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Mental health, physical impairment and violence among FSWS in North Karnataka, South India: a story of intersecting vulnerabilities

Published online by Cambridge University Press:  18 June 2021

Alicja Beksinska*
Affiliation:
Department of Global Health and Development, London School of Hygiene and Tropical Medicine
Tara S Beattie
Affiliation:
Department of Global Health and Development, London School of Hygiene and Tropical Medicine
Lucy Platt
Affiliation:
Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine
Parinita Bhattacharjee
Affiliation:
Karnataka Health Promotion Trust
Ravi Prakash
Affiliation:
Karnataka Health Promotion Trust
Satyanarayana Ramanaik
Affiliation:
Karnataka Health Promotion Trust, University of Manitoba, Department of Community Health Sciences
Kavitha Dibbadahalli
Affiliation:
Karnataka Health Promotion Trust
Martine Collumbien
Affiliation:
Department of Global Health and Development, London School of Hygiene and Tropical Medicine
Mitzy Gafos
Affiliation:
Department of Global Health and Development, London School of Hygiene and Tropical Medicine
Calum Davey
Affiliation:
Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine
Charlotte Watts
Affiliation:
Department of Global Health and Development, London School of Hygiene and Tropical Medicine
Shajy Isac
Affiliation:
Karnataka Health Promotion Trust, University of Manitoba, Department of Community Health Sciences
Rachel Jewkes
Affiliation:
Gender and Health Division, South African Medical Research Council
*
*corresponding author.
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Abstract

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Aims

This study examines the prevalence and associations between recent violence experience, mental health and physical health impairment among Female Sex Workers (FSWs) in north Karnataka, India.

Background

Multi-morbidity, in particular the overlap between physical and mental health problems, is an important global health challenge to address. FSWs experience high levels of gender-based violence, which increases the risk of poor mental health, however there is limited information on the prevalence of physical health impairments and how this interacts with mental health and violence.

Method

We conducted secondary analysis of cross-sectional quantitative survey data collected in 2016 as part of a cluster-RCT with FSWs called Samvedana Plus. Bivariate and multivariate analyses were used to examine associations between physical impairment, recent (past 6 months) physical or sexual violence from any perpetrator, and mental health problems measured by PHQ-2 (depression), GAD-2 (anxiety), any common mental health problem (depression or anxiety), self-harm ever and suicidal ideation ever.

Result

511 FSWs participated. One fifth had symptoms of depression (21.5%) or anxiety (22.1%), one third (34.1%) reported symptoms of either, 4.5% had ever self-harmed and 5.5% reported suicidal ideation ever. Over half (58.1%) reported recent violence. A quarter (27.6%) reported one or more chronic physical impairments. Mental health problems such as depression were higher among those who reported recent violence (29%) compared to those who reported no recent violence (11%). There was a step-wise increase in the proportion of women with mental health problems as the number of physical impairments increased (e.g. depression 18.1% no impairment; 30.2% one impairment; 31.4% ≥ two impairments). In adjusted analyses, mental health problems were significantly more likely among women who reported recent violence (e.g. depression and violence AOR 2.42 (1.24–4.72) with rates highest among women reporting recent violence and one or more physical impairments (AOR 5.23 (2.49–10.97).

Conclusion

Our study suggests multi-morbidity of mental and physical health problems is a concern amongst FSWs and is associated with recent violence experience. Programmes working with FSWs need to be mindful of these intersecting vulnerabilities, inclusive of women with physical health impairments and include treatment for mental health problems as part of core-programming.

Samvedana Plus was funded by UKaid through Department for International Development as part of STRIVE (structural drivers of HIV) led by London School of Hygiene and Tropical Medicine and the What Works to Prevent Violence Against Women and Girls Global Programme led by South African Medical Research Council

Type
Research
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists
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