Is Denial Helpful or Harmful in Coping With Heart Attack? Interview with:
Xiaoyan Fang and
Sophia Hoschar

Institute of Epidemiology II
Mental Health Research Unit
Helmholtz Zentrum München
German Research Center for Environmental Health
Neuherberg What is the background for this study? What are the main findings?

Response: Time to treatment is a crucial determinant of survival in patients who have suffered an acute myocardial infarction. 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). Indeed, some small exploratory studies, mainly performed over 10 years ago, provided a preliminary evidence that denial contributes to decreased adherence to effective cardiac treatment by disavowing of the diagnosis and by minimizing the perceived symptom burden and symptom severity. Thus, the object of Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study is to find the effect of denial on patients’ prehospital delay.

Our study contributes important new findings to the role of denial in the face of an AMI in an extended data set of STEMI patients.

  • First, the psychological coping mechanism of denial in the face of an AMI turned out to have more beneficial than adverse effects: denial contributed to less suffering from heart-related symptoms and negative potentially traumatizing affectivity without leading the patients to maladaptive behavior (e.g. waiting for the symptoms to resolve).
  • In addition, from an overall perspective, denial only minimally increased the delay time, whereas in the time window of 3-24hrs, denial led to a clinical significant longer delay. Apparently denial did not function in the most favorable time window presumably because of an extreme painful symptom pattern which overcame the effect of denial on prehospital delay. In this case, denial might be an intervention point for those who are without severe symptoms. What should readers take away from your report?

Response: Generally, denial is more likely to be assumed as a maladaptive coping mechanism in people facing MI onset. However, in our study, it shows more adaptive mood regulating effect and no significant longer delay for the overall population. In addition, denial did lead to longer delay in a certain group of patients. This indicates that the interventions targeting denial needs to be adjusted to different patients. Especially for those who do not experience typical and severe symptoms, efforts must be made to help them recognizing the severity and urgency of the situation enabling them to react appropriately to symptom onset. For the patients with severe symptoms, the medical care personal should be aware of the patients’ denial, but only interfere when it causes maladaptive behavior. What recommendations do you have for future research as a result of this study?

Response: Our study was not designed for evaluating the long term consequences of acute myocardial infarction. Evidence shows that deniers were less likely to participate in post-AMI cardiac rehabilitation programs or avoid cardio-protective health behaviors including treatment adherence. Potential determinants of the relationship between denial and long term prognosis should be explored. Thank you for your contribution to the community.


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Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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