title: Denial in patients with a first-time myocardial infarction: relations to pre-hospital delay and attendance to a cardiac rehabilitation programme.
abstract: BACKGROUND
  Survival of a myocardial infarction and subsequent prognosis are highly dependent on the time between onset of symptoms and medical intervention.
  
  
  METHODS
  This cross-sectional study examines whether patients who used the psychological defence mechanism of denial when faced with symptoms of a first-time myocardial infarction tended to also show a prolonged delay in going to the hospital and to be less willing to participate in a cardiac rehabilitation programme.
  
  
  METHODS
  One hundred and seven patients, 78 men and 29 women, were enrolled in this study. The sample was divided into two groups depending on whether the patients sought medical help within 4 h after they began experiencing myocardial infarction symptoms (non-delayers) or whether they waited longer (delayers). Denial was measured with the Hackett and Cassem semi-structured interview 3-5 days after the patients entered the hospital. Data on participation (attenders) or not (non-attenders) in the rehabilitation programme was also obtained.
  
  
  RESULTS
  Forty-nine patients exhibited a prolonged delay and 76 patients did not attend the rehabilitation programme. Both prolonged delay and a lesser readiness to attend the rehabilitation programme that was offered were related to a greater use of denial. In addition, the great majority of the patients categorized as being high deniers were found to also be both delayers and non-attenders.
  
  
  CONCLUSIONS
  The results suggest denial to increase the health risks of persons potentially prone to myocardial infarction. If our knowledge about this psychological defence mechanism is increased, we might be able to reach more patients in alternative and individually based cardiac rehabilitation programmes.
authors.affiliation: School of Health Sciences, Jönköping University, Jönköping, Sweden. Ulf.Stenstrom@hhj.hj.se
authors.forename: Ulf
authors.initials: U
authors.lastname: Stenström
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Nilsson
authors.forename: Camilla
authors.initials: C
authors.lastname: Stridh
authors.forename: Johnny
authors.initials: J
authors.lastname: Nijm
authors.forename: Ingela
authors.initials: I
authors.lastname: Nyrinder
authors.forename: Asa
authors.initials: A
authors.lastname: Jonsson
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Karlsson
authors.forename: Lena
authors.initials: L
authors.lastname: Jonasson
mesh_terms: D000328:Adult; D000368:Aged; D016507:Cardiology Service, Hospital; D003430:Cross-Sectional Studies; D003717:Denial, Psychological; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology* / Q000534:rehabilitation*; D010349:Patient Compliance; D011379:Prognosis; D013997:Time Factors