Risk factors for mental disorders in women survivors of human trafficking: a historical cohort study

BMC Psychiatry

Siân Oram²  Carolina Trigub⁴  Viorel I Gorceag¹  Martin Prince²  Nicolae V Ostrovschi³  Melanie Abas² 

[1] United Nations Population Fund, Chisinau, Republic of Moldova;Institute of Psychiatry, Kings College London, London, UK;N. Testemitanu Medical and Pharmaceutical University, Chisinau, Moldova;ProGENEVA, Chisinau, Republic of Moldova

关键词: Women’s mental health;    Violence;    Trauma;    Human trafficking;    PTSD;    Depression;   

Others  :  1123989
DOI  :  10.1186/1471-244X-13-204

 received in 2012-12-07, accepted in 2013-07-23,  发布年份 2013

【 摘 要 】

Background

Previous studies have found high levels of symptoms of depression, anxiety, and post-traumatic stress disorder among women survivors of human trafficking. No previous research has described risk factors for diagnosed mental disorders in this population.

Methods

A historical cohort study of women survivors of trafficked women aged 18 and over who returned to Moldova and registered for assistance with the International Organisation for Migration (IOM). Women were approached by IOM social workers and, if they gave informed consented to participate in the study, interviewed by the research team. At 2–12 months post-return to Moldova, a psychiatrist assessed DSM-IV mental disorders blind to information about women’s pre-trafficking and post-trafficking experiences using the Structured Clinical Interview for DSM-IV (SCID). A backwards stepwise selection procedure was used to create a multivariable regression model of risk factors for DSM-IV mental disorder measured at an average of 6 months post-return.

Results

120/176 (68%) eligible women participated. At an average of 6 months post-return, 54% met criteria for any DSM-IV mental disorder: 35.8% of women had PTSD (alone or co-morbid), 12.5% had depression without PTSD and 5.8% had another anxiety disorder. Multivariable regression analysis found that childhood sexual abuse (Adjusted Odds Ratio [AOR] 4.68, 95% CI 1.04-20.92), increased number of post-trafficking unmet needs (AOR 1.80; 95% CI 1.28-2.52) and post-trafficking social support (AOR 0.64; 95% CI 0.52-0.79) were independent risk factors for mental disorder, and that duration of trafficking showed a borderline association with mental disorder (AOR 1.12, 95% CI 0.98-1.29).

Conclusions

Assessment for mental disorders should be part of re-integration follow-up care for women survivors of human trafficking. Mental disorders at that time, most commonly PTSD and depression, are likely to be influenced by a range of predisposing, precipitating and maintaining factors. Care plans for survivors of trafficking must be based on individual needs, and must apply clinical guidelines for the treatment of PTSD and of depression. Evidence is needed on the effectiveness of therapy for PTSD in survivors of human trafficking.

