Abstract
BackgroundIn Cambodia, there has been an increase in entertainment work as a result of the breakdown of the traditional brothel-based sex industry, presenting new challenges to addressing the health issues and needs of people working in the entertainment industry. This study aims to identify factors associated with psychological distress among female entertainment workers (FEWs) in Cambodia.MethodsA two-stage cluster sampling method was used to randomly select 657 FEWs from entertainment establishments in Phnom Penh and Siem Reap in April and May 2014 for interviews using a structured questionnaire. Psychological distress was measured using the General Health Questionnaire (GHQ-12), and multivariate logistic regression analysis was conducted.ResultsAlmost half of FEWs (43.2 %) had a higher level of psychological distress (GHQ-12 > 3), while 19.5 % reported having suicidal thoughts, and 7.3 % reported having attempted to commit suicide in the past 3 months. Controlling for confounding factors, women with a higher level of psychological distress were significantly more likely to rate their overall health (AOR = 1.88, 95 % CI 1.20 to 2.94) and quality of life (AOR = 2.39, 95 % CI 1.47 to 3.87) as poor. They were also significantly more likely to have suicidal ideation (AOR = 2.41, 95 % CI 1.45 to 3.76), rate their HIV risk as higher than the general population (AOR = 0.48, 95 % CI 0.31 to 0.74), have been forced to drink at work (AOR = 1.77, 95 % CI 1.19 to 2.62), have had clients requesting not to use a condom (AOR = 3.48, 95 % CI 1.14 to 10.62), be not able to find condoms when they needed it (AOR = 0.64, 95 % CI 0.45 to 0.93), have had a family member who said hurtful things to them during childhood (AOR = 1.84, 95 % CI 1.24 to 2.75), and have had a parent or guardian who had been physically abused (AOR = 1.93, 95 % CI 1.34 to 2.82).ConclusionsFEWs in Cambodia experience high levels of psychological distress, which likely stems from both past negative experiences and current working conditions. For women that are experiencing psychological distress, intervention programs aimed at improving mental health should specifically address substance use, condom availability and negotiation skills, and suicide risk.
Highlights
In Cambodia, there has been an increase in entertainment work as a result of the breakdown of the traditional brothel-based sex industry, presenting new challenges to addressing the health issues and needs of people working in the entertainment industry
This study aims to identify the factors associated with psychological distress among female entertainment workers (FEWs) in Cambodia
Study sites, sampling, and training Data used for this study were collected in April and May 2014 as part of an impact evaluation of the Sustainable Action against Human immunodeficiency virus (HIV) and Acquired immune deficiency syndrome (AIDS) in Communities (SAHACOM) Project implemented by KHANA, the largest national non-governmental organization providing integrated HIV prevention, care, and support services at the community level in Cambodia
Summary
In Cambodia, there has been an increase in entertainment work as a result of the breakdown of the traditional brothel-based sex industry, presenting new challenges to addressing the health issues and needs of people working in the entertainment industry. FEWs, in particular those who participate in sex work, are at greater risk for health problems than the general women population due to occupational hazards such as engaging in unsafe sex, exposure to violence, and drug use [1,2,3] This group can be difficult to reach with health services due to the hidden and stigmatizing nature of their work [2, 3]. Available evidence suggests that FSWs experience worse mental health outcomes than the general public such as high rates of anxiety, depression, posttraumatic stress disorder (PTSD), and psychological distress [4,5,6,7] These poor mental health outcomes have been associated with experiences of violence, childhood trauma, drug addiction, and the experience of stigma as reported in a review of the literature [8]. The existing evidence does not establish a temporal relationship but suggests that there is likely a bi-directional relationship between poor mental health and sex work
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