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. 2021 Oct 14;21(1):503.
doi: 10.1186/s12888-021-03515-5.

Prevalence and correlates of common mental health problems and recent suicidal thoughts and behaviours among female sex workers in Nairobi, Kenya

Alicja Beksinska  1 , Zaina Jama  2 , Rhoda Kabuti  2 , Mary Kungu  2 , Hellen Babu  2 , Emily Nyariki  2 , Pooja Shah  3 ; Maisha Fiti Study Champions; Chrispo Nyabuto  2 , Monica Okumu  2 , Anne Mahero  2 , Pauline Ngurukiri  2 , Erastus Irungu  2 , Wendy Adhiambo  2 , Peter Muthoga  2 , Rupert Kaul  4 , Janet Seeley  3 , Tara S Beattie  3 , Helen A Weiss #  5 , Joshua Kimani #  2
Collaborators, Affiliations

Prevalence and correlates of common mental health problems and recent suicidal thoughts and behaviours among female sex workers in Nairobi, Kenya

Alicja Beksinska et al. BMC Psychiatry. .

Abstract

Background: Adverse childhood experiences (ACEs), poverty, violence and harmful alcohol/substance use are associated with poor mental health outcomes, but few studies have examined these risks among Female Sex Workers (FSWs). We examine the prevalence and correlates of common mental health problems including suicidal thoughts and behaviours among FSWs in Kenya.

Methods: Maisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme (SWOP) clinics across Nairobi. Baseline behavioural-biological survey (n = 1003) data were collected June-December 2019. Mental health problems were assessed using the Patient Health Questionnaire (PHQ-9) for depression, the Generalised Anxiety Disorder tool (GAD-7) for anxiety, the Harvard Trauma Questionnaire (HTQ-17) for Post-Traumatic Stress Disorder (PTSD) and a two-item tool to measure recent suicidal thoughts/behaviours. Other measurement tools included the WHO Adverse Childhood Experiences (ACE) score, WHO Violence Against Women questionnaire, and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Descriptive statistics and multivariable logistic regression were conducted using a hierarchical modelling approach.

Results: Of 1039 eligible FSWs, 1003 FSWs participated in the study (response rate: 96%) with mean age 33.7 years. The prevalence of moderate/severe depression was 23.2%, moderate/severe anxiety 11.0%, PTSD 14.0% and recent suicidal thoughts/behaviours 10.2% (2.6% suicide attempt, 10.0% suicidal thoughts). Depression, anxiety, PTSD and recent suicidal thoughts/behaviours were all independently associated with higher ACE scores, recent hunger (missed a meal in last week due to financial difficulties), recent sexual/physical violence and increased harmful alcohol/substance. PTSD was additionally associated with increased chlamydia prevalence and recent suicidal thoughts/behaviours with low education and low socio-economic status. Mental health problems were less prevalent among women reporting social support.

Conclusions: The high burden of mental health problems indicates a need for accessible services tailored for FSWs alongside structural interventions addressing poverty, harmful alcohol/substance use and violence. Given the high rates of ACEs, early childhood and family interventions should be considered to prevent poor mental health outcomes.

Keywords: Anxiety; Depression; Female sex workers; Kenya; Mental health; Post-traumatic stress disorder; Suicide.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual framework for exploring risk factors for mental health problems across the life course
Fig. 2
Fig. 2
Overlap between common mental health problems [33]
Fig. 3
Fig. 3
Overlap between mental health problems and recent suicidal thoughts/behaviours
Fig. 4
Fig. 4
Overlap between any mental health problem, recent suicidal thoughts/behaviours and harmful alcohol/substance use
See this image and copyright information in PMC

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