The Relationship of Trauma to Mental Disorders Among Trafficked and Sexually Exploited Girls and Women

Mazeda Hossain, MSc; Cathy Zimmerman, PhD; Melanie Abas, MD, MSc; Miriam Light, MSc; Charlotte Watts, PhD

Disclosures

Am J Public Health. 2010;100(12):2442-2449. 

In This Article

Abstract and Introduction

Abstract

Objectives. We explored the association between traumatic events and mental health among girls and women trafficked for sexual exploitation.
Methods. We used subscales of the Brief Symptom Inventory and Harvard Trauma Questionnaire to interview 204 trafficked girls and women in 7 post-trafficking service settings. Multivariate logistic regression models based on interview data were fitted for depression, anxiety, and posttraumatic stress disorder (PTSD) separately and adjusted for pretrafficking abuse to determine impact of trafficking-related trauma exposures.
Results. Injuries and sexual violence during trafficking were associated with higher levels of PTSD, depression, and anxiety. Sexual violence was associated with higher levels of PTSD (adjusted odds ratio [AOR]=5.6; 95% confidence interval [CI]=1.3, 25.4). More time in trafficking was associated with higher levels of depression and anxiety (AOR=2.2; 95% CI=1.1, 4.5). More time since trafficking was associated with lower levels of depression and anxiety but not of PTSD.
Conclusions. Our findings inform the emerging field of mental health care for trafficked persons by highlighting the importance of assessing severity and duration of trafficking-related abuses and need for adequate recovery time. Therapies for anxiety, PTSD, and mood disorders in low-resource settings should be evaluated.

Introduction

Trafficking in persons is a human rights violation that occurs around the world. Human trafficking involves the recruitment and movement of individuals—generally by force, coercion, or deception—for the purposes of criminal exploitation or abuse.[1] Statistics on trafficking are notoriously difficult to obtain, although the International Labor Organization has estimated that approximately 12.3 million people are in situations of forced or bonded labor, half of whom are believed to be women and girls.[2]

Although men, women, and children are trafficked and exploited in such economic sectors as construction, farming, fishing, textiles, and mining, the trafficking of women and girls for forced prostitution is among the most well-recognized forms of trafficking. Because of the often extreme sexual, physical, and psychological abuses associated with this form of gender-based violence, women and girls who are trafficked and sexually exploited through forced sex work or in other circumstances such as domestic servitude, are a population of particular concern for mental health specialists.[3,4] Researchers and advocates continue to call for urgently needed psychological support services for trafficked persons—and for sexually abused women and girls in particular[5]—but there is little research-based information about the mental health needs of this population.

Some trafficked girls and women do not suffer extraordinary levels of abuse; nevertheless, assault, coercion, threats of harm to themselves and their families, and severely restricted freedom are common.[4,6] Indeed, many of the menacing tactics used to control trafficked girls and women are readily comparable with the characteristics of abuse described in the literature on torture.[7] Like torture victims, girls and women who are in a trafficking situation have little ability to predict ormanage events that affect their health and safety. Many are unable, for example, to determine when they work or sleep, what they eat, howmany and which clients they accept, or whether they protect themselves by condom use, and a significant number are subjected to sudden physical punishment. ''Unpredictability'' and ''uncontrollability'' are theorized to be predictive of more intense or prolonged psychological reactions to abuse.[8]

The association between such experiences and an increased risk of posttraumatic stress disorder (PTSD) and depression has been identified in other situations of trauma,[9,10] such as interpersonal violence,[11] and co-occurrence of these symptoms is also frequently found.[12,13] Women trafficked for sexual exploitation have also commonly experienced violence prior to being trafficked, which may have contributed to their vulnerability to being trafficked and may put them at greater risk of mental disorders later.

There is currently only a small body of published research on the health consequences of any form of human trafficking, and there is an extremely limited body of research on the mental health consequences of trafficking. Most trafficking-related health studies have focused on sexually transmitted infections among women trafficked for sexual exploitation, particularly HIV in Asia.[14,15] A study on mental health that was carried out with women in Nepal who were trafficked for sex work and various forms of labor (n=164) found that sexually exploited women reported higher levels of anxiety, depression, and PTSD than did women exploited for other purposes.[16] An earlier study that explored the mental health of migrant sex workers awaiting deportation in Israel (n=47) reported that 79% had depression symptoms and 17% had symptoms of PTSD.[17] A small study in Greece found that women who were victims of trafficking (n=11) had a higher risk of developing PTSD than did other abused women.[18]

Our earlier findings on women receiving posttrafficking services in Europe (n=197) highlighted women's exposure to multiple forms of abuse and the high symptom levels of PTSD, depression, and anxiety among survey participants, but we did not examine the links between their symptoms and risk factors.[4] In the current study, we sought to identify associations between girls' and women's experiences prior to and during the period when they were trafficked and symptoms of common mental disorders.

Given the absence of evidence on common mental disorders in the posttrafficking care setting, we decided a priori to measure anxiety, depression, and PTSD separately. Specifically, given our earlier developmental work,[4] we wanted to test whether posttrafficking mental health symptoms could be explained by trafficking-related exposures to violence, independent of experiences of violence before trafficking. We also wanted to explore the extent to which any of the trafficking-related exposures were associated with anxiety, depression, or PTSD. This is the first study to test such associations among a cohort of girls and women entering posttrafficking assistance centers and to consider the implications for policies and services that respond to the needs of this vulnerable and often stigmatized group.[4]

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