Sex Differences and Psychological Assessments in Chronic Pain: A Systematic Review and Meta-Analysis.

Objective: Mental illnesses often coexist with pain, forming a vicious cycle that exacerbate disabilities. Existing sex biases and conflicting study results remain contentious. The primary outcome of this systematic review and meta-analysis is to compare different psychological assessment scores across sexes in chronic pain populations. Method: We performed a systematic review of the association of mental health outcomes among different sexes in the chronic pain population based on a comprehensive search of PubMed, ScienceDirect, ProQuest, and EBSCOhost. A meta-analysis was conducted based on available data to clarify the association between psychological test results and sex differences. Joanna Briggs Institute (JBI tool) was used to verify the quality of the evidence. The Standardized Mean Differences (SMD) with a confidence interval (CI) of 95% were used to determine the association. Results: Nine cross-sectional studies were included in the meta-analysis (3,003 participants), comprising four anxiety and eight depression assessments. The JBI tool rated all studies as high quality. The analysis showed that females had significantly lower anxiety scores (SMD - 0.10; p = 0.03) with chronic pain. The depression scores did not differ between sexes (SMD 0.13; p = 0.20). Conclusions: This study demonstrated that females had significantly lower anxiety scores than males in chronic pain populations, with no differences in depression. Therefore, care should unbiasedly address the pain experience and mental health in males, which is often underrecognized among chronic pain sufferers.