Journal of psychosomatic research · 2026
How sex and gender affect the general population's illness beliefs, emotional reactions and endorsement of the sick role: Evidence from persistent somatic symptoms.
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Ballering Aranka, Bracke Piet, van Tol Donald, von dem Knesebeck Olaf, Goubert Liesbet
Аннотация
OBJECTIVE: Persistent somatic symptoms (PSS) are stigmatized, as their legitimacy and the credibility of patients are frequently doubted. Individuals experiencing PSS may also be denied entrance to the sick role: the socially sanctioned status that exempts patients from regular responsibilities and legitimizes help-seeking. Although PSS occur more frequently in women and are embedded in gendered expectations about health and illness, little research examines how sex and gender associate with the public endorsement of the sick role for individuals with PSS.
METHODS: Using the sick role as analytic lens, we conducted an experimental 2 × 2 between-subject vignette study among a Dutch population sample (N = 458; 63.3% female, 35.8[SD = 17.1] years) in which patient gender (man/woman) and PSS context (fibromyalgia/rheumatoid arthritis) were varied over vignettes. Participants subsequently evaluated illness beliefs (regarding consequences, controllability and credibility of PSS), emotional reactions and endorsement of the sick role, and provided information on their sex and gender role adherence.
RESULTS: Endorsement of the sick role is gendered. Women and individuals with rheumatoid arthritis were more likely exempted from social responsibilities than men and individuals with fibromyalgia (OR = 1.69, 95%CI = 1.18-2.41;OR = 0.53; 95%CI = 0.37-0.76, respectively). Male participants more often viewed PSS as personally controllable (F(1,446) = 9.52, η2 = 0.02) and perceived patients experiencing PSS as less credible (F(1, 446) = 16.0; η2 = 0.04). Credibility beliefs partially mediated the association between PSS context and sick role endorsement in female participants.
CONCLUSION: The findings illustrate sex and gender associate with public responses to PSS, potentially reinforcing stigma and hindering adequate care. Understanding gendered dynamics in PSS is essential for addressing stigma in a gender-equitable manner.
METHODS: Using the sick role as analytic lens, we conducted an experimental 2 × 2 between-subject vignette study among a Dutch population sample (N = 458; 63.3% female, 35.8[SD = 17.1] years) in which patient gender (man/woman) and PSS context (fibromyalgia/rheumatoid arthritis) were varied over vignettes. Participants subsequently evaluated illness beliefs (regarding consequences, controllability and credibility of PSS), emotional reactions and endorsement of the sick role, and provided information on their sex and gender role adherence.
RESULTS: Endorsement of the sick role is gendered. Women and individuals with rheumatoid arthritis were more likely exempted from social responsibilities than men and individuals with fibromyalgia (OR = 1.69, 95%CI = 1.18-2.41;OR = 0.53; 95%CI = 0.37-0.76, respectively). Male participants more often viewed PSS as personally controllable (F(1,446) = 9.52, η2 = 0.02) and perceived patients experiencing PSS as less credible (F(1, 446) = 16.0; η2 = 0.04). Credibility beliefs partially mediated the association between PSS context and sick role endorsement in female participants.
CONCLUSION: The findings illustrate sex and gender associate with public responses to PSS, potentially reinforcing stigma and hindering adequate care. Understanding gendered dynamics in PSS is essential for addressing stigma in a gender-equitable manner.