【 授权许可】

   
2013 Abas et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 1.

【 参考文献 】

• [1]Council of Europe: Council of Europe Convention on Action against Trafficking in Human Beings and its Explanatory Report. Warsaw 16V 2005: Council of Europe; 2005.
• [2]ILO: A Global Alliance Against Forced Labour. Geneva, Switzerland: International Labour Office; 2005.
• [3]UNHCR: Principles and guidelines on human rights and trafficking. Geneva, Switzerland: United Nations High Commissioner for Human Rights; 2002.
• [4]United Nations: Optional Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, Supplementing the United Nations Convention Against Transnational Organized Crime, G.A. Res. 55/25(2000). New York: United Nations General Assembly; 2000.
• [5]McCauley HL, Decker MR, Silverman JG: Trafficking experiences and violence victimization of sex-trafficked young women in Cambodia. Int J Gynecol Obstet 2010, 110(3):266-267.
• [6]Sarkar K, Bal B, Mukherjee R, Chakraborty S, Saha S, Ghosh A, Parsons S: Sex-trafficking, violence, negotiating skill, and HIV infection in brothel-based sex workers of eastern India, adjoining Nepal, Bhutan, and Bangladesh. J Health Popul Nutr 2008, 26(2):223-231.
• [7]Zimmerman C, Hossain M, Yun K, Gajdadziev V, Guzun N, Tchomarova M, Ciarrocchi RA, Johansson A, Kefurtova A, Scodanibbio S, et al.: The health of trafficked women: a survey of women entering posttrafficking services in Europe. Am J Public Health 2008, 98:55-59.
• [8]Oram S, Stöckl H, Busza J, Howard LM, Zimmerman C: Prevalence and risk of violence and the physical, mental, and sexual health problems associated with human trafficking: systematic review. PLoS Med 2012, 9(5):e1001224.
• [9]Turner-Moss E, Zimmerman C, Howard LM, Oram S: Labour exploitation and health: a case series of men and women seeking post-trafficking services. J Immigrant Minority Health 2013.
• [10]Gupta J, Raj A, Decker MR, Reed E, Silverman JG: HIV vulnerabilities of sex-trafficked Indian women and girls. Int J Gynecol Obstet 2009, 107(1):30-34.
• [11]Silverman JG, Decker MR, Gupta J, Maheshwari A, Patel V, Raj A: HIV prevalence and predictors among rescued sex-trafficked women and girls in Mumbai, India. JAIDS Journal of Acquired Immune Deficiency Syndromes 2006, 43(5):588.
• [12]Silverman JG, Decker MR, Gupta J, Maheshwari A, Willis BM, Raj A: HIV prevalence and predictors of infection in sex-trafficked Nepalese girls and women. JAMA 2007, 298(5):536.
• [13]Cwikel J, Chudakov B, Paikin M, Agmon K, Belmaker R: Trafficked female sex workers awaiting deportation: comparison with brothel workers. Arch Womens Ment Health 2004, 7(4):243-249.
• [14]Tsutsumi A, Izutsu T, Poudyal AK, Kato S, Marui E: Mental health of female survivors of human trafficking in Nepal. Soc Sci Med 2008, 66(8):1841-1847.
• [15]Ayazi T, Lien L, Eide AH, Malek Ruom M, Hauff E: What are the risk factors for the comorbidity of posttraumatic stress disorder and depression in a war-affected population? a cross-sectional community study in South Sudan. BMC Psychiatry 2012., 12(175) BioMed Central Full Text
• [16]Ostrovschi N, Prince M, Zimmerman C, Hotineanu M, Gorceag L, Gorceag V, Flach C, Abas M: Women in post-trafficking services in moldova: diagnostic interviews over two time periods to assess returning women’s mental health. BMC Publ Health 2011, 11(1):232. BioMed Central Full Text
• [17]Brewin CR, Andrews B, Valentine JD: Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 2000, 68(5):748.
• [18]Ehlers A, Clark DM: A cognitive model of posttraumatic stress disorder. Behav Res Ther 2000, 38(4):319-345.
• [19]Ozer EJ, Best SR, Lipsey TL, Weiss DS: Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 2003, 129(1):52.
• [20]Oram S, Ostrovschi N, Gorceag VI, Hotineanu MA, Gorceag L, Trigub C, Abas MA: Physical health symptoms reported by trafficked women receiving post-trafficking support in Moldova: prevalence, severity and associated factors. BMC Women's Health 2012, 12(20):1-19.
• [21]International Organization for Migration: Caring for Trafficked Persons- Guidance for Health Providers. Geneva: International Organization for Migration; 2009.
• [22]Zimmerman C, Watts C: WHO Ethical and Safety Recommendations for Interviewing Trafficked Women. Geneva, Switzerland: World Health Organization; 2003.
