Psychological Assessment of Illness Denial in Medical Settings: A Critical Review

This is the first critical review to assess the clinimetric properties, particularly the sensitivity (i.e., the ability to detect changes in clinical trials and yield clinical distinctions that may demarcate major prognostic and therapeutic differences), and to determine the clinical utility of instruments of illness denial in patients with medical disorders. A comprehensive search of the literature was performed on several databases. Patient-reported outcome measures and clinician-rated instruments of illness denial were identified and analysed. The findings indicate that the Acceptance and Action Diabetes Questionnaire and the Denial of Illness Scale can be used as screening tools to early detect diabetes and stroke patients at increased risk for clinical complications. The Diagnostic Criteria for Psychosomatic Research and the Levine Denial of Illness Scale are transdiagnostic instruments that are particularly suitable to identify the maladaptive manifestations of illness denial and its affective, behavioural and cognitive components. The Illness Denial Questionnaire, particularly the eight-item version of the instrument, is another transdiagnostic measure that may be better suited for the evaluation of illness denial severity. The Denial of Cancer Interview can be used for a longitudinal monitoring of illness denial, whereas the Hackett-Cassem Denial Scale is recommended to assess the degree of illness denial in individuals with cardiac disorders. The use of instruments such as the Cardiac Denial of Impact Scale, the Denial Questionnaire and the Havik and Mæland Denial Scale, which were found to have considerable prognostic utility, may help patients promptly recognize and respond to life-threatening diseases.