Socio-ecological factors associated with depression, suicidal ideation and suicidal attempt among female injection drug users who are sex workers in China

Abstract

ObjectiveFemale injection drug users who are also sex workers (FSW-IDUs) occupy a pivotal population in HIV transmission, whereas their mental health problems are largely overlooked. We aimed to investigate prevalence and associated socio-ecological factors of depression, suicidal ideation and suicidal attempts among FSW-IDUs in China. MethodsUsing snowball sampling methods, 200 FSW-IDUs were recruited from communities in Liuzhou, China. Anonymous face-to-face interviews were administered by trained doctors. ResultsThirty-nine percent of participants had severe or extremely severe depression, 44.7% had suicidal ideation in the last six months and 26.8% had suicidal attempts in the last six months. After adjusting for background variables, self-stigma was significantly associated with severe or extremely severe depression (OR=1.18, 95% CI: 1.07–1.31). Self-stigma (OR=1.08, 95% CI: 1.01–1.15), depression (OR=1.11, 95% CI: 1.05–1.18), having completely broken up with family (OR=2.60, 95% CI: 1.35–5.02) and having been abused by clients or gatekeepers (OR=2.15, 95% CI: 1.32–3.50) were associated with suicidal ideation in the last six months, while self-stigma (OR=1.03, 95% CI: 1.10–1.16), depression (OR=1.12, 95% CI: 1.04–1.20) and being abused by clients or gatekeepers (OR=2.15, 95% CI: 1.09–4.24) were associated with suicidal attempt in the last six months. In mediation analyses, the associations between self-stigma and the two suicidal outcomes were fully mediated by depression. ConclusionsThere are unmet mental health needs of FSW-IDUs. Screening of mental health problems should be integrated into current HIV-related services. Psychological intervention efforts should include components such as self-stigma, family support and abuse.