Five-year follow-up for adverse outcomes in males with at least minimally positive angiograms: importance of “denial” in assessing psychosocial risk factors

The purpose of this study was to test the role of “denial” (spouse/friend minus self-ratings on parallel versions of the same questionnaire) in diluting the predictive value of emotional distress for cardiac events (deaths, new MIs, and/or revascularizations). One hundred forty-four men with no history of prior revascularization who had at least minimally positive diagnostic coronary angiograms, and someone they selected as “someone who knows you well,” completed parallel versions of the Ketterer Stress Symptom Frequency Checklist (KSSFC). They were followed up by phone an average of 59.7 months after recruitment. Length of follow-up, baseline cardiac risk factors, and a number of baseline-obtained psychosocial risk factors were tested as prospective predictors of combined events (death by any cause, new MIs, and/or revascularizations) and current anginal frequency. Only spouse/friend observed anxiety on the KSSFC predicted current anginal frequency ( p=0.001). On the self-report version of the KSSFC, patients with one or more events reported less anger ( p=0.031), depression ( p=0.008), and anxiety ( p=0.003). These results may be attributable to “denial” because there were no differences in spouse/friend ratings, and difference scores (spouse/friend minus patient) on the KSSFC scales, particularly anger, were also related to events: AIAI ( p=0.002); depression ( p=0.063); and anxiety ( p=0.010). Denial may be a major limiting factor in accurately assessing emotional distress in cardiac populations, and may help account for a number of the previous findings.