Longitudinal experiences and risk factors for common mental health problems and suicidal behaviours among female sex workers in Nairobi, Kenya.
Longitudinal experiences and risk factors for common mental health problems and suicidal behaviours among female sex workers in Nairobi, Kenya.
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DOI：
10.1017/gmh.2022.44
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Kimani, Joshua
中科院分区：
文献类型：
--
作者：
Beksinska, Alicja;Shah, Pooja;Kungu, Mary;Kabuti, Rhoda;Babu, Hellen;Jama, Zaina;Panneh, Mamtuti;Nyariki, Emily;Nyabuto, Chrispo;Okumu, Monica;Ngurukiri, Pauline;Irungu, Erastus;Kaul, Rupert;Seeley, Janet;Gafos, Mitzy;Beattie, Tara S.;Weiss, Helen A.;Kimani, Joshua
女性性工作者（FSW）是心理健康问题和自杀风险的高风险人群。很少有纵向研究探讨了女性性工作者心理健康状况不佳的风险因素。Maisha Fiti是一项纵向研究，研究对象是从内罗毕的性工作者外展方案诊所随机挑选的性工作者。在基线（n = 1003，2019年6月至12月）、中线（n = 366）（2020年1月至3月）和终点（n = 877）（2020年6月至2021年1月）收集行为生物学调查数据。向报告有精神健康问题的妇女提供了咨询服务。多变量混合逻辑回归模型被用来检查与心理健康问题和自杀行为相关的因素。报告任何心理健康问题（抑郁和/或焦虑和/或创伤后应激障碍）的妇女比例有所下降（基线：29.9%，中线：13.3%，终点：11.8%）。有强有力的证据表明，任何心理健康问题都与最近的饥饿（aOR 1.99; 95% CI 1.37-2.88）和最近的非亲密伴侣暴力（2.23; 95% CI 1.55-3.19）有关。在各轮调查中，最近的自杀行为流行率相似（基线：10.2%;中线：10.2%;底线：10.4%），并且与最近来自非亲密伴侣的暴力有关（aOR 1.96; 95% CI 1.31-2.95）、近期饥饿（aOR 1.69; 95% CI 1.15-2.47）和除性工作外还有其他工作（aOR 1.50; 95% CI 1.00-2.23）。我们的研究发现，女性性工作者的心理健康问题有所下降，但持续自杀行为水平较高。包括粮食不安全和暴力在内的综合风险因素与心理健康问题和最近的自杀行为纵向相关。有必要为女性性工作者提供可获得的心理健康服务，同时采取结构性干预措施解决贫困和暴力问题。
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 among FSWs. Maisha 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. 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 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). 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 suicidal behaviours. There is a need for accessible mental health services for FSWs, alongside structural interventions addressing poverty and violence.
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