Life stress, denial and outcome in ischemic heart disease patients

Goldberg's 20-item General Health Questionnaire was administered to 320 male ischemic heart disease patients prior to discharge from hospital. The relationship between GHQ scores and rehospitalization/death rates for the subsequent year was examined. Surprisingly, a curvilinear relationship emerged with both low and high scorers having better outcomes than patients scoring in the middle ranges. This relationship held regardless of physical risk factors reflecting severity of disease, and demographic factors failed to explain the curve. It was suggested that denial and compliance accounted for the good outcomes of the low and high scorers respectively, whereas the medium scoring patients were neither adequate deniers nor sufficiently enthusiastic about entering the sick role.