Is denial a maladaptive coping mechanism which prolongs pre-hospital delay in patients with ST-segment elevation myocardial infarction?

J Psychosom Res. 2016 Dec:91:68-74. doi: 10.1016/j.jpsychores.2016.10.008. Epub 2016 Oct 22.

Abstract

Objective: During an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). However, empirical evidences are still sparse.

Methods: This cross-sectional study included 533 ST-elevated myocardial infarction (STEMI) patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed using the Cardiac Denial of Impact Scale (CDIS) with the median split as cutoff point. A total of 206 (41.8%) STEMI patients were thus classified as deniers.

Results: Deniers were less likely to suffer from major depression (p=0.04), anxiety (p=0.01) and suboptimal well-being (p=0.01) compared to non-deniers during the last six months prior to STEMI. During STEMI, they were less likely to perceive severe pain strength (p=0.04) and racing heart (p=0.02). Male deniers were also less likely to perceive shortness of breath (p=0.03) and vomiting (p=0.01). Denial was not associated with overall delay time. However, in the time window of 3 to 24h, denial accounted for roughly 40min extra delay (356 vs. 316.5min p=0.02 n=196).

Conclusions: Denial not only contributes to less suffering from acute heart related symptoms and negative affectivity but also leads to a clinically significant delay in the prevalent group.

Keywords: Behavior response; Decision time; Denial; Prehospital delay.

Publication types

  • Multicenter Study

MeSH terms

  • Adaptation, Psychological*
  • Aged
  • Cross-Sectional Studies
  • Delayed Diagnosis*
  • Denial, Psychological*
  • Electrocardiography
  • Female
  • Germany
  • Hospitals
  • Humans
  • Illness Behavior
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Personality Inventory / statistics & numerical data
  • Psychometrics
  • Retrospective Studies
  • ST Elevation Myocardial Infarction / diagnosis*
  • ST Elevation Myocardial Infarction / psychology*
  • Sex Factors
  • Type D Personality