title: Is denial a maladaptive coping mechanism which prolongs pre-hospital delay in patients with ST-segment elevation myocardial infarction?
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: X Y
authors.initials: XY
authors.lastname: Fang
authors.affiliation: Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Albarqouni
authors.affiliation: Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: A F
authors.initials: AF
authors.lastname: von Eisenhart Rothe
authors.affiliation: Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Hoschar
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Ronel
authors.affiliation: Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany. Electronic address: ladwig@helmholtz-muenchen.de.
authors.forename: K-H
authors.initials: KH
authors.lastname: Ladwig
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003717:Denial, Psychological; D004562:Electrocardiography; D005260:Female; D005858:Germany; D006761:Hospitals; D006801:Humans; D055809:Illness Behavior; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000523:psychology*; D012737:Sex Factors; D064415:Type D Personality
keywords: Behavior response; Decision time; Denial; Prehospital delay