Abstract
BackgroundHuman 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.MethodsWe 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).ResultsAdjusted 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).ConclusionsThe 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.
Highlights
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
It is known that females trafficked for commercial sex and domestic work are subjected to high levels of sexual violence [4, 6]
Systematic evaluation on the implementation, delivery, and outcomes of mental health interventions is essential for treatment programs, stakeholders and policy makers to improve care and bring accountability to the care of trafficking survivors. In conclusion, it is important for policy makers and stakeholders to consider the complex and severe effects that violence and coercion inflict on the mental health of survivors of trafficking
Summary
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. Perpetrators may take advantage of the inherent characteristics of the particular labor sector, such as its informality or engagement of irregular migrants, to assert their power over trafficked individuals [7] This complex asymmetrical manifestation of power, control and violence over trafficked individuals and the fact that different forms of trafficking tend to be sex specific (i.e., females are more commonly exploited for sex work, men for fishing or construction) suggests that experiences of violence (e.g., sexual, physical or both) and coercion will differ for females and males [8,9,10,11]. This in turn has led to an underestimate of the number of females and males affected by the different forms of exploitation in most locations [12, 13]
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