1. Is denial a maladaptive coping mechanism which prolongs pre-hospital delay in patients with ST-segment elevation myocardial infarction?
- Author
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Fang, XY, Albarqouni, L., von Eisenhart Rothe, A.F., Hoschar, S., Ronel, J., Ladwig, K.-H., and Fang, X Y
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PSYCHOLOGICAL adaptation , *MYOCARDIAL infarction , *MENTAL depression , *VOMITING , *DISEASE prevalence , *PATIENTS , *ADAPTABILITY (Personality) , *BEHAVIOR , *COMPARATIVE studies , *DENIAL (Psychology) , *DIAGNOSIS , *ELECTROCARDIOGRAPHY , *HOSPITALS , *RESEARCH methodology , *MEDICAL cooperation , *MEDICAL errors , *MYERS-Briggs Type Indicator , *HEALTH outcome assessment , *PERSONALITY development , *PSYCHOMETRICS , *RESEARCH , *SEX distribution , *EVALUATION research , *CROSS-sectional method , *RETROSPECTIVE studies , *IMPACT of Event Scale - 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. [ABSTRACT FROM AUTHOR]- Published
- 2016
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