Chest
Volume 130, Issue 6, December 2006, Pages 1839-1843
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Original Research: Cough
Prevalence of Depressive Symptoms Among Patients With Chronic Cough

https://doi.org/10.1378/chest.130.6.1839Get rights and content

Study objectives

Cough is the most common complaint for which patients in the United States seek medical attention. Although the significant effect of cough on quality of life has been reported, the association of chronic cough with depressive symptomatology has not previously been investigated.

Design

Prospective, nonrandomized evaluation.

Setting

Outpatient department of academic medical center.

Patients

Representative sample of patients presenting to a specialty center seeking evaluation and treatment of chronic cough.

Interventions

Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D), a 20-item self-report questionnaire designed to measure depressive symptomatology and risk for clinical depression, on initial evaluation and again after 3 months. Patients also provided subjective cough scores reflecting the severity of their cough.

Measurements and results

Of 100 patients undergoing initial evaluation, 53% scored positive (≥ 16) on the CES-D. Mean CES-D score was 18.3 ± 13.2 (± SD). Among 81 subjects followed up at 3 months, mean CES-D score fell to 7.4 ± 10.4, and subjective cough score decreased from 10 to 4.9 ± 3.1. There was a statistically significant improvement in both cough and depression scores after 3 months (p < 0.001). Improvement in cough score correlated significantly with improvement in depression score (p = 0.003; Spearman ρ = 0.323).

Conclusion

Depressive symptomatology is very common in patients with chronic cough. Physicians and other caregivers must be aware of the significant risk of clinical depression in this patient population.

Section snippets

Materials and Methods

Between July 2004 and April 2005, patients with chronic cough presenting for their initial evaluation at the Montefiore Cough Center (Bronx, NY) completed the Center for Epidemiologic Studies Depression Scale (CES-D). The CES-D, a widely used and validated instrument, is a 20-item self-report questionnaire designed to measure depressive symptomatology.5 A score ≥ 16 reflects significant depressive symptomatology and risk for clinical depression.5 The CES-D was administered verbally by one of

Results

One hundred patients (79 women, 21 men) completed the CES-D at their initial visit. Three subjects were not enrolled because of a preexistent diagnosis of depression and/or use of an antidepressant medication. The predominance of women in this study accurately reflects the overall percentage of women seen at the Montefiore Cough Center since its inception, and mirrors the experience at other subspecialty cough centers where women, who have enhanced cough reflex sensitivity compared to men,6, 7

Discussion

Chronic cough can result in significant morbidity and loss of quality of life.3, 4 Patients have a host of physical complaints, including chest and throat discomfort, sleep deprivation, nausea and/or vomiting after paroxysms of cough and, especially in women, urinary incontinence. Furthermore, many patients with chronic cough become socially isolated; fear of severe coughing in public places forces them to abandon activities such as attending movies and concerts, eating in restaurants, and

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    The authors have no conflicts of interest related to this work to disclose.

    Presented in part at the American Thoracic Society International Conference, San Diego, CA, May 23, 2005.

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