Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2018 Jul 5;13(7):e0196759. doi: 10.1371/journal.pone.0196759. eCollection 2018.
Sex workers in South Africa are exposed to high levels of violence, yet little is known about their mental health needs. This study aims to understanding the prevalence of depression and post-traumatic stress disorder (PTSD) and their risk factors amongst female sex worker (FSWs) in Soweto, South Africa.
A cross-sectional, respondent-driven sampling (RDS) survey enrolled 508 FSWs. Raw and RDS adjusted data were analyzed using a chi-squared test of association and multinomial regression for risk factors associated with depression and PTSD.
Symptoms of severe depression were prevalent amongst 68.7%, PTSD was 39.6%, and 32.7% suffered from comorbid PTSD and depression. Experiencing ≥3 kinds of violence increased the likelihood of comorbidity (RRR4.11, 95% CI 1.52-11.12,p = 0.005). Internalised stigma increased the likelihood of one mental health condition (RRR1.25, 95% CI 1.10-1.42,p = 0.001), higher self-esteem was associated with independent (RRR1.14, 95% CI 1.05-1.25,p = 0.002) and comorbid conditions (RRR1.17, 95% CI 1.07-1.27,p = 0.001).
Our findings highlight the sizable burden of treatable mental health conditions among FSWs in Soweto. This was driven by multiple exposures to violence, sex work related discrimination and overall moderate levels of self-esteem masking defence mechanisms. This suggests the urgent need to design and integrate services geared to the mental health needs for this population.
南非的性工作者面临着高度的暴力风险，但他们的心理健康需求却知之甚少。本研究旨在了解南非索韦托地区女性性工作者（FSW）中抑郁和创伤后应激障碍（PTSD）的患病率及其危险因素。
采用横断面、应答驱动抽样（RDS）调查方法，共招募了 508 名 FSW。采用卡方检验和多变量回归分析，对抑郁和 PTSD 的危险因素进行分析。
68.7%的性工作者存在严重抑郁症状，39.6%的性工作者患有 PTSD，32.7%的性工作者同时患有 PTSD 和抑郁。经历≥3 种类型的暴力会增加共病的可能性（RRR4.11，95% CI 1.52-11.12，p=0.005）。内化的耻辱感会增加一种心理健康状况的可能性（RRR1.25，95% CI 1.10-1.42，p=0.001），较高的自尊心与独立的（RRR1.14，95% CI 1.05-1.25，p=0.002）和共病（RRR1.17，95% CI 1.07-1.27，p=0.001）相关。
我们的研究结果强调了索韦托地区 FSW 中可治疗的心理健康状况的负担。这是由多种暴力暴露、与性工作相关的歧视以及整体中等水平的自尊心掩盖了防御机制所驱动的。这表明迫切需要为这一人群设计和整合针对心理健康需求的服务。
