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. 2018 Dec 12;6(1):56.
doi: 10.1186/s40359-018-0269-5.

Mental health, violence and psychological coercion among female and male trafficking survivors in the greater Mekong sub-region: a cross-sectional study

Lisbeth Iglesias-Rios  1 , Siobán D Harlow  2 , Sarah A Burgard  3 , Ligia Kiss  4 , Cathy Zimmerman  4
Affiliations

Mental health, violence and psychological coercion among female and male trafficking survivors in the greater Mekong sub-region: a cross-sectional study

Lisbeth Iglesias-Rios et al. BMC Psychol. .

Abstract

Background: Human trafficking is a pervasive global crime with important public health implications that entail fundamental human rights violations in the form of severe exploitation, violence and coercion. Sex-specific associations between types of violence or coercion and mental illness in survivors of trafficking have not been established.

Methods: We conducted a cross-sectional study with 1015 female and male survivors of trafficking (adults, adolescents and children) who received post-trafficking assistance services in Cambodia, Thailand or Vietnam and had been exploited in various labor sectors. We assessed anxiety and depression with the Hopkins Symptoms Checklist (HSCL-25) and post-traumatic stress disorder (PTSD) symptoms with the Harvard Trauma Questionnaire (HTQ), and used validated questions from the World Health Organization International Study on Women's Health and Domestic Violence to measure physical and sexual violence. Sex-specific modified Poisson regression models were estimated to obtain prevalence ratios (PRs) and their 95% confidence intervals (CI) for the association between violence (sexual, physical or both), coercion, and mental health conditions (anxiety, depression and PTSD).

Results: Adjusted models indicated that for females, experiencing both physical and sexual violence, compared to not being exposed to violence, was a strong predictor of symptoms of anxiety (PR = 2.08; 95% CI: 1.64-2.64), PTSD (PR = 1.55; 95% CI: 1.37-1.74), and depression (PR = 1.57; 95% CI: 1.33-1.85). Among males, experiencing physical violence with additional threats made with weapons, compared to not being exposed to violence, was associated with PTSD (PR = 1.59; 95% CI: 1.05-2.42) after adjustment. Coercion during the trafficking experience was strongly associated with anxiety, depression, and PTSD in both females and males. For females in particular, exposure to both personal and family threats was associated with a 96% elevated prevalence of PTSD (PR = 1.96; 95% CI: 1.32-2.91) and more than doubling of the prevalence of anxiety (PR = 2.11; 95% CI: 1.57-2.83).

Conclusions: The experiences of violence and coercion in female and male trafficking survivors differed and were associated with an elevated prevalence of anxiety, depression, and PTSD in both females and males. Mental health services must be an integral part of service provision, recovery and re-integration for trafficked females and males.

Keywords: Anxiety; Coercion; Depression; Females; Forced labor; Human trafficking; Males; PTSD; Violence.

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Conflict of interest statement

Authors’ information

LIR is a PhD level epidemiologist with interests in addressing human trafficking and labor explotation in females and males through research, advocacy and policy. SH is a professor of epidemiology and global public health. SH is the director of the Center for Midlife Science at the School of Public Health, University of Michigan. SB is an associate professor of sociology, joint associate professor of epidemiology, and research assistant professor in the Population Studies Center at the University of Michigan. SB studies the social determinants of health disparities by gender, race/ethnicity and socioeconomic positions across societies. LK is an assistant professor of social epidemiology at the Gender Violence and Health Centre at the London School of Hygiene and Tropical Medicine (LSHTM). CZ is a professor and founder of the Gender Violence and Health Centre at the LSHTM. Both LK and CZ are experts in the field of human trafficking with years of experience in policy and service-focused evidence from various countries in Asia, Latinoamerica and Europe.

Ethics approval and consent to participate

Ethical approval for the study was granted by the LSHTM and by the National Ethics Committee for Health Research in Cambodia, the Hanoi School of Public Health in Vietnam, and the Ministry of Social Development and Human Security in Thailand. Core ethical guidance included measures to ensure that participation was voluntary and confidential, assurance that declining participation would not affect the provision of support services, avoidance and management of distress, and the offering of options for supported referral for health or other problems. The secondary analysis was approved by the University of Michigan Health Sciences and Behavioral Sciences Institutional Review Board, eResearch ID: HUM00097096.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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