Author Interviews, Heart Disease, Psychological Science / 28.10.2016 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.