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

[摘要] Background. Female 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 amongFSWs.Methods. Maisha Fiti is a longitudinal study among FSWs randomly selected from SexWorker Outreach Programme clinics across Nairobi. Behavioural-biological survey datawere collected at baseline (n = 1003, June–December 2019), midline (n = 366) (Jan–March2020) and endline (n = 877) (June 2020–Jan 2021). Women reporting mental health problemswere offered counselling services. Multivariable mixed logistic regression models were used toexamine factors associated with mental health problems and suicidal behaviours.Results. There 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 recenthunger (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 violencefrom non-intimate partners (aOR 1.96; 95% CI 1.31–2.95), recent hunger (aOR 1.69; 95% CI1.15–2.47) and having an additional employment to sex work (aOR 1.50; 95% CI 1.00–2.23).Conclusions. Our 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 suicidalbehaviours. There is a need for accessible mental health services for FSWs, alongside structural interventions addressing poverty and violence.

[学科分类] 化石学

[关键词] Female sex workers;mental health