**2. Methods**

This study is based on the survey of the male and female population living in one of the districts of Novosibirsk (Russia). The research was carried out within the

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

framework of screenings conducted in 1994–1995, 2003–2005, 2013–2016, and 2016–2017.

In 1994–1995, the third screening under the WHO program Multinational Monitoring of Trends and Determinants of Cardiovascular Disease Optional Psychosocial Sybstudy (MONICA-MOPSY) examined individuals aged 25–64 (n = 1527, 43% men, mean age 44.85 0.4 years, response rate 77.3%) [10].

Another international project HAPIEE (Health, Alcohol and Psychosocial Factors in Eastern Europe) in 2003–2005 examined 45–64-year-old individuals (n = 1650, 34.9% of men, mean age 54.25 0.2 year, response rate 66.5%) [11].

In 2013–2016, a survey of a random representative sample aged 25–44 was conducted as part of screening studies under the budgeting scheme of The Institute of Internal and Preventive Medicine, state reg. no. 01201282292 (n = 975, 43.8% men, mean age 34.5 0.4 years, response rate 71.5%).

In 2016–2017, the International PCDR project (The International Project on Cardiovascular Disease in Russia) examined 35–64-year-old individuals (n = 663, 41.3% men, mean age 51.95 0.32 years, response rate 73.6%). The study surveyed the residents of the same district of Novosibirsk as in the previous years.

All samples were formed based on electoral rolls using a random number table. We used a random mechanical selection method. The general examination was conducted according to the standard methods accepted in epidemiology and included in the program. The methods were strictly standardised and conformed to the requirements of the MONICA project protocol. The material was validated and processed under the WHO program MONICA-psychosocial in the Information Collection Center of the MEDIS Institute in Munich, Germany (Institut für Medizinische Informatik und Systemforschung). Quality control was carried out in MONICA quality control centres: Dundee (Scotland), Prague (Czech Republic), Budapest (Hungary). The results presented were considered satisfactory.

#### **2.1 Psychosocial testing**

Anxiety traits levels were assessed using the Spielberger test (Anxiety subscale, as a personality trait). Interpretation of the data was based on the following criteria: the assessment of a trait of anxiety less than 30 corresponded to low anxiety (LAL); the score from 31 to 44 was a sign of moderate anxiety (MAL); and a score of more than 45 indicated high anxiety level (HAL).

A depression scale blank, i.e., the MOPSY test (Depression Scale, MMPI Adopted by MONICA protocol), consisting of 15 questions, was used to assess depression. For each question, there are two answers: "I agree" and "I disagree". The severity of depression was evaluated as no depression (ND), moderate (MD), or major (major D).

The vital exhaustion level was studied using the MOPSY questionnaire (Maastricht Vital Exhaustion Questionnaire). The test consisted of 14 statements. To respond to each statement, there are 3 answers: "yes", "no", "I don't know". The level of vital exhaustion was estimated as no vital exhaustion (NVE), moderate vital exhaustion (MVE), or high vital exhaustion (HVE).

Hostility (Hostility Scale, Cook-Medley test). The test consisted of 20 statements. 2 answers, "agree" and "disagree", were provided to respond to each statement. Hostility expression was assessed as low, moderate, or high.

Social support (Berkman-Syme test) [12]. A 17-point index of close contacts (ICC) was determined. It was evaluated as low, moderate, or high. Social Network Index (SNI), consisting of 9 points, was assessed as low, moderate-1, moderate-2, or high.

The subjects were asked to answer the scale questions on their own according to the given instructions. Individuals who did not fill out the questionnaire were not included in the sample.

#### **2.2 Endpoints**

The study identified the following "endpoints": the first cases of arterial hypertension (AH), myocardial infarction (MI), and stroke. All MI cases were recorded under the WHO epidemiological program Register of acute myocardial infarction, conducted in Novosibirsk from 1978 to the present day [13]; newly occuring cases of hypertension and stroke were recorded during the observation of the cohort. Sources used to identify cases of AH and stroke included population-based cohort study (annually), medical history, hospital discharge, medical records in polyclinics or general practices documents, death certificates, interviews with relatives, pathological and forensic reports. AH was defined as a condition in which SBP was 140 mmHg and above and/or DBP 90 mmHg and/or antihypertensive medication was taken.

#### **2.3 Participants**

The object for the study of CVD risk was the cohort formed from the number of 25–64-year-old individuals examined at the III MONICA-psychosocial screening. The prospective follow-up period for the participants was 16 years (1994–2010). A total of 384 women and 190 men, with a baseline age of 25–64 years without CVD or DM at the time of screening, were included in the analysis. Over 16 years, the cohort had 15 cases of first-onset MI in women and 30 in men, and 35 cases of the first-onset stroke in women and 22 in men. During the same period, 229 cases of first-time AH were detected in women and 46 cases in men.

### **3. Results and discussion**

#### **3.1 Sex differences in the dynamics of psychosocial factors from 1994 to 2017**

The results of the study showed that high levels of anxiety traits were present in two-third of the female population aged 25–64 in 1994 (**Table 1**). Whereas among men, high anxiety was found in less than half of those surveyed. Among the male population in 1994, the frequency of high anxiety increased linearly from younger to older age groups. In contrast, among women, high levels of AT were more common in the younger age groups of 25–34 and 35–44. Between 2003 and 2005, the maximum HAL values among both sexes, except for men in the 45–54 year group, were observed. In 2013–2016, there was a significant decrease in the prevalence of HAL in young groups in both sexes (**Table 1**). By 2016–2017, only the female population of 35–64-year- olds had consolidated such a favourable trend, but in men, the prevalence of high anxiety was back to 1994 levels. Thus, for the first time, the frequency of HAL among men 35–44 years was higher than in women of the same age group, although the differences did not reach statistical significance. The increase in anxiety levels among men is likely due to peak values of social tensions amid the economic crisis that began to gain momentum after 2014. Subsequently, we should expect similar changes among the female population.

The study of sex differences in epidemiological studies in the United States showed that the prevalence of anxiety changed slightly from 1990 to 2003 and averaged about 30% among women and 20% among men [14, 15]. This is lower


**Table 1.** *Gender differences*

 *in the dynamic of anxiety traits levels in age groups of a population*

 *aged 25–64 years in 1994–2017.*
