Sex and gender differences in primary care help-seeking for common somatic symptoms: A longitudinal study

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 ¼
44.5 years [SD ¼ 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 ¼ 1.78; 95%CI ¼ 1.13–2.80), whereas feminine gender was not (OR ¼
0.67; 95%CI ¼ 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 ¼ 0.95; 95%CI
¼ 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.