Mental Health Disorders among Truck Stop and Street Sex Workers

Purpose: The prevalence of mental health disorders among the lowest tiers of the sex worker hierarchy is largely unknown. This group has been characteristically described as experiencing complex trauma, with factors that compound trauma such as mental illness, substance use disorders, and the engagement in survival sex just to meet basic needs. Knowing the burden of mental health disorders will inform what resources and training are needed at primary care and emergency centers to ensure compassionate trauma-sensitive care. We investigated the prevalence of mental health disorders among truck stop and street sex workers with experiences of survival sex and whether the prevalence of mental health disorders differed by race, age, and gender identity. Methods: A secondary data analysis was conducted using data collected from a cross-sectional study of street and truck stop sex workers in the Dallas-Fort Worth Metroplex (n=601, 2007-2013). Baseline demographics (race, gender, age) and prevalence of self-reported and diagnostic mental health disorders (DSM-IV Diagnostic Criteria) were abstracted from assessment forms completed on the street by mental health and social worker professionals. Chi-square tests (α criteria < 0.05) were used to compare the prevalence of each mental disorder (bipolar, schizophrenia, major depression, suicide ideation) by gender (female, male, transgender), race (white, non-white), and age (< 35 years and 35+ years). Pearson's correlation coefficient was used to determine correlation between number of self-reported mental health disorders and number of physical health disorders and separately for the number of drugs. Results: Majority of participants were non-white (83%), 56% were 35 years of age or older, 4% self-identified as transgender, and 28% reported history of either physical and/or emotional abuse. At least one mental disorder was diagnosed in 83% of participants and 62% reported >1 mental disorder. Prevalence of bipolar disorder among non-whites was higher than that of whites. The prevalence of schizophrenia among those 35 years of age or older was higher than their younger counterparts. A significant correlation was observed between number of mental disorders and number of drugs used, but not with the number of physical health conditions. Conclusion: This analysis highlights the disproportionate mental health burden experienced by truck stop and street sex workers with experiences of survival sex. Preliminary findings from this study suggest there are differences in the prevalence of mental health disorders between race and age, but not gender identity compared to the US population. Data suggests that comprehensive and integrated treatment trauma-informed approaches from health care, mental health, and substance abuse agencies may best be targeted to specific subgroups in this underserved population. Study protocols for this secondary analysis were approved by the North Texas Regional IRB (#2021-135), as were the original projects from which data were collected (IRB #2014-012 and IRB #2008-053).