The Impact of Violence, Perceived Stigma, and Other Work-Related Stressors on Depressive Symptoms Among Women Engaged in Sex Work

Abstract

While the physical health risks of sex work have been well documented, fewer studies have explored mental health risks associated with sex work. This study examined rates of depressive symptoms and associated risk factors among women engaged in sex work in Mongolia (n=222), a country experiencing significant economic and social development and where mental health infrastructure is in its infancy. A linear regression analysis indicated that significant risk factors for depressive symptoms included paying partner sexual violence, perceived occupational stigma, less social support, and higher harmful alcohol use. As one of the first studies to examine depression among sex workers, this study holds important social welfare implications for this marginalized population in Mongolia and other low-resource settings globally.

Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis

“…Seventeen studies reported on associations between mental health problems and violence experience [ 30 , 34 , 36 , 37 , 39 , 43 , 44 , 46 , 49 , 52 , 53 , 57 , 59 , 75 , 79 , 80 , 82 ], usually by an intimate partner or a client ( Table 2 ). Measures of violence varied by timeframe (recent versus ever), typology (physical, sexual, emotional) and perpetrator (client, intimate partner, etc.).…”

“…Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak (S3 Text). Sixteen studies (14 moderate; 2 weak) selected participants based on harmful alcohol or drug use (n = 9) [24,26,31,33,34,[37][38][39][40], or positive [32,41] or negative [29,[42][43][44][45] HIV status (n = 5), and were excluded from the meta-analyses (regardless of CEBM score) to avoid biasing the pooled estimates. Analyses used a variety of validated scales and cut-off points to assess mental disorders (Table 1).…”

“…Forty-four studies examined depression among FSWs, with 37 reporting prevalence estimates (Table 1) [9,10,23,27,[32][33][34][35][36][37]39,. A meta-analysis was conducted with 23 studies (Fig 2).…”

“…Measures of violence varied by timeframe (recent versus ever), typology (physical, sexual, emotional) and perpetrator (client, intimate partner, etc.). Overall, 13 studies reported associations between depression and violence [34,37,39,43,44,46,49,52,53,59,79,83], with 7 studies included in the meta-analyses (S1 Fig). The pooled unadjusted OR of depression and violence experience (ever or recent) is 2.2 (1.4-3.3), p < 0.001 (n = 7 studies), and the pooled unadjusted OR of depression and recent violence experience is 2.3 (1.3-4.2), p = 0.005 (n = 5 studies).…”

Personal and Financial Risk Typologies Among Women Who Engage in Sex Work in Mongolia: A Latent Class Analysis

“…One recent study with women engaged in sex work in Ulaanbaatar found that 60.4% were at high risk for depression. Furthermore, variables such as harmful alcohol use, sexual violence, lack of social support, and perceived social stigma were identified as risk factors for depression among sex workers in Mongolia (Carlson et al, 2016). …”