[Denial in coronary heart disease].

OBJECTIVE

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.