Increased Incidence of Stress-related Tic Habit Cough in Children During the Recent Greek Financial Crisis

Abstract

Background/Aim: Tic habit cough (THC) is not easily recognized and requires a high index of suspicion. Since there is evidence for stress-related etiology, the study presents our experience during the eight-year period of the recent Greek financial crisis. Patients and Methods: This is a descriptive prospective cross-sectional clinical study using a consistent approach to diagnosis, possible triggers and treatment options. Results: Fifty-one children (26 girls, age 9.5±3.1y) from a total of 3,793 new referrals for chronic cough fulfilled the criteria of THC (1.34%). Incidence rates per 1,000 person-years were 1.34 (95%CI=0.34-5.40), 3.91 (95%CI=1.86-8.19), 4.03 (95%CI=2.01-8.06) and 14.60 (95%CI=10.43-20.44) for every two years. Poisson analysis showed an increased trend during the four time periods with an incidence rate ratio equal to 2.21 (95%CI=1.58-3.09, p<0.001). THC was mainly attributed to learning difficulties, as well as stress-related impact of peer or family bullying, family financial problems and child anxiety disorders. Conclusion: The incidence of THC is associated with the negative aspects of stressors during a period of financial crisis. The potential underlining psycho-physiological mechanisms are discussed as well as the fact that prompt diagnosis may result in successful interventions.