A two factor model of denial of illness: a confirmatory factor analysis.

Analyses of the data obtained by the use of a reliable semi-structured interview format, the Levine Denial of Illness Scale (LDIS) confirmed the existence of two distinct, but interrelated factors of denial of illness. The two factors were termed denial of cognitions and denial of affects. One hundred medical patients from four different patient groups (cardiac, epilepsy, stroke, hypertensive) were interviewed and assessed. Confirmatory factor analytic procedures were used, and they demonstrated that these two factors accounted for a major proportion of the variance in the observed data that reflected denial of illness. A moderate but significant correlation between these two factors, in addition to their discriminant validity, also supported the validity of the unifying and overarching construct, denial of illness. The concurrent and discriminant validity of the two factors was further supported by the different relationships of the two factors with external criterion measures. The reliability, validity and the potential predictive validity of these two factors may be useful in further investigations of the use of denial. Further studies of their different influences on the initial and continued resistance of seriously ill patients to comply with medical treatment and prescribed self care are indicated. When seriously ill patients persist in denial, appropriate interventions may help them to give up their evasive behavior and they may comply with medical recommendations.