Sex and gender differences in the public stigmatization of persistent somatic symptoms: a systematic review

Individuals with persistent somatic symptoms (PSS) experience stigmatization by the public. Little is known about how PSS-related public stigmatization is influenced by sex and gender. This review therefore aims to assess the quality of, and synthesize, the research assessing sex and gender-specific differences in PSS-related public stigmatization. We conducted a systematic review using six databases (PubMed, Web of Science, CINAHL, SocIndex, PsychInfo, and Scopus), combining search strings related to PSS, sex/gender, and public stigmatization. Additional studies were identified by manual searches of reference lists. Data extraction was systematically conducted, and study quality was systematically assessed by two independent reviewers. Out of 2664 records, 12 studies met the inclusion criteria. Ten studies had a quantitative, experimental vignette design, the others a qualitative or mixed-method design. Stereotypes were assessed in 92 % of the studies, while 50 % and 58 % of studies assessed prejudices and discrimination, respectively. No consistent patterns in sex and/or gender differences in PSS-related public stigmatization were found. Substantial heterogeneity was present in the measurements of PSS, sex, gender, and stigmatization. Most studies were of low quality and showed a high risk of bias. This review highlights the scarcity of (high-quality) research on sex and gender differences in PSS-related public stigma, as well as substantial heterogeneity in the operationalization of key concepts. This variability is problematic as it limits identification of consistent patterns. Future research could focus on moving beyond using vignette designs, incorporating reliable and validated measures for key concepts, introduce intersectionality in its design, and assess public stigmatization in cross-cultural settings.