Unbalanced Associations between Physical, Psychological, and Social Domains of the Leicester Cough Questionnaire: Network and Mediation Analyses

Abstract

Background: The Leicester Cough Questionnaire (LCQ) is a validated instrument forevaluating cough-related impairments within three domains: physical, psychological,and social. This study investigated how the physical, psychological, and social domainsof chronic cough are interrelated using the LCQ. Methods: Adult patients with chronic cough from 16 respiratory centers who completedthe LCQ and underwent diagnostic workup were retrospectively reviewed. Spearman's rank correlation was used to examine the correlations among LCQ itemsacross the physical, psychological, and social domains. Causal mediation analysis wasperformed to partition the total effect between domains into direct and indirect effectsmediated by the third domain. The mediation analysis findings were subsequently validatedin an independent cohort. Results: Network analysis of LCQ items identified distinct patterns for each domain. Items in the physical domain showed weaker correlations both within and betweendomains compared to the psychological and social domains. In contrast, items in thepsychological and social domains exhibited strong interrelationships. Mediation analysisdemonstrated that direct effects from one domain to another differed among thethree domains. The overall estimated effects of the physical domain on the social andpsychological domains were largely mediated by the psychological (76.1%) and socialdomains (67.1%), respectively. Conversely, the mediating effect of the physical domainon the psychological and social domains was minimal, accounting for only 12.8% and18.0%, respectively. Conclusion: Given the strong correlations and impact of the psychological and social domains, it is recommended that a thorough evaluation including psychosocial factorsbe incorporated into the management of chronic cough.