*Sex Differences in Long-Term Trends of Psychosocial Factors and Gender Effect on Risk… DOI: http://dx.doi.org/10.5772/intechopen.99767*

than presented in our study. Similarly, a comparison of data from the European Union showed no significant change in the rates of anxiety disorders between 2005 and 2011. Anxiety was more often recorded among the female population, but its prevalence, on the contrary, was higher among middle-aged Europeans [1, 16]. Significant differences in prevalence are related to the use of different instruments to assess anxiety in our study [17].

Depression (D) occurred in more than half of the female population aged 25–64 in 1994 (**Table 2**). The prevalence of D among men was less than 30%. At the same time, the frequency of major depression among women is 4 times higher on average than among men (p < 0.001). The prevalence of major D in 1994 in men increased with age and was unexpectedly higher among 45–54-year-olds. Among women of 45–54 years old, major D in 2003 increased by 2% over 1994, but the 4-fold drop in major D in the 55–64-year-olds group was reflected in a decline in the overall average major depression rates of that period. In 2013, in the young-age population, there was an increase in the high prevalence of major D among men, and we observed a tendency of the narrowing gap in the prevalence of depression with the female population. In 2017, high levels of major D persisted among men and women in the younger age group of 35–44 years old, and even an explosive increase in major D was found in the category of 55–64-year-old women. At the same time, the proportion of individuals with no D in the population aged 45–64 years of both sexes was higher than in 1994.

Sex distribution was studied in 2006–2009 and 2013–2015 as part of the first and second waves of the European health interview survey (EHIS). The proportion of people suffering from depressive disorders among women was higher than among men in each of the EU member states [18]. Portugal recorded the largest gender gap: the proportion of Portuguese women with chronic depression was 11.3% higher than men. The third wave of the European health interview survey (EHIS) was scheduled to start in 2019, but the COVID-19 pandemic is delaying new findings to help understand the current trend in the prevalence of depression depending on sex and age in the Eurozone.

The prevalence of high VE in 1994 was 2 times higher among women than men in the open population aged 25–64 (14.6% and 31%, for men and women of 25–64 years old, respectively; p < 0.001). In 1994, both men and women showed a non-linear increase in the frequency of high VE from younger to older age groups (**Table 3**). Between 2003 and 2005, the increase in average levels of VE compared to 1994 reduced the proportion of those who did not experience vital exhaustion. The gender gap in high VE levels was heterogeneous across age groups. The 2013–2016 trend for a significant decrease in high and average VE levels in men and women in 2017 remained only in the 35–44-year-olds group. However, in older age categories, the decrease in VE occurred only among the female population of 45–64 years old, whereas in men of this age, the levels of vital exhaustion did not decrease, but, on the contrary, slightly increased compared to 2003. Then, for the first time in the entire 23-year follow-up period, men were more likely to report VE than women (16.9% and 15.6% for men and women of 35–64 years old, respectively, n.s.).

According to The Copenhagen City Heart Study, the prevalence of medium and high VE levels measured between 1991 and 1994 was 25% in the population, of which 58.5% were women. It should be noted that in this study, the examined population was quite old: the average age was 60 [19]. In a large-scale epidemiological study in the United States, high levels of VE were observed in 24% of the participants, and average levels of VE were found in 44% of the surveyed. Women were more likely than men to report high VE levels [20].

More than half of the male and female population have high or average levels of hostility (**Table 4**). At the same time, the prevalence of hostility in 1994 was


*Sex Differences in Long-Term Trends of Psychosocial Factors and Gender Effect on Risk… DOI: http://dx.doi.org/10.5772/intechopen.99767*

> **Table 2.**

*Gender differences in the dynamic of depression levels in age groups of a population aged 25–64 years in 1994–2017.*


#### **3.**  *differences in the dynamic of vital exhaustion levels in age groups of a population aged 25–64 years in 1994–2017.*

*Gender*

**Table**
