Mental ill health experiences of female sex workers and their perceived risk factors: A systematic review of qualitative studies

Abstract

Background: Female sex workers globally face a high prevalence of mental ill health due to social inequalities, including classism, gender inequality, discrimination and criminalisation, coupled with stigma and violence. However, few reviews comprehensively discuss the combined impact of these perceived risk factors on the mental well-being of female sex workers worldwide. Aim: This systematic qualitative literature review seeks to explore the mental health experiences of female sex workers and their perceived risk factors for mental ill health. Design: A systematic qualitative literature review. Methods: Searches across ten databases, including CINAHL Plus, Cochrane Library, Medline (1949 to current date 2022), ProQuest, PTSDPubs, PsycINFO, EMBASE, Web of Science (Core Collection), AMED, and Google Scholar. Included studies were assessed for quality using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist and subsequently thematically analysed. Results: Seventeen studies met the inclusion criteria, leading to the development of five key themes through thematic analysis: (1) mental ill health, (2) addiction, (3) stigma, (4) normalisation of violence, and (5) lack of support systems. Notable findings include the adverse impact of stigma on the mental well-being of female sex workers, the prevalence of mental illnesses related to their involvement in the sex industry, the role of violence as a critical risk factor for mental ill health, and the utilisation of addiction as a coping mechanism. Conclusions: The identified themes contribute to our existing understanding of the mental health experiences of female sex workers and have practical implications. Practice recommendations encompass initiatives such as public education, soliciting feedback from sex workers about their healthcare experiences, establishing community-based support teams, and providing integrated services for those with dual diagnoses. Further research is necessary to assess the effectiveness of public education schemes, address stigma within the sex industry, and investigate the mental health experiences of sex workers in American and Western European contexts.