Table 2. Studies on mental health and outcomes of interest.
| Author and study | Country | Sample | Mental health measure | Outcome(s) of interest | Sample size | Odds in the exposed1 | Odds in the unexposed2 | Crude OR (95% CI) | P value |
|---|---|---|---|---|---|---|---|---|---|
| VIOLENCE | |||||||||
| Berger (2018) | Swaziland | FSWs | Suicide ideation ever | Physical violence (as a result of selling sex) or sexual violence ever | 325 | 124/65 | 67/68 | 1.9 (1.2–3.0) | 0.006 |
| Cange (2019) | Burkina Faso | FSWs | Suicide ideation ever | Physical violence ever | 696 | 106/43 | 318/220 | 1.7 (1.2–2.5) | 0.008 |
| Sexual violence ever | 91/58 | 193/353 | 2.9 (2.0–4.2) | <0.001 | |||||
| Carlson (2017) | Mongolia | FSWs with harmful level of alcohol use | Depression (BSI) | Physical violence ever by client | 222 | 114/20 | 67/21 | 1.8 (0.9–3.5) | 0.09 |
| Sexual violence ever by client | 79/55 | 24/64 | 3.8 (2.1–6.9) | <0.001 | |||||
| Coetzee (2018) | South Africa | FSWs | Depression (CES-D) | Physical or sexual violence past year | 508 | 295/41 | 142/28 | 1.4 (0.8–2.4) | 0.2 |
| PTSD (PTSD-8) | 244/31 | 195/38 | 1.5 (0.9–2.6) | 0.13 | |||||
| Gu (2014) | China | FSWs who inject drugs | Depression (Chinese Depression Anxiety Stress Scale) | Verbal, physical violence or threats past 6 months by clients or gatekeepers | 200 | 25/53 | 25/97 | 1.83 (1.0–3.5) | 0.06 |
| Suicide ideation past 6 months | 33/56 | 16/94 | 3.4 (1.6–7.0) | 0.001 | |||||
| Suicide attempt past 6 months | 22/30 | 26/116 | 3.2 (1.3–7.6) | 0.01 | |||||
| Hong (2007b) |
China | FSWs | Depression (CES-D) | Sexual violence past 6 months | 278 | 17/157 | 3/101 | 1.5 (0.4–5.9) | 0.6 |
| Suicide ideation past 6 months | 18/47 | 52/337 | 2.5 (1.3–4.6) | 0.004 | |||||
| Suicide attempt past 6 months | 14/24 | 60/356 | 3.5 (1.7–7.1) | 0.001 | |||||
| Hong (2013)* Zhang (2017)* |
China | FSWs | Depression (CES-D) | Sexual, physical, or emotional violence ever by client | 1,022 | 252/170 | 244/271 | 1.6 (1.3–2.1) | <0.001 |
| Sexual, physical, or emotional violence ever by intimate partner | 241/189 | 124/189 | 1.9 (1.4–2.6) | <0.001 | |||||
| Suicide ideation or attempt ever | Sexual, physical, or emotional violence ever by client | 55/367 | 37/478 | 1.9 (1.2–3.0) | 0.006 | ||||
| Sexual, physical, or emotional violence ever by intimate partner | 52/378 | 15/298 | 2.7 (1.5–5.0) | 0.001 | |||||
| Depression (CES-D) | Sexual, physical, or emotional violence ever by intimate partner or non-partner | 358/163 | 279/222 | 1.7 (1.4–2.3) | <0.001 | ||||
| Suicide ideation or attempt ever | Sexual, physical, or emotional violence ever by intimate partner or non-partner | 79/18 | 558/367 | 2.9 (1.7–4.9) | <0.001 | ||||
| Jain (2020) | Mexico | FSWs | Depression (PHQ-9) | Physical violence ever by client | 295 | 50/56 | 57/132 | 2.1 (1.3–3.4) | 0.002 |
| Patel (2015) | India | FSWs | Depression (PHQ-2) | Physical violence past 6 months | 1,986 | 158/620 | 189/1020 | 1.4 (1.1–1.7) | 0.008 |
| Police arrest ever | 165/613 | 133/1075 | 2.2 (1.7–2.8) | <0.001 | |||||
| Patel (2016) | India | FSWs | Depression (PHQ-2) | Physical or sexual violence past year | 2,400 | 285/418 | 291/1407 | 3.3 (2.7–4.0) | <0.001 |
| Poliah (2017) | South Africa | FSWs | Depression (PHQ-9) | Violence ever during sex work | 150 | 93/27 | 17/11 | 2.2 (0.9–5.3) | 0.08 |
| Police harassment ever | 85/38 | 19/8 | 0.9 (0.4–2.3) | 0.9 | |||||
