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Exploring the etiology of depression among urban women in treatment for substance use disorders: The role of sex work

Thomas M. Brady, PhD, Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Parklawn Building, 5600 Fishers Lane, Suite 16-105, Rockville, MD 20857, (301) 443-9049, tbrady@samhsa.gov

Women who practice sex work experience multiple stressful events that put them at risk for onset of depression. History of physical and sexual abuse are also associated with depression in women with substance use disorders (SUD). The purpose of this paper is to test the association of sex work with recent symptoms of major depression (SMD) while adjusting for other lifetime traumas. Methods: The records of 2,776 women entering addiction treatment were used from the Drug Abuse Treatment Outcome Studies (DATOS). The dependent variable was SMD, a measure constructed by identifying female clients who presented five or more DSM-IV symptoms of major depression during a two-week period (depressed mood, diminished interest in activities, loss of appetite, difficulty sleeping, psychomotor retardation, loss of energy, feelings of worthlessness, diminished ability to concentrate and recurrent thoughts of death). A multivariate logistic regression model was developed that controlled for age, education, race/ethnicity, homelessness, and drug use as well as self-reported childhood sexual abuse and lifetime history of psychical abuse. Results: Women who reported exchanging sex for money or drugs were at elevated risk of SMD compared to women who did not report sex trading (Odds ratio=1.4, 95% C.I. (1.1, 1.8), Wald ChiSq. = 8.995, p < 0.01). Conclusions: The data suggest that women with a history of sex work in treatment for SUD may be at risk of major depression. Substance abuse treatment programs need to address the mental health as well as the drug abuse treatment needs of these female clients.

Learning Objectives:

Keywords: Sex Workers, Depression

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Sex Workers: Voluntary and Forced

The 132nd Annual Meeting (November 6-10, 2004) of APHA