This longitudinal study investigated the relationship between denial of illness and the course of recovery in patients with coronary heart disease. Using a newly developed interview instrument, the Levine Denial of Illness Scale (LDIS), the level and modes of denial were assessed in 45 male patients who were hospitalized for myocardial infarction or for coronary bypass surgery, of whom 30 were followed for 1 year after discharge. The reliability, internal consistency, and validity of the LDIS were found to be satisfactory. Furthermore, the LDIS showed discriminant validity from trait measures of denial. LDIS scores were not associated with severity of illness or risk factors. High deniers spent fewer days in intensive care and had fewer signs of cardiac dysfunction during their hospitalization relative to low deniers. However, in the year following discharge, high deniers adapted more poorly than low deniers: high deniers were more noncompliant with medical recommendations and required more days of rehospitalization. The findings suggest that denial of illness is adaptive during acute hospital recovery, but is maladaptive in the long-run after hospital discharge.

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Two defensive coping styles, denial of illness and repressive coping, were studied in two groups of medical patients whose blood pressure (BP) was measured during a stress interview. Denial of illness was measured using the Levine Denial of Illness Scale (LDIS), and repressive coping was measured using a combination of the Marlowe-Crowne (MC) Social Desirability Scale and the SCL-90R anxiety subscale (ANX). Consistent with our prior research indicating that LDIS was associated with adaptive outcomes in the short run, high deniers manifested reduced systolic BP reactivity compared to low deniers. Although not related to repressive coping, systolic BP reactivity was correlated positively with MC and ANX separately. The results demonstrate that LDIS and MC measure different types of defensive coping. Current theories of the MC scale suggest two possible interpretations of the MC findings, one that focuses on avoidant coping and the second on attentional coping in high MC scorers.

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