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. 2017 Dec 19;17(1):133.
doi: 10.1186/s12905-017-0491-y.

Burden and correlates of mental health diagnoses among sex workers in an urban setting

Nitasha Puri  1   2 , Kate Shannon  1   3 , Paul Nguyen  1 , Shira M Goldenberg  4   5
Affiliations

Burden and correlates of mental health diagnoses among sex workers in an urban setting

Nitasha Puri et al. BMC Womens Health. .

Abstract

Background: Women involved in both street-level and off-street sex work face disproportionate health and social inequities compared to the general population. While much research has focused on HIV and sexually transmitted infections (STIs) among sex workers, there remains a gap in evidence regarding the broader health issues faced by this population, including mental health. Given limited evidence describing the mental health of women in sex work, our objective was to evaluate the burden and correlates of mental health diagnoses among this population in Vancouver, Canada.

Methods: An Evaluation of Sex Workers Health Access (AESHA) is a prospective, community-based cohort of on- and off-street women in sex work in Vancouver, Canada. Participants complete interviewer-administered questionnaires semi-annually. We analyzed the lifetime burden and correlates of self-reported mental health diagnoses using bivariate and multivariable logistic regression.

Results: Among 692 sex workers enrolled between January 2010 and February 2013, 338 (48.8%) reported ever being diagnosed with a mental health issue, with the most common diagnoses being depression (35.1%) and anxiety (19.9%). In multivariable analysis, women with mental health diagnoses were more likely to identify as a sexual/gender minority (LGBTQ) [AOR=2.56, 95% CI: 1.72-3.81], to use non-injection drugs [AOR=1.85, 95% CI: 1.12-3.08], to have experienced childhood physical/sexual trauma [AOR=2.90, 95% CI: 1.89-4.45], and work in informal indoor [AOR=1.94, 95% CI: 1.12 - 3.40] or street/public spaces [AOR=1.76, 95% CI: 1.03-2.99].

Conclusions: This analysis highlights the disproportionate mental health burden experienced by women in sex work, particularly among those identifying as a sexual/gender minority, those who use drugs, and those who work in informal indoor venues and street/public spaces. Evidence-informed interventions tailored to sex workers that address intersections between trauma and mental health should be further explored, alongside policies to foster access to safer workspaces and health services.

Keywords: Mental health; Non-injection drugs; Sexual/gender minority; Trauma; Women sex workers.

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Conflict of interest statement

Ethics approval and consent to participate

The AESHA study was developed based on substantial community collaborations with sex work agencies, and was monitored by a Community Advisory Board of representatives of over 15 community agencies. The study holds ethical approval through Providence Health Care/University of British Columbia Research Ethics Board. All participants were given an extensive consent form that detailed purpose of the research, voluntary participation and withdrawal, study procedures, risks, and benefits, as well as compensation and access to HIV and other health treatment. The form also ensured confidentiality and attention to patients’ rights. If participants were illiterate, the form was read to them and staff ensured there was clear understanding before obtaining signatures.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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