Introduction and objectives Between 20–40% of patients seen in respiratory clinics with chronic cough have an ‘idiopathic cough’ with persistent symptoms that are refractory to treatment and have no obvious underlying pathology. Adverse consequences of chronic cough are well documented in the literature, but relatively little is known about this patient population. We aimed to investigate the association of psychological factors, identified as important in the medically unexplained, persistent symptom literature, with chronic cough.

Methods Eighty-nine participants (63 female, mean age = 59) took part. Sixty-seven patients attending a specialist cough clinic (idiopathic; n = 25, explained cough; n = 42) and 22 normal controls were asked to complete questionnaires; all participants completed the Hospital Anxiety and Depression Scale, Big Five Inventory (Personality), Chalder Fatigue Scale and Patient Health Questionnaire-15. Cough patients also completed the Illness Perception Questionaire-Revised. Appropriate statistical analyses were conducted comparing the participant groups.

Results Idiopathic coughers displayed significantly higher levels of neuroticism (p < 0.05), anxiety (p < 0.05), depression (p < 0.001), fatigue (p < 0.001) and somatic physical symptoms (p < 0.005) than controls. In comparison to explained coughers, significantly higher depression (p < 0.005) and fatigue (p = 0.01) scores were reported by idiopathic coughers, who also had significantly more negative illness perceptions (p < 0.005). Specifically, they had strong beliefs regarding negative consequences, lower illness coherence and higher emotional representations. Explained coughers only differed significantly to the control group in the increased levels of fatigue reported (p < 0.05).

Conclusions Many psychological factors are associated with chronic cough and seem to differentiate between the two patient groups. The prevalence of neuroticism, negative affect, negative illness beliefs and increased physical symptom reporting suggest a patient profile of idiopathic cough similar to that of other medically unexplained symptoms. This, as well as the novel and significant finding of the prevalence of fatigue, should be considered in consultations and developing novel interventions.