• [23]Jirapramukpitak T, Harpham T, Prince M: Family violence and its ‘adversity package’: a community survey of family violence and adverse mental outcomes among young people. Soc Psychiatry Psychiatr Epidemiol 2011, 46(9):825-831.
• [24]Straus MA: Measuring intrafamily conflict and violence: the conflict tactics (CT) scales. J Marriage Fam 1979, 41(1):75-88.
• [25]Wyatt GE: The sexual abuse of Afro-American and White-American women in childhood. Child Abuse Negl 1985, 9(4):507-519.
• [26]Barling J, O’Leary KD, Jouriles EN, Vivian D, MacEwan KE: Factor similarity of the Conflict Tactics Scale across samples, spouses and sites: issues and implications. Journal of Family Violence 1987, 2:37-54.
• [27]World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.
• [28]American Psychiatric Association: Diagostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision). Washington D.C: American Psychiatric Association; 2000.
• [29]First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Non-patient Edition (SCID-I/NP). New York: Biometrics Research, New York State Psychiatric Institute; 2002.
• [30]Kilpatrick DG, Resnick HS, Acierno R: Should PTSD Criterion A be retained? J Trauma Stress 2009, 22:374-383.
• [31]Andresen R, Caputi P, Oades LG: Interrater reliability of the Camberwell assessment of need short appraisal schedule. Aust N Z J Psychiatry 2000, 34:856-861.
• [32]Broadhead JC, Abas MA: Life events, difficulties and depression among women in an urban setting in Zimbabwe. Psychol Med 1998, 28(1):29-38.
• [33]Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH: The Duke-UNC functional social support questionnaire: measurement of social support in family medicine patients. Medical Care 1988, 26:709-723.
• [34]Mehta CR, Patel NR: A network algorithm for performing fisher exact test in R X C contingency-tables. J Am Stat Assoc 1983, 78:427-434.
• [35]StataCorp: Stata Statistical Software: Release 11. College Station, TX: StataCorp LP; 2009.
• [36]Brown GW, Harris TO: Social origins of depression: a study of psychiatric disorder in women. London: Tavistock; 1978.
• [37]Pereda N, Guilera G, Forns M, Gomez-Benito J: The international epidemiology of child sexual abuse: a continuation of Finkelhor (1994). Child Abuse Negl 2009, 33:331-342.
• [38]Yehuda R, LeDoux J: Response variation following trauma: a translational neuroscience approach to understanding PTSD. Neuron Review 2007, 56:19-32.
• [39]Hossain M, Zimmerman C, Abas M, Light M, Watts C: The relationship of trauma to mental disorders among trafficked and sexually exploited girls and women. Am J Public Health 2010, 100(12):2442-2449.
• [40]Laban CJ, Gernaat HBPE, Komproe IH, van der Tweel I, De Jong JTVM: Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 2005, 193:825-832.
• [41]Laban CJ, Gernaat HBPE, Komproe IH, Schreuder GA, De Jong JTVM: Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 2004, 192:843-852.
• [42]Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z: Anxiety, depression and PTSD in asylum seekers: associations with pre-migration trauma and post-migration stressors. Br J Psychiatry 1997, 170:351-357.
• [43]Ehlers A, Clark DM, Hackmann A, McManus F, Fennell M: Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behav Res Ther 2005, 43(4):413-431.
• [44]Foa EB, Ehlers A, Clark DM, Tolin DF, Orsillo SM: The Posttraumatic Cognitions Inventory (PTCI): development and validation. Psychol Assess 1999, 11:303-314.
• [45]Beck AT, Rush JA, Shaw BF, Emery G: An overview. In Cognitive Therapy of Depression. Edited by Beck AT, Rush JA, Shaw BF, Emery G. New York: The Guilford Press; 1979.
• [46]Carr C, McNulty M: Depression. In The Handbook of Adult Clinical Psychology. Edited by Carr C, McNulty M. London: Routledge; 2006.
• [47]Fergusson DM, Horwood LJ, Boden JM: Structural equation modeling of repeated retrospective reports of childhood maltreatment. Int J Methods Psychiatr Res 2011, 20(2):93-104.
• [48]NICE: Clinical Guideline 26. Post-traumatic stress disorder (PTSD): the management of PTSD in adult and children in primary and secondary care. London: NICE. Developed by the National Collaborating Centre for Mental Health; 2005.
• [49]Herman JL: Trauma and Recovery. New York: BasicBooks; 2001.
• [50]Bisson JL, Ehlers A, Matthews R, Pilling S, Richards D, Turner S: Psychological treatments for chronic posttraumatic stress disorder. Systematic review and meta-analysis. Br J Psychiatry 2007, 190:97-104.