Unbalanced Associations Between Physical, Psychological, and Social Domains of the Leicester Cough Questionnaire: Network and Mediation analyses.

Background: The Leicester Cough Questionnaire (LCQ) is a validated tool for assessing cough-related impairments across three domains: physical, psychological, and social. This study explored the interrelationships among the physical, psychological, and social domains of chronic cough using the LCQ.

Methods: Adult patients with chronic cough from 16 respiratory centers who completed the LCQ and diagnostic workup were retrospectively analyzed. Spearman's rank correlation analysis was conducted to evaluate the correlations among LCQ items across the physical, psychological, and social domains. Causal mediation analysis decomposed the total effect between domains into direct and indirect effects mediated by the third domain. Findings from the mediation analysis were further validated in an independent cohort.

Results: Network analysis of the LCQ items revealed distinct characteristics for each domain. The items in the physical domain demonstrated weaker intra- and inter-domain correlations compared to those in the psychological and social domains. In contrast, strong correlations were observed between the items in the psychological and social domains. Mediation analysis demonstrated that direct effects from one domain to another varied across the three domains. The total estimated effects of the physical domain on the social and psychological domains were predominantly mediated by the psychological (76.1%) and social domains (67.1%), respectively. However, the physical domain had a minimal mediating effect on the psychological and social domains, contributing only 12.8% and 18.0%, respectively.

Conclusions: Given the strong correlations and impacts of the psychological and social domains, a comprehensive assessment including psychosocial influences should be considered for managing chronic cough.