Fang X Y, Albarqouni L, von Eisenhart Rothe A F, Hoschar S, Ronel J, Ladwig K-H
Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
J Psychosom Res. 2016 Dec;91:68-74. doi: 10.1016/j.jpsychores.2016.10.008. Epub 2016 Oct 22.
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.
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.
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).
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.
在急性心肌梗死期间，患者常将否认作为一种应对机制，这可能会产生积极的情绪调节作用，但也可能延长院前延误时间（PHD）。然而，实证证据仍然稀少。
这项横断面研究纳入了来自慕尼黑急性心肌梗死患者延误检查（MEDEA）研究的533例ST段抬高型心肌梗死（STEMI）患者。在床边收集了社会人口统计学、临床和心理行为特征的数据。使用心脏否认影响量表（CDIS）进行评估，以中位数分割作为分界点。共有206例（41.8%）STEMI患者被归类为否认者。
与非否认者相比，在STEMI前的最后六个月中，否认者患重度抑郁症（p=0.04）、焦虑症（p=0.01）和幸福感欠佳（p=0.01）的可能性较小。在STEMI期间，他们感觉到剧烈疼痛强度（p=0.04）和心跳加速（p=0.02）的可能性较小。男性否认者感觉到呼吸急促（p=0.03）和呕吐（p=0.01）的可能性也较小。否认与总体延误时间无关。然而，在3至24小时的时间窗口内，否认导致额外延误约40分钟（356分钟对316.5分钟，p=0.02，n=196）。
否认不仅有助于减轻急性心脏相关症状和负面情感，还会导致该普遍群体出现临床上显著的延误。
