Sirois F
Département de Psychiatrie, Hôpital Laval, Sainte-Foy, Qué.
CMAJ. 1992 Aug 1;147(3):315-21.
To examine the extent and the significance of the psychologic mechanism of denial in coronary heart disease. This problem is known to be frequent, but its significance remains controversial. DATA SOURCES: From the bibliographies of recent publications, the author traced 21 empirical studies on denial in coronary heart disease published during the last 25 years. STUDY SELECTION: For a chronologic and historical approach all the studies were retained. The oldest had a qualitative and descriptive approach; the most recent used a scale of measurement. DATA EXTRACTION: This review examines the clinical data found in the publications and does not critically analyse the measurement tools. RESULTS: The results show that the ambiguity of the question arises from three aspects that have to be clarified: (1) there is a difference between the short-term effect and the long-term effect of denial in coronary heart disease; (2) part of the contradictory results could be linked to the scale of measure; and (3) the concept of denial is a notion that is used in an equivocal way that is not clarified even by the precision of the scale of measurement. CONCLUSIONS: Persistence of denial would have negative effects in the long term. The scale of Hackett and Cassem is useful in measuring denial in the acute stage but not in the rehabilitation stage. The very notion of denial is used ambiguously in several of the studies examined.
探讨冠心病中否认心理机制的程度及意义。已知该问题较为常见，但其意义仍存在争议。资料来源：作者通过近期出版物的参考文献，追溯了过去25年发表的21项关于冠心病中否认现象的实证研究。研究选择：为采用编年和历史的方法，所有研究均被保留。最早的研究采用定性和描述性方法；最新的研究使用了测量量表。资料提取：本综述检查了出版物中发现的临床数据，并未对测量工具进行批判性分析。结果：结果表明，问题的模糊性源于三个需要澄清的方面：（1）冠心病中否认的短期效应和长期效应存在差异；（2）部分相互矛盾的结果可能与测量量表有关；（3）否认的概念是一个使用方式模棱两可的概念，即使测量量表很精确也未得到澄清。结论：长期存在否认心理会产生负面影响。哈克特和卡塞姆量表在急性期测量否认有用，但在康复期则不然。在所审查的几项研究中，否认这一概念的使用都很模糊。
