**4. Conclusions**

In the period from 1994 to 2003/05, our study registered high levels of negative psychological characteristics, which prevailed among women. The favourable trend of 2013 in the reduction of affective states reversed shortly. By 2017, younger men for the first time began reporting higher levels of anxiety and vital exhaustion than women. For 23 years, against the background of an increase in the proportion of people of both sexes without negative psychological conditions, the gender gap in the frequency of major depression decreased. Such multifaceted trends are due to a decrease in the average levels of PSF in our study.

It is worth mentioning that an increased level of hostility in the Russian/Siberian population is associated with a negative risk of stroke. It can be assumed that a low level of hostility is probably not the most advantageous, from an evolutionary point of view, tool of adaptability in the conditions of the permanent crisis in Russia in the post-Soviet period. At the same time, high anxiety, as a personality trait, develops in character over many years, activates biological mechanisms and leads to the development of cardiovascular events. This also applies to other psychosocial factors. It should be pointed out that the increase in the risk of CVD is observed already in the first 5 years after the initial study and remains significant for a long period – 16 years in both sexes. The magnitude of the risk depends on gender. Its higher values were determined in men with unfavourable levels of PSF in the development of AH and stroke. Yet the inclusion of social characteristics to the model often changed this ratio, weakening the risk magnitude in men, but maintaining the same or increasing in women. This is explained by the high sensitivity of men to living outside wedlock, increasing the risk of CVD among divorced and, especially, widowed (6–8 times). In women, such associations were not typical. Obviously, more men benefit from being married rather than women who have to bear the domestic burden. These explanations can be found in our earlier works. The influence of occupational status was also decisive for men. Working professions are associated with a higher risk of CVD in men compared to engineers, technicians and managers. In women, the prognostically unfavourable factor was the initial level of education attained and age over 44 years in combination with affective states. Among men, the impact of these factors was less significant.

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