Gender, Gender Role Beliefs, and Evaluation of Pain in Others: Indirect and Moderated Pathways

BACKGROUND: Gender disparities in observer pain assessment are well-documented, with women's pain often underestimated, yet the mechanisms underlying this bias remain unclear. This study examined how patient gender, gender role beliefs, and pain-related attributions shape perceptions of pain. METHODS: One hundred thirty-two community participants were randomised to view either a female or male patient with chronic pain performing a movement. Participants rated pain severity, interference, genuineness, and emotional attribution. Moderated serial mediation tested indirect pathways from patient gender to pain severity and interference and whether these effects varied by participants' gender role beliefs. RESULTS: Compared to the male patient, the female patient was rated as having less severe pain, less interference, more emotional/psychological contributors to the pain, and lower genuineness. Serial mediation indicated that patient gender predicted lower perceived pain interference through greater emotional/psychological attributions, which was associated with reduced perceived genuineness. For pain severity, indirect effects emerged through emotional/psychological attributions and genuineness, though serial mediation was not supported. Gender role beliefs did not moderate serial mediation but did moderate the links between patient gender and perceived genuineness, as well as the direct effect of gender on pain severity. CONCLUSIONS: Findings extend evidence of gender bias in observer pain evaluation by showing that the female patient was judged as experiencing less interference and severity through pathways involving emotional/psychological attributions and reduced credibility. Results underscore the layered nature of gender bias in observer pain assessment and highlight the need for research with more diverse patients and clinical providers. SIGNIFICANCE STATEMENT: This study advances understanding of gender bias in pain assessment by identifying pathways through which gender discrepancies may arise and how such pathways may be further conditioned by evaluators' gender role beliefs. These findings highlight the need to address both implicit gender stereotypes and attributional reasoning that may be associated with underestimating women's pain to promote more equitable care.