Abstract:
In Nigeria, sex workers by nature of their job are exposed to high risks and multiple
health hazards including mental health. However, little is known about their mental
health challenges and consequences on the sex worker and the general public. This
study was therefore designed to investigate the influence of perceived occupational
stress, substance dependence, personality traits, age, duration of sex work, educational
levels and efficacy of hypnotherapy on depression and suicidality among brothel-based
female sex workers in the Lagos metropolis.
Beck's theory of depression and Klosky and May's theory of suicidality guided the
study. The sequential exploratory design was utilised in three phases: exploratory,
cross-sectional survey as well as pre-test and post-test quasi experimental design. In
phase one, two Focused Group Discussions (FGD), three In Depth Interviews (IDI)
and five Key Informant Interviews (KII) were conducted among brothel- based female
sex workers, ex- sex workers and key informants. In phase two, 224 brothel-based
female sex workers were selected using the Respondent-Driven Sampling (RDS)
method. The Centre for Epidemiologic Studies Depression Scale (α=0.89), MINI
Suicidality Scale (α=0.87), Sex Work Stress Questionnaire (α=0.98), The Severity of
Dependence Scale (α=0.66), Alcohol Use Disorder Identification Test (AUDIT)
(α=0.80), and the Big Five Personality Inventory-10 (Neurotism α=0.74, Extraversion
α=0.83, Openness to Experience α=0.85, Agreeableness α=0.81 and Conscientiousness
α=0.92), were administered. In phase three, 16 participants who scored high on
depression and suicidality from phase two were randomly selected and assigned into
experimental and control groups. Qualitative data were content- analysed, while
quantitative data were analysed using zero-order correlation, multiple regression, oneway ANOVA, paired t-test and Independent sample t-test at p≤0.05.
Participants’ age was =26.28±5.29 years. Prevalence for depression and suicidality
among the sex workers were 42.9%, and 21.4% respectively. Pressure, frustration,
conflicts, work load, insecurity, financial and health concerns were identified as
domains of sex work stress. Occupational stress (r=0.18) age (β = 0.19, t=2.72),
educational level (β = -0.14, t=-2.20), and duration of sex work (β = 0.24, t=3.48)
independently predicted depression; while perceived occupational stress (R2=0.07, F
(7,216= 2.19):, severity of substance use (R2=0.14,F (3,220) =11.46), Openness
personality traits (β = -0.15, t=-2.07), age, (β = -0.15, t=-2.15), educational level (β =
0-.20, t=-3.02) and duration of sex work (R2=0.07, F (3,220) =5.86) jointly predicted
suicidality. Hypnotherapy was found to be positively effective in reducing depression
(t (7) = -3.83)) and suicidality (t (7) = -9.92)) at post- test evaluation.
Occupational stress, age, educational level and duration of sex work are important
predisposing factors in depression; while openness to experience, age, educational
level influenced suicidality among brothel-based female sex workers in Lagos.
Hypnotherapy is effective in reducing depression and suicidality and therefore should
be considered in psychological management among brothel-based female sex workers
in Lagos, Nigeria.
