The prevalence and factors associated with common mental health conditions among female sex workers in Dar es salaam, Tanzania

Female sex workers (FSWs) encounter increased risk of negative health consequences, including common mental health conditions (CMCs) in Tanzania. The prevalence and association of the CMCs with social, structural, and violence-related factors remains to be fully understood. We assessed the prevalence of CMCs and associations with socio-structural risk factors among FSW. We used Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Harvard Trauma Questionnaire-17 (HTQ-17), World Health Organization violence against women Instrument, Alcohol Use Disorder Identification Test (AUDIT), and a two-item questionnaire to measure depression, anxiety, post-traumatic stress disorder (PTSD), violence, alcohol use risks, and suicidal behavior, respectively. Descriptive statistics and logistic regression were used in data analyses, with a significance level set at 0.05. The prevalence of depression, anxiety, and PTSD was 49.2%, 40.4% and 20.2%, respectively. Thirty-five percent had ever had suicidal thoughts, and 7.7% had ever attempted suicide. Being raped by a gang of men was significantly associated with depression, anxiety, and PTSD. Non-intimate partner violence (non-IPV) was significantly associated with depression, anxiety, and suicidal behavior, while both non-consensual sex at sexual debut and duration since last vaginal sex were significantly associated with PTSD and suicidal behavior. Some factors were condition-specific: religion and client volume in the past seven days were associated with anxiety; living with three or more children and sex work mobility were associated with increased PTSD; while place of residence, extra source of income, and engagement in anal sex in the past six months were significantly associated with suicidal behaviors. Alcohol use partially and fully mediated the relationship between non-IPV and anxiety and PTSD, respectively, whereas sex work mobility showed no moderation effect on the relationship between non-IPV and any CMC. Innovative and integrative mental health care targeting critical risk factors among FSWs is essential to mitigate the increasing prevalence of CMCs.