| Roberts (2018) | Kenya | HIV-negative FSWs | Depression (PHQ-9) | Sexual, physical, moderate emotional violence ever by intimate partner or non-partner | 283 | 26/4 | 197/56 | 1.8 (0.6–5.5) | 0.3 |
| PTSD (PCL-C) | 41/5 | 182/55 | 2.5 (0.9–6.6) | 0.07 | |||||
| Sagtani (2013) | Nepal | FSWs | Depression (CES-D) | Physical, sexual, or emotional violence past 6 months | 210 | 90/62 | 10/48 | 7.0 (3.2–15.1) | <0.001 |
| Shahmanesh (2009) | India | FSWs | Suicide attempt past 3 months | Sexual violence ever | 326 | 18/55 | 18/234 | 4.3 (2.1–8.7) | <0.001 |
| Sexual, physical, or verbal violence past 12 months by intimate partner | 38/55 | 29/44 | 2.3 (1.2–4.3) | 0.01 | |||||
| Sexual, physical, or verbal violence past 12 months by others | 29/44 | 40/212 | 3.5 (2.0–6.2) | 0.001 | |||||
| Police raid past 12 months | 18/55 | 32/220 | 2.3 (1.2–4.3) | 0.01 | |||||
| Sherwood (2015) | Gambia | FSWs | Sad or depressed mood for more than 2 weeks at a time in past 3 years | Sexual violence ever by client | 251 | 51/100 | 19/71 | 1.9 (1.0–3.5) | 0.05 |
| Ulibarri (2013) | Mexico | FSWs who inject drugs | Depression (CES-D) | Physical violence ever | 624 | 269/269 | 35/49 | 1.4 (0.9–2.2) | 0.1 |
| Physical violence ever by client | 108/430 | 15/69 | 1.2 (0.6–2.1) | 0.6 | |||||
| Sexual violence ever | 283/255 | 30/54 | 2.0 (1.2–3.2) | 0.006 | |||||
| Ulibarri (2014) | Mexico | HIV-negative FSWs | Psychological distress (BSI) | Physical, sexual, or emotional violence past 6 months by clients | 924 | NA | NA | 2.0 (1.6–2.4) | <0.001 |
| ALCOHOL AND DRUG USE | |||||||||
| Bitty-Anderson (2019)*, Tchankoni (2020)* | Togo | FSWs | Psychological distress (Kessler) | Harmful/hazardous alcohol (AUDIT) | 952 | 82/99 | 350/421 | 1.0 (0.7–1.4) | 1.0 |
| Coetzee (2018) | South Africa | FSWs | Depression (CES-D) | Severe binge drinking (AUDIT) | 508 | 196/174 | 81/55 | 0.8 (0.5–1.1) | 0.2 |
| PTSD (PTSD-8) | 99/96 | 179/134 | 0.8 (0.5–1.1) | 0.2 | |||||
| Hong (2007a) | China | FSWs | Depression (CES-D) | Alcohol intoxication past 6 months | 454 | 62/112 | 26/78 | 1.7 (1.0–2.9) | 0.05 |
| Suicide ideation past 6 months | 31/34 | 118/221 | 1.7 (1.0–2.9) | 0.06 | |||||
| Suicide attempt past 6 months | 21/17 | 128/288 | 2.8 (1.4–5.4) | 0.003 | |||||
| Jain (2020) | Mexico | HIV-negative FSWs | Depression (PHQ-9) | Hazardous alcohol past year (AUDIT) | 295 | 57/49 | 79/110 | 1.6 (1.0–2.6) | 0.05 |
| Polydrug use past month | 45/61 | 40/149 | 2.8 (1.6–4.6) | <0.001 | |||||
| Patel (2015) | India | FSWs | Depression (PHQ-2) | Alcohol use past 30 days | 1,986 | 493/285 | 455/751 | 2.9 (2.4–3.4) | <0.001 |
| Zhang (2014a) | China | FSWs | Depression (CES-D) | Illicit drug use ever | 1,022 | 118/403 | 67/434 | 1.9 (1.4–2.6) | <0.001 |
| Zaller (2014)***, Yang (2018)*** | China | FSWs | Depression (CES-D) | Alcohol dependent (AUDIT ≥16) | 358 | 19/32 | 76/231 | 1.8 (1.0–3.4) | 0.06 |
| Suicide ideation past 12 months | Alcohol dependent (AUDIT ≥16) | 11/84 | 22/241 | 1.4 (0.7–3.1) | 0.4 | ||||
| Depression (CES-D) | Illicit drug use ever | 15/96 | 12/235 | 3.1 (1.4–6.8) | 0.005 | ||||
| CONDOM USE | |||||||||
| Abelson (2019) | Cameroon | FSWs | Depression (PHQ-9) | Inconsistent condom use with clients ever | 2,136 | 108/274 | 391/1363 | 1.4 (1.1–1.8) | 0.013 |
| Brody (2016) | Cambodia | FSWs | Psychological distress (GHQ-12) | Inconsistent condom use with clients past 3 months | 657 | 235/49 | 322/51 | 0.8 (0.5–1.2) | 0.2 |
| Inconsistent condom use with partner past 3 months | 255/29 | 340/33 | 0.9 (0.5–1.4) | 0.6 | |||||
