Journal Article

Longitudinal experiences and risk factors for common mental health problems and suicidal behaviours among female sex workers in Nairobi, Kenya

Okumu, Monica, Zaina Jama, Irungu, Erastus, Nyariki, Emily, Kungu, Mary, Seeley, Janet, Weiss, Helen A, Beattie, Tara S, Kabuti, Rhoda, Chrispo Nyabuto, Kaul, Rupert, Gafos, Mitzy, Beksinska, Alicja, Kimani, Joshua, Ngurukiri, Pauline, Panneh, Mamtuti, Shah, Pooja, Babu, Hellen

2022

Overview

BackgroundFemale sex workers (FSWs) are at high risk of mental health problems and suicide risk. Few longitudinal studies have examined risk factors for poor mental health among FSWs.MethodsMaisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme clinics across Nairobi. Behavioural-biological survey data were collected at baseline (n = 1003, June–December 2019), midline (n = 366) (Jan–March 2020) and endline (n = 877) (June 2020–Jan 2021). Women reporting mental health problems were offered counselling services. Multivariable mixed logistic regression models were used to examine factors associated with mental health problems and suicidal behaviours.ResultsThere was a decline in the proportion of women reporting any mental health problem (depression and/or anxiety and/or PTSD) (baseline: 29.9%, midline: 13.3%, endline: 11.8%). There was strong evidence that any mental health problem was associated with recent hunger (aOR 1.99; 95% CI 1.37–2.88) and recent violence from non-intimate partners (2.23; 95% CI 1.55–3.19). Recent suicidal behaviour prevalence was similar across survey rounds (baseline: 10.2%; midline: 10.2%; endline: 10.4%), and was associated with recent violence from non-intimate partners (aOR 1.96; 95% CI 1.31–2.95), recent hunger (aOR 1.69; 95% CI 1.15–2.47) and having an additional employment to sex work (aOR 1.50; 95% CI 1.00–2.23).ConclusionsOur study found a decline in mental health problems but high levels of persistent suicidal behaviours among FSWs. Syndemic risk factors including food insecurity and violence were longitudinally associated with mental health problems and recent suicidal behaviours. There is a need for accessible mental health services for FSWs, alongside structural interventions addressing poverty and violence.

• Publisher: Cambridge University Press
• Subject: Alcohol use / Anxiety / Behavior / Behavior problems / Clinics / Counseling / Counseling services / COVID-19 / Data collection / Disease transmission / Domestic violence / Drug use / Employment / Females / Food security / Health behavior / Health problems / Healthy food / High risk / Hunger / Intervention / Intimacy / Job insecurity / Literacy / Longitudinal studies / Low income groups / Mental depression / Mental disorders / Mental health / Mental health services / Outreach programs / Polls & surveys / Post traumatic stress disorder / Poverty / Questionnaires / Risk factors / Sex industry / Sex workers / Sexually transmitted diseases / Socioeconomic factors / STD / Suicidal behavior / Suicide / Suicides & suicide attempts / Systematic review / Violence / Women / Womens health / Work / Working women