GENDER DIFFERENCES IN PSYCHOSOCIAL ADJUSTMENT TO CHRONIC PAIN AND EXPENDITURES FOR HEALTH-CARE SERVICES USED

Gender differences in reports of chronic pain, in coping responses to the consequences of painful conditions, and in the use of health care services have recently received considerable attention. This report ex amines the gender effects of referral practices to a chronic pain spec ialty clinic and the nature of the relationship between health care ne eds and use of health care services. This historical cohort analytic s urvey of 571 patients referred to the pain clinic assessed them by gen der for selected referral variables through a chart review, and random ly sampled (n = 222) these patients' current adjustment and health ser vice use through mailed questionnaires or telephone interview. The que stionnaire consisted of psychosocial scales (PAIS-SR; Social Support); cognitions, including the Meaning of Illness Questionnaire (MIQ); and a health service utilization inventory designed to assess direct, out -of-pocket, indirect, and cash transfer expenditures. Selected referra l demographic characteristics were similar between the gender groups a t referral with the exception of three factors: distance from clinic, referring physician, and having a disability pension. At follow-up, th e adjustment groups were similar to their gender counterparts on all s ociodemographic and clinical variables including a high prevalence of poor psychosocial adjustment. Women's adjustment was accounted for by cognitive variables, whereas men's adjustment was by social variables. There were differential expenditures for health service use by gender with similar health care needs. Women used specific health care servi ces more than men, which was explained in part by psychological need a nd meaning. Men's use of services, on the other hand, was explained in part by meaning alone. The importance of gender differences in the ro le that social support and meaning variables play in predicting psycho social adjustment to chronic pain is elaborated in this study. The int eraction effects between health care need and gender to explain variat ions in use of health care services indicates that users of services v aried in ways that suggest a bias or barrier of their own or of servic e providers to access services.