Prevalence and correlates of anxiety and depression among female sex workers in Dire Dawa city administration, Eastern Ethiopia

The mental health states of female sex workers (FSWs) in low and middle-income countries are least explored, with inconclusive and contradictory results about associated factors. The present study, therefore, examined the mental health states of FSWs in Dire Dawa city, Ethiopia, and associated factors. A cross-sectional explanatory sequential mixed-method research design was used. The Beck Anxiety Inventory and the Patient Health Questionnaire were used to collect data from 292 FSWs, and interviews were conducted with six respondents. Descriptive statistics, Pearson correlation, and multiple linear regressions were used to analyze the quantitative data, while the qualitative data underwent thematic analysis. Anxiety prevalence was 43.5%, where psychosocial and demographic variables explained 56% of its variations (F = 43.324, p = < 0.01, R2 = 0.557). Khat use (b = 0.371, p < 0.01), violence (b = 0.272, p < 0.01), stigma (b = 0.258, p < 0.01), tobacco use (b = 0.200, p < 0.01) and alcohol use (b = − 0.136, p < 0.01) were correlated with anxiety. Depression prevalence was 69.8%, with psychosocial and demographic variables explained 23% of its variations (F = 10.319, p < 0.01, R2 = 0.228). Experiencing violence (b = 0.298, p < 0.01), alcohol use (b = − 0.162, p < 0.01), stigma (b = 0.160, p < 0.05), and Khat use (b = 0.151, p < 0.01) were associated with depression. FSWs in Dire Dawa city experienced higher mental health problems, and psychosocial and demographic variables were significant correlates of FSWs’ mental health states. There is a timely need to provide evidence-based mental health and psychosocial interventions.