Sex and gender differences in primary care help-seeking for common somatic symptoms: a longitudinal study 2023 Ballering, Rosmalen et al

Andy

Andy

Senior Member (Voting rights)
Objective
Women are reported to consult general practitioners (GPs) more frequently than men. However, previous studies on sex differences in help-seeking behavior for somatic symptoms do not distinguish between sex and gender, do not account for sex differences in presented symptoms, and are frequently conducted in clinical settings, automatically excluding non-help seekers. Therefore, we aim to assess the independent associations of sex and gender with primary care help-seeking for somatic symptoms in the general population.

Design and setting
Records from the longitudinal population-based Lifelines Cohort Study were linked to routine electronic health records from GPs.

Subjects
Participants reporting new-onset common somatic symptoms.

Main outcome measures
Associations between sex and gender, operationalized via a novel gender-index, with primary care help-seeking for somatic symptoms and differences in the strength of the association between gender and help-seeking for somatic symptoms between women and men.

Results
Of 20,187 individuals with linked data, 8325 participants (67.5% female; mean age = 44.5 years [SD = 12.9]) reported at least one new-onset somatic symptom. Hereof, 255 (3.1%) consulted the GP within 6 weeks of symptom onset. Female sex was positively associated with consulting the GP (OR = 1.78; 95%CI = 1.13–2.80), whereas feminine gender was not (OR = 0.67; 95%CI = 0.39–1.16). The latter association did not differ in strength between men and women. More paid working days are negatively associated with help-seeking (OR = 0.95; 95%CI = 0.91–0.98).

Conclusions
The results suggest that female sex rather than feminine gender is associated with primary care help-seeking behavior for somatic symptoms. Nevertheless, clinicians should be aware that gender-related variables, such as mean paid working days, may be associated with help-seeking behavior.

Open access, https://www.tandfonline.com/doi/full/10.1080/02813432.2023.2191653
 
Data on GP consultations for common somatic symptoms as described in the Symptom CheckList-90 Somatization subscale (SCL-90 SOM; Table S1) were retrieved from electronic health records for all participants that were listed in one of the 63 NPCD GP practices located in the North of the Netherlands.
Click to expand...


These researchers seem to have a weird understanding of the word 'gender'.
Female sex was positively associated with consulting the GP (OR = 1.78; 95%CI = 1.13–2.80), whereas feminine gender was not (OR = 0.67; 95%CI = 0.39–1.16).
Click to expand...
How could female sex and feminine gender have such drastically different odds ratios?

They say
Sex refers to biological characteristics, including but not limited to chromosomes, hormones and anatomy, of female and male bodies. In contrast, gender is a socioculturally-constructed, multidimensional concept that entails the embodiment of different roles, behaviors, identities and relationships of women and men prescribed by social norms in a given time and society [Citation10].
Click to expand...
but in any modern society, the roles and behaviours of women and men are going to be highly overlapping for most things.

This is how they worked out someone's gender:
Participants’ feminine and masculine gender roles were operationalized via a recently developed, data-driven gender index, which accounts for the place-, time- and society-bound nature of gender roles [Citation6]. In a subsample of baseline Lifelines adult participants that had no suspected intersex variation or gender-diverse gender identity, we performed LASSO logistic regression analyses that used 153 psychosocial characteristics, including dietary preferences, hobbies, time spend on household tasks or odd jobs, type of profession and personality traits, to predict participants’ municipally-registered sex.
Click to expand...

The gender index ranges from 0% (fully masculine) to 100% (fully feminine). An index of 50% indicates androgyny, with equal levels of feminine and masculine
Click to expand...

It's past my bed time, but, I have to read on in this paper, to find out what century these researchers think they are living in.
 
Last edited:
First, women experience, describe and report their symptoms in a different manner, and more readily attribute these to somatic causes than men
Click to expand...
I think the word 'somatic' should be banned. I never know what people mean when they use it, and I'm not sure these researchers did either.

Here, we used a novel gender measure to disentangle associations of sex and gender with help-seeking behavior.
Click to expand...
Yeah. I think they should have stuck to their analyses of 'does being a homemaker make you more likely to seek medical help? (apparently no); 'does being a health professional make you more likely to seek medical help?' (also apparently no). I'm not sure what gender health professionals are supposed to be. Their 'novel gender measure' surely just added confusion, rather than disentangling anything. Sadly, they don't tell us much at all about what qualifies a person to have a 'feminine gender'. I would like to know what food is feminine and what food is masculine.

Femininity operationalized by the gender index showed no association with help-seeking for new-onset common somatic symptoms. We assessed whether specific gender-related factors that were identified by previous qualitative research were associated with help-seeking. We found that working as a healthcare professional or considering oneself as a homemaker showed no association with help-seeking within 6 weeks (OR = 0.93; 95%CI = 0.65–1.32 and OR = 0.68; 95%CI = 0.42–1.14, respectively). Weekly mean days of paid work did associate with help-seeking within 6 weeks (OR = 0.95; 95%CI = 0.91–0.98). No associations were found with help-seeking within 3 months.
Click to expand...

I can't see much that is useful in this study.
 
