Modern Slavery: Violence, Coercion and Mental Health of Female and Male Trafficking Survivors in the Mekong Sub-region: Cambodia, Thailand, and Vietnam

Abstract

Background: Human trafficking is a crime and a violation of fundamental human rights that affects 40.3 million people worldwide. The Asia Pacific region accounts for the largest number of forced laborers including children, adolescents, and adults of both sexes. Previous research has reported a high prevalence of poor mental health among trafficking survivors, but limited research has assessed the sex-specific associations of trafficking-related exposures on the mental health of survivors of trafficking across different trafficking sectors Methods: This dissertation uses data from the Study on Trafficking, Exploitation and Abuse in the Mekong Sub-region (STEAM). Aim 1 analyzes first the association of violence (sexual, physical, or both) and coercion (personal and family threats) with mental health symptoms (anxiety, depression, and PTSD) by sex. Aim 2 examines how the living, working, and legal and economic insecurity conditions during trafficking affect the mental health of trafficking survivors, female and male. Aim 3 describes patterns of violence and coercion using a latent class analysis approach, assessing the association of these latent classes with mental health. Results: For females, both physical and sexual violence were associated with higher levels of anxiety, PTSD, and depression, while for males, exposure to physical violence with threats made with weapons was strongly associated with PTSD. Coercion in females was particularly strongly related to anxiety and PTSD, especially among those receiving both personal and family threats. Deprived conditions during trafficking were strongly associated with poor mental health in both females and males, but sex-related differences were observed. While for females, living conditions were strongly associated with anxiety, PTSD, and depression, the association in males in each of the three outcomes more than doubled. Excessive working hours were associated with poor mental health in females and males. For men and boys working excessively was associated strongly with anxiety, depression, but particularly with PTSD symptoms. For females, there was a twofold increase in PTSD for those working excessively. Being in a detention center or jail in the country of exploitation was strongly associated with anxiety, PTSD, and depression in males. Two different patterns of violence and coercion were identified in females and in males. A twofold higher prevalence of anxiety and PTSD was found in females classified as being exposed to “severe sexual and physical violence and coercion” compared to females exposed to “sexual violence and coercion.” For males the associations for PTSD and depression were elevated among those who were exposed to the class of “severe physical violence and coercion” relative to the “personal coercion” class but the findings were not statistically significant. Conclusions: Measuring the human trafficking experience is complex as it occurs in diverse labor sectors beyond sexual exploitation and affects both females and males of all ages. The experience of violence and coercion is pervasive yet multidimensional and differs by sex with profound effects on the mental health of trafficked female and male survivors. Exploitation as embodied in the trafficking experience entails abuse, violence, and deprived living and working conditions with profound consequences for mental health. Implementation of public health approaches at all levels of the spectrum of prevention (primary, secondary, and tertiary) and acknowledging the social determinants of health as major structural forces are fundamentally important to prevent and address human trafficking.