Mental health, violence and psychological coercion among female and male trafficking survivors in the greater Mekong sub-region: a cross-sectional study

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.

Mental Health of Human trafficking; A Systematic Review

“…Characteristics of participants in 14 studies were described as follows: characteristics of study participants in Ethiopia were male and female under the age of 18 years old (Gezie et al, 2018). Cambodia, Thailand, Vietnamese were male, female, adolescents and children aged 10-17 years (Iglesias-rios et al, 2018;Aberdein & Zimmerman, 2015), Moldova special for female aged >18 years (Abas et al, 2013), Ghana special for girls and female without mentioning age (Okech et al, 2018), US to keep track of medical records of patients <18 years (Moore, Houck, Hirway, Barron, & Goldberg, 2017). South London and East London in search of medical records of children and women up to 30 years (Cary et al, 2016;Oram et al, 2015) India, Laos, Nepal without specifying gender and age, East Nusa Tenggara for women aged 21-37 years (Kiling-Bunga, 2019) and the rest did not mention the place, age, or gender of the participants (Rafferty, 2018).…”

“…Human trafficking is not a new problem in the world as a global phenomenon which has implications for the health and human rights (Iglesias-rios, Harlow, Burgard, Kiss, & Zimmerman, 2018). Human trafficking is modern form of slavery in which the perpetrators of financial gain through the exploitation of the victim.…”

“…Human trafficking is modern form of slavery in which the perpetrators of financial gain through the exploitation of the victim. UN issues protocol to prevent, suppress and punish trafficking in persons especially women and children (Iglesias-rios et al, 2018). Forms of exploitation by perpetrators of trafficking (Oram, Khondoker, Abas, Broadbent, & Howard, 2015) are violence, fraud, coercion to make money from victims through employment or commercial sex workers (Brace, Sanders, Oommen, & Brace, 2018).…”

“…exploitation implications negative on health that makes the victim isolated from society (Rafferty, 2018). In fact, the victim vulnerable to physical illness acute/chronic and mental health disorders (Iglesias-rios et al, 2018). The victim very likely to experience anxiety, depression and PTSD.…”

“…Mental disorders are continuing according to the condition of victims plus predisposing factors aggravate the situation (Abas et al, 2013) such as differences in experiences of violence on female victims and male. The prevalence of anxiety, depression, and PTSD in women victims higher than male victims (Iglesias-rios et al, 2018). Based on the description above, the systematic review and summarize it wants to identify mental health issues to the victims of human trafficking.…”