Exploitation, Violence, and Suicide Risk Among Child and Adolescent Survivors of Human Trafficking in the Greater Mekong Subregion

Abstract

IMPORTANCE Human trafficking and exploitation of children have profound health consequences. To our knowledge, this study represents the largest survey on the health of child and adolescent survivors of human trafficking. OBJECTIVE To describe experiences of abuse and exploitation, mental health outcomes, and suicidal behavior among children and adolescents in posttrafficking services. We also examine how exposures to violence, exploitation, and abuse affect the mental health and suicidal behavior of trafficked children. DESIGN, SETTING, AND PARTICIPANTS A survey was conducted with 387 children and adolescents aged 10 to 17 years in posttrafficking services in Cambodia, Thailand, or Vietnam, which along with Laos, Myanmar, and Yunnan Province, China, compose the Greater Melong Subregion. Participants were interviewed within 2 weeks of entering services from October 2011 through May 2013. MAIN OUTCOMES AND MEASURES Depression, posttraumatic stress disorder, anxiety, suicidal ideation, self-injury, and suicide attempts. RESULTS Among the 387 children and adolescent study participants, most (82%) were female. Twelve percent had tried to harm or kill themselves in the month before the interview. Fifty-six percent screened positive for depression, 33% for an anxiety disorder, and 26% for posttraumatic stress disorder. Abuse at home was reported by 20%. Physical violence while trafficked was reported by 41% of boys and 19% of girls. Twenty-three percent of girls and 1 boy reported sexual violence. Mental health symptoms were strongly associated with recent self-harm and suicide attempts. Severe physical violence was associated with depression (adjusted odds ratio [AOR], 3.55; 95% CI, 1.64-7.71), anxiety (AOR, 2.13; 95% CI, 1.12-4.05), and suicidal ideation (AOR, 3.68; 95% CI, 1.77-7.67). Sexual violence while trafficked was associated with depression (AOR, 2.27; 95% CI, 1.22-4.23) and suicidal ideation (AOR, 3.43; 95% CI, 1.80-6.54). CONCLUSIONS AND RELEVANCE Children and adolescents in posttrafficking care showed high symptom levels of depression, anxiety, and posttraumatic stress disorder, which are strongly associated with self-harm or suicidal behaviors. Mental health screening and reintegration risk assessments are critical components of posttrafficking services, especially in planning for family reunification and other social integration options.

Mandatory Reporting of Human Trafficking: Potential Benefits and Risks of Harm

“…The prevalence of human trafficking is not known, but it is estimated to affect millions of people globally [1,7]. Trafficking victims and survivors are diverse in terms of age, income, gender, race, and other factors, although members of vulnerable groups are almost certainly at increased risk [1][2][3][4]7]. In the US, for example, at-risk youth include those who have been sexually abused; youth who lack stable housing; sexual and gender minority youth; youth who have used or abused drugs and/or alcohol; and youth who have experienced homelessness, foster care placement, or juvenile justice involvement [1].…”

“…In the US, for example, at-risk youth include those who have been sexually abused; youth who lack stable housing; sexual and gender minority youth; youth who have used or abused drugs and/or alcohol; and youth who have experienced homelessness, foster care placement, or juvenile justice involvement [1]. Trafficked children, adolescents, and adults experience adverse social, legal, and health consequences [1][2][3][4][9][10][11][12][13][14][15]. Health consequences are both physical-sexual and reproductive health problems, injuries from physical abuse, and chronic medical conditions-and mental-posttraumatic stress disorder (PTSD), anxiety disorders, depression, substance use, suicidal ideation and attempts, and homicide risk [14].…”

“…Beginning in the late 1990s, prevention and protection have been increasingly prioritized alongside prosecution; there is also an increased recognition that diverse strategies implemented by multiple sectors-journalism and the media, human rights agencies and nongovernmental organizations (NGOs), social service and medical providers, the public health sector, and small businesses and large corporations-are essential complements to a law enforcement approach [1,10]. In the past few years the medical and public health communities have become involved in raising the visibility of human trafficking, developing responses to the health needs of trafficked persons, and advocating for necessary services and improved human trafficking policies [2][3][4][9][10][11]. This involvement is reflected in the development of new protocols for identification and treatment of trafficked persons in health care settings, policy statements by organizations of health care professionals, and legislation to require training of health care professionals in human trafficking and trauma-informed care (i.e., care that is grounded in and directed by a thorough understanding of the neurological, biological, psychological, and social effects of trauma) [16][17][18].…”

“…Mandated reporters and the child welfare and law enforcement officials who receive and investigate the reports must be appropriately trained to identify trafficked persons and to provide, refer, or connect trafficking victims and survivors to specialized services [9][10][11][12]. Identified victims and survivors must have access to specialized trauma-informed care to address their physical and psychological health needs and be aware that those services are available to them [2][3][4][13][14][15]. Perhaps most importantly, child welfare systems must have sufficient resources to protect and support trafficked children brought to their attention and delivered into their care [10,12].…”

“…Human trafficking, which includes both sex and labor trafficking, has profound consequences for the health, safety, and well-being of victims and survivors [1][2][3][4]. Human trafficking has been defined as: the recruitment, transportation, transfer, harbouring or receipt of persons by means of threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power, or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.…”