A structural equation model of perceived stigma, alcohol use, partner violence, and depressive symptoms among female sex workers in China

Background: Perceived stigma, partner violence and alcohol use disorder are prevalent among female sex workers (FSW) in China. Previous research suggested that perceived stigma and alcohol use disorder were associated with depression among FSW. Limited research is available to assess whether partner violence and social support mediate the relationships. Methods: Data were collected using a self-administered cross-sectional survey among 1,022 FSW recruited from 60 entertainment establishments in two cities of Guangxi, China. A structural equation modeling (SEM) was employed including a measurement model using confirmatory factor analysis to examine the indicators of the latent constructs and relationships between the latent constructs, and a final structural model to test the hypothesized relationships. Results: SEM results indicated that perceived stigma was directly positively associated with depressive symptoms (standardized path coefficient =0.29, p<0.001). Alcohol use disorder (AUDIT scale) also was directly positively associated with depressive symptoms (standardized path coefficient =0.25, p<0.001). Alcohol use disorder was positively associated with partner violence, and partner violence was positively associated with depressive symptoms. Partner violence mediated the effects of alcohol use order on depressive symptoms. Perceived social support medicated the effect of stigma on depression. In addition, perceived stigma was highly correlated with alcohol use disorder. Conclusions: Partner violence strengthens the effect of alcohol use on depressive symptoms. Future prevention intervention aimed to improve mental health of FSW need to reduce partner violence, stigma and alcohol use disorder.