Prevalence and factors associated with major depression among female sex workers in post-conflict Gulu District : a cross-sectional study

Abstract

Introduction: Although female sex workers in post-conflict settings are more prone to major depression, the prevalence and associated factors of major depression among this population remain understudied. This study aimed to determine the prevalence and associated factors of major depression among female sex workers operating in the post-conflict Gulu district to inform appropriate integrated mental health interventions for this population. Methods: We conducted this cross-sectional study between March and June 2020 among 300 adult female sex workers operating in Gulu. Participants were selected using simple random sampling, assessed for major depression using MINI 7.0.0, and possible factors associated with major depression were assessed using a semi-structured questionnaire. Data were entered and cleaned in EPI INFO 7 and exported into STATA 14.0 for analysis using multivariable logistic regression following backward elimination to determine factors associated with major depression. Results: Mean age of participants was 26.4 years (SD ± 6), 57.7% attained primary education, 51.7% never married, and 42.1% were HIV-positive. Almost half (47.7%) of the participants were diagnosed with major depression, of whom half (50.4%) had a severe form of major depression and one-third (34.3%) had suicidal ideation. Factors that showed significant positive associations with major depression were: feeling stressed (aOR = 11.0, 95%CI: 5.77-20.86), living with HIV/AIDS (aOR= 2.32, 95%CI: 1.29-4.15), being verbally abused (aOR = 2.27, 95%CI: 1.26-4.07) and being 30 or more years of age [older age] (aOR = 1.95, 95%CI: 1.05-3.61). However, providing sexual services at the client's place (aOR=0.46, 95%CI: 0.24-0.91), using modern family planning method (aOR=0.47, 95%CI: 0.25-0.87), and daily intake of alcohol (aOR=0.50, 95%CI: 0.28-0.88) all showed significant negative associations with major depression. Conclusion and Recommendation: The findings underscore the high prevalence of major depression among female sex workers driven by multiple factors like stress, living with HIV, verbal abuse, and older age and calls for the government and the development partners to urgently address the gaps in mental health service provision for female sex workers.