis indicated that independent factors of poor well-being included female gender (OR\u202f=\u202f2.692, <jats:italic>p<\/jats:italic>\u202f=\u202f0.004), lower weight (OR\u202f=\u202f0.971, <jats:italic>p<\/jats:italic>\u202f=\u202f0.038), lower education level (OR\u202f=\u202f0.642, <jats:italic>p<\/jats:italic>\u202f=\u202f0.028), lack of physical exercise (OR\u202f=\u202f0.541, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), and cirrhosis (OR\u202f=\u202f1.944, <jats:italic>p<\/jats:italic>\u202f=\u202f0.017). For patients with cirrhosis, only female gender (OR\u202f=\u202f5.884, <jats:italic>p<\/jats:italic>\u202f=\u202f0.007) and lack of exercise (OR\u202f=\u202f0.541, <jats:italic>p<\/jats:italic>\u202f=\u202f0.023) were significant factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Well-being mediates the relationship between fatigue and HRQoL in CHB patients, underscoring its critical role in improving patient outcomes. Interventions targeting well-being, such as promoting physical activity, may enhance HRQoL and overall mental health in CHB patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1535916","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T05:50:14Z","timestamp":1749793814000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Beyond the liver: well-being as the bridge between fatigue and quality of life in chronic hepatitis B patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Caixia","family":"Zheng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunxiu","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingyun","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinrui","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhua","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1016\/S0140-6736(22)01468-4","article-title":"Hepatitis 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