Denial: Predictor of Outcome following Coronary Bypass Surgery

Abstract

Using a modified version of the Hackett-Cassem denial scale we measured preoperative denial in 121 patients scheduled for CABG surgery. A significant inverse relationship was found between the denial scale and Hamilton Anxiety measures four days postoperatively (p less than .02). Longitudinal assessments were carried out using the Spielberger State Anxiety Inventory (SSAI), the Zung Self-Rating Depression Scale (Zung SDS) and the Psychosocial Adjustment to Illness Scale (PAIS). Six months following the surgery, significant negative relationships between denial and these self-report outcome measures were observed as follows: denial and SSAI (p less than .001), denial and Zung SDS (p less than .01), and denial and PAIS (p less than .01). However, the same analysis at twelve months showed no statistically significant correlations between denial and these psychologic outcome measures. Our findings suggest that denial serves as an adaptive mechanism, especially in the immediate postoperative period. Furthermore, higher levels of denial may be predictive of improved psychologic outcome for up to six months following surgery. Subsequently, however, other events, unrelated to the surgery, may be of greater importance than preoperative denial in determining psychological outcome from CABG surgery.

Longitudinal Risk Factors for Adverse Psychological Functioning Six Months after Coronary Artery Bypass Graft Surgery

“…Change in avoidance coping fully mediated the prospective relationship between illness representation and change in anxiety over the six-month follow-up period, and partially mediated the prospective relationships between illness representation and change in depression over the sixmonth follow-up period, self-rated health and change in depression over the six-month follow-up period and self-rated health and change in anxiety over the six-month follow-up period. The findings in the current study are consistent with results reported in cardiac populations (including CABG patients), where the use of avoidance as a coping method, has been found to be either of no effect or detrimental to long-term outcomes (Carver & Scheier, 1993;Folks, Freeman, Sokol, & Thurstin, 1988;van Elderen et al, 1999). This suggests that CABG patients should be encouraged to engage in alternative ways of coping as a means to facilitate better long-term psychological and in turn physical health outcomes.…”

Which factors predict the persistence of DSM-IV depression, anxiety, and somatoform disorders in the medically ill three months post hospital discharge?

“…Consistent with some studies of the medically ill [74], but inconsistent with others [45,75], our results indicated that a lower denial score predicted persistence of anxiety disorders.…”

Determinants of an impaired quality of life five years after coronary artery bypass surgery

“…Dispositional optimism as a personality resource can have an important role in the response to recovery from CABG 2223 Furthermore, preoperative denial was an adaptive mechanism in the early postoperative period,24 although it seemed to be maladaptive in the late postoperative period 23. Adjustment after CABG is probably a multidimension phenomenon explained by medical and psychosocial factors.…”