Hutan said:
Sadly, they don't tell us much at all about what qualifies a person to have a 'feminine gender'. I would like to know what food is feminine and what food is masculine.
Click to expand...

Once I dated a guy who, when being offered vegetarian options at a restaurant etc, tended to say: I am a man, I eat meat. And there was this other time when I was drinking a glass of beer and the guy I was talking to looked at me with horror, said that women should never drink beer, took my glass away and bought me a cocktail instead. Maybe it is that kind of logic. If you eat salad and like gin and tonic, you better go and start identifying as female. :alien:
 
Wyva said:
Once I dated a guy who, when being offered vegetarian options at a restaurant etc, tended to say: I am a man, I eat meat. And there was this other time when I was drinking a glass of beer and the guy I was talking to looked at me with horror, said that women should never drink beer, took my glass away and bought me a cocktail instead. Maybe it is that kind of logic. If you eat salad and like gin and tonic, you better go and start identifying as female. :alien:
Click to expand...

Is it possible that you had accidentally time travelled to the 1970s?
 
Why would seeking help with symptoms be a genuine problem. The NHS are concerned enough about people delaying seeking help for possible cancer to be advertising on TV saying if something doesn’t feel right get it checked out, one of the adverts focuses on getting any concerns checked out so you can rule out cancer for your peace of mind. How do oncologists, cardiologists feel about fellow doctors who judge patients for “help-seeking”.
 
Wyva said:
Possibly! Maybe I should do it again, find young Simon Wessely and warn him that this whole CFS thing he will have an interest in in the future, will really not turn out the way he will expect it to and it is really not worth bothering with it. :whistle:
Click to expand...
IIRC, his first degree was in art history. If you could convince him to stick with that for his career we would all be very grateful. :thumbup:
 
Hutan said:
I would like to know what food is feminine and what food is masculine.
Click to expand...

I then wondered whether foods in French and German share the same gender, but, of course, you’d also have to factor in the foods in German which are neuter too.
Then also add in all the other languages that use masculine/feminine :nailbiting:

Oh dear, failed at first my first, easiest, example - “the apple”

Der Apfel (m)

La pomme (f)

:thumbsdown:
 
NelliePledge said:
Why would seeking help with symptoms be a genuine problem. The NHS are concerned enough about people delaying seeking help for possible cancer to be advertising on TV saying if something doesn’t feel right get it checked out, one of the adverts focuses on getting any concerns checked out so you can rule out cancer for your peace of mind. How do oncologists, cardiologists feel about fellow doctors who judge patients for “help-seeking”.
Click to expand...

I’ve often thought exactly the same @NelliePledge when I’ve seen those adverts.

Not cancer worries, but heart - I’ve had increasing concerns over a racing heart beat on exertion (or even sitting quietly on the sofa with my legs up). Following 2 years with a Fitbit to “prove” the phenomenon, I eventually persuaded myself to ask my GP for a second referral for PoTS investigations again last year - after being gaslit by a Consultant in 2017 (I knew he had now retired to private work).
 
Interestingly the person doing the eating seems to be masculine in both French and German
  • le mangeur
  • le consommateur
  • der Verbraucher
  • der Verbraucher
Does gender change according to action, are we all gender fluid as we flow through the day?
 
Peter Trewhitt said:
Interestingly the person doing the eating seems to be masculine in both French and German
  • le mangeur
  • le consommateur
  • der Verbraucher
  • der Verbraucher
Does gender change according to action, are we all gender fluid as we flow through the day?
Click to expand...
These nouns in German can be turned into feminine (eg der Verkäufer, die Verkäuferin, etc) and I checked and die Verbraucherin seems to exist too.

Things are not always so clear though, das Mädchen (the girl) is neuter for example.
 
Wyva said:
These nouns in German can be turned into feminine (eg der Verkäufer, die Verkäuferin, etc) and I checked and die Verbraucherin seems to exist too.

Things are not always so clear though, das Mädchen (the girl) is neuter for example.
Click to expand...

Then I guess in German as in English the actor is treated as male, unless otherwise specified: a generic person is ‘he’ whereas a specific individual is ‘he’ or ‘she’ as appropriate. That’s a shame as as I quite liked the idea of everyone shifting continuously between genders.
 
NelliePledge said:
Why would seeking help with symptoms be a genuine problem. The NHS are concerned enough about people delaying seeking help for possible cancer to be advertising on TV saying if something doesn’t feel right get it checked out, one of the adverts focuses on getting any concerns checked out so you can rule out cancer for your peace of mind. How do oncologists, cardiologists feel about fellow doctors who judge patients for “help-seeking”.
Click to expand...

A few years ago I had a copious GI bleed. It went on for several years. Initially I was worried that I might have cancer. But due to the total incompetence and disbelief I met with I thought I might bleed to death or die of heart failure before diagnosis because the bleeding was getting worse and worse. It took three hospitals three and a half years to find the source of that bleed (a 4cm polyp with very fragile blood vessels). There was no urgency from anyone. I bought my GP records after that and discovered that a doctor at the first hospital I had been seen by had minimised what I said to "Patient has bleeding piles".
 
You must log in or register to reply here.
Back
Top Bottom