Prevalence of suicidal ideation in patients with refractory chronic cough

Introduction Refractory chronic cough (RCC; duration >8 weeks) persists despite treatment and is associated with psychological co-morbidities. Little is known about suicidal ideation prevalence in chronic cough. This observational study aimed to investigate the prevalence and associations of suicidal ideation and psychological distress in patients with RCC. Methods Cough symptoms and impact were assessed in consecutive patients with RCC by cough severity visual analogue scale (VAS), Patient Global Impression of Severity (PGI-S) scale and cough-specific health status Leicester Cough Questionnaire (LCQ) at a specialist cough clinic. Treatable traits were identified by the clinician and recorded. Suicidal ideation was identified through the Patient Health Questionnaire (PHQ-9). Depression and anxiety symptoms were self-reported with PHQ-9 and Generalised Anxiety Disorder Assessment (GAD-7) respectively. Results A total of 339 participants completed assessment; 73% female, median (IQR) age 57 (45–67) years and duration of cough 4 (2–10) years. 36 (11%) participants reported suicidal ideation, and 104 (31%) and 62 (20%) participants reported moderate or more severe depression (PHQ-9>10) and anxiety (GAD-7≥10) symptoms, respectively. Suicidal ideation in RCC was associated with cough severity VAS, cough-specific LCQ health status, and anxiety (GAD-7) and depression (PHQ) symptoms (all p≤0.02). In contrast, suicidal ideation was not associated with age, sex, duration of cough or presence of treatable traits. Conclusion Suicidal ideation, depression and anxiety were common in patients with RCC, and the former was associated with cough severity, health-status and depressive symptoms. Thus, an assessment of suicidal ideation and psychological comorbidities should be integral to RCC management.