| Gu (2010a) | China | FSWs who inject drugs | Depression (Chinese Depression Anxiety Stress Scale) | Inconsistent condom use with clients past 6 months | 234 | NA | NA | 1.2 (1.1–1.3) | <0.001 |
| Hong (2007b) | China | FSWs | Depression (CES-D) | Inconsistent condom use with clients | 278 | 140/34 | 62/42 | 2.8 (1.6–4.8) | <0.001 |
| Patel (2015) | India | FSWs | Depression (PHQ-2) | Inconsistent condom use occasional clients | 1,986 | 274/504 | 277/928 | 1.8 (1.5–2.2) | <0.001 |
| Inconsistent condom use with regular clients | 356/41 | 342/845 | 2.1 (1.8–2.6) | <0.001 | |||||
| Shahmanesh (2009) | India | FSWs | Suicide attempt past 3 months | Inconsistent condom use with clients | 326 | 26/47 | 63/189 | 4.3 (2.1–8.7) | <0.001 |
| Shen (2016) | China | FSWs | Depression (GHQ) | No condom last sex client | 653 | 69/270 | 64/245 | 1.0 (0.7–1.4) | 1.0 |
| No condom last sex partner | 70/138 | 120/105 | 0.4 (0.3–0.7) | <0.001 | |||||
| Urada (2013) | Philippines | FSWs | Depression (CES-D) | Inconsistent condom use with clients | 143 | 47/60 | 13/23 | 1.4 (0.6–3.0) |
0.4 |
| Zaller (2014)***, Yang (2018)*** | China | FSWs | Depression (CES-D) | Inconsistent condom use with clients past 6 months | 358 | 16/95 | 16/231 | 1.6 (1.2–2.1) | 0.018 |
| Inconsistent condom use with partner past 6 months | 67/44 | 138/109 | 1.2 (0.9–1.9) | 0.4 | |||||
| HIV/STIs | |||||||||
| Bitty-Anderson (2019)*, Tchankoni (2020)* | Togo | FSWs | Psychological distress (Kessler) | HIV positive | 952 | 80/101 | 45/726 | 12.8 (8.4–19.5) | <0.001 |
| Cange (2019) | Burkino Faso | FSWs | Suicide ideation ever | HIV positive | 696 | 22/104 | 56/395 | 1.5 (0.9–2.6) | 0.14 |
| Jain (2020) | Mexico | HIV-negative FSWs | Depression (PHQ-9) | Syphilis, chlamydia, or gonorrhoea positive | 295 | 32/74 | 24/165 | 3.0 (1.6–5.4) | <0.001 |
| MacLean (2018) | Malawi | FSWs | Depression (PHQ-9) | HIV positive | 200 | 12/3 | 126/59 | 1.9 (0.5–6.9) | 0.3 |
| PTSD (PCL-C) | 10/6 | 128/56 | 0.7 (0.3–2.1) | 1.6 | |||||
| Ortblad (2020) | Uganda | FSWs | Depression (PHQ-9) | HIV positive | 711 | 57/143 | 136/375 | 1.1 (0.8–1.6) | 0.6 |
| Suicide ideation | 45/93 | 148/425 | 1.4 (0.9–2.1) | 0.11 | |||||
| Zambia | Depression (PHQ-9) | HIV positive | 682 | 65/86 | 158/373 | 1.8 (1.2–2.6) | 0.002 | ||
| Suicide ideation | 85/142 | 138/317 | 1.4 (1.0–1.9) | 0.06 | |||||
| Peitzmeier (2014) | Gambia | FSWs | Sad or depressed mood for more than 2 weeks at a time in past 3 years | HIV positive | 246 | 31/123 | 9/87 | 2.4 (1.1–5.4) | 0.03 |
| Poliah (2017) | South Africa | FSWs | Depression (PHQ-9) | HIV positive | 150 | 93/17 | 22/6 | 1.5 (0.5–4.2) | 0.5 |
| Shen (2016) | China | FSWs | Depression (GHQ) | HIV positive | 653 | 3/339 | 1/310 | 2.7 (0.3–26.5) | 0.4 |
| Syphilis positive | 13/329 | 20/291 | 0.6 (0.3–1.2) | 0.1 | |||||
| Hepatitis C positive | 8/334 | 5/306 | 1.5 (0.5–4.5) | 0.5 | |||||
1Odds in the exposed (e.g., Depression and Violence/Depression and No Violence).
2Odds in the unexposed (e.g., No Depression and Violence/No Depression and No Violence).
*Studies use same data source.
***Studies use same data source but different cut-off for depression.
Abbreviations: AUDIT, Alcohol Use Disorders Identification Test; BSI, Brief Symptom Inventory; CES-D, Centre for Epidemiological Studies Depression Scale; FSW, female sex worker; GHQ, General Health Questionnaire; HIV, human immunodeficiency virus; OR, odds ratio; PCL-C, PTSD CheckList Civilian Version; PHQ, Patient Health Questionnaire; PTSD, post-traumatic stress disorder; STI, sexually transmitted infection.