Sex trafficking and commercial sex: outcomes in suicide ideation and economic strain among young women.

INTRODUCTION

Documenting the effects of sex trafficking on survivors' health, psychological, and economic needs is pivotal for designing responsive and comprehensive interventions. Although women engaged in commercial sex may be at heightened risk of experiencing sex trafficking, there is limited evidence about how outcomes may differ among women who may be survivors of sex trafficking and those who have not experienced sex trafficking. We examine differences in suicidality, economic strain, food security, and self-efficacy by sex trafficking classification and tested whether economic strain, food security, and self-efficacy were associated with suicidality beyond trafficking classification.

METHODS

We analyzed endline survey data from women engaged in commercial sex in the artisanal and small-scale gold mining area of Kédougou, Senegal, recruited using link-tracing sampling, and estimated survey-weighted descriptive and regression models of suicidality severity and any suicidality in relation to sex trafficking classification, economic strain, food security, self-efficacy, and age. We also constructed four trafficking experience domains and a cumulative domain count to examine heterogeneity beyond a binary classification.

RESULTS

In the full analytic sample (N = 842), 450 respondents (53.4%) were classified as individuals who experienced sex trafficking. In survey-weighted multivariable models adjusting for age, economic strain, food security, and self-efficacy, sex trafficking classification was not independently associated with suicidality. Greater economic strain was associated with higher suicidality severity, whereas higher self-efficacy was associated with lower severity. In the full sample, food security showed a trend toward lower suicidality (p <.10). Findings were consistent when suicidality was modeled as a binary outcome. Domain-based trafficking indicators differed markedly by trafficking classification, but no single domain uniquely predicted suicidality after adjustment; restriction of freedom of movement showed the most consistent trend, and cumulative domain exposure showed a modest dose-response association with suicidality severity.

DISCUSSION: Suicidality among women engaged in commercial sex was more strongly associated with economic strain and self-efficacy than with binary sex trafficking classification. Findings support integrated responses that address material hardship and strengthen coping capacity, while screening approaches may benefit from capturing cumulative trafficking-related harms and indicators of restricted freedom. The distinction between commercial sex and sex trafficking is complex and blurred, and interventions should not exclude those not identified as sex trafficking victims because they may present similar needs to those identified as victims of sex trafficking.