PSYCHOSOCIAL PREDICTORS OF DEPRESSION, SUICIDALITY AND EFFICACY OF HYPNOTHERAPY AMONG BROTHEL- BASED FEMALE SEX WORKERS IN LAGOS METROPOLIS, NIGERIA

Abstract

In Nigeria, sex workers by nature of their job are exposed to high risks and multiple health hazards including mental health. However, little is known about their mental health challenges and consequences on the sex worker and the general public. This study was therefore designed to investigate the influence of perceived occupational stress, substance dependence, personality traits, age, duration of sex work, educational levels and efficacy of hypnotherapy on depression and suicidality among brothel-based female sex workers in the Lagos metropolis. Beck's theory of depression and Klosky and May's theory of suicidality guided the study. The sequential exploratory design was utilised in three phases: exploratory, cross-sectional survey as well as pre-test and post-test quasi experimental design. In phase one, two Focused Group Discussions (FGD), three In Depth Interviews (IDI) and five Key Informant Interviews (KII) were conducted among brothel- based female sex workers, ex- sex workers and key informants. In phase two, 224 brothel-based female sex workers were selected using the Respondent-Driven Sampling (RDS) method. The Centre for Epidemiologic Studies Depression Scale (α=0.89), MINI Suicidality Scale (α=0.87), Sex Work Stress Questionnaire (α=0.98), The Severity of Dependence Scale (α=0.66), Alcohol Use Disorder Identification Test (AUDIT) (α=0.80), and the Big Five Personality Inventory-10 (Neurotism α=0.74, Extraversion α=0.83, Openness to Experience α=0.85, Agreeableness α=0.81 and Conscientiousness α=0.92), were administered. In phase three, 16 participants who scored high on depression and suicidality from phase two were randomly selected and assigned into experimental and control groups. Qualitative data were content- analysed, while quantitative data were analysed using zero-order correlation, multiple regression, oneway ANOVA, paired t-test and Independent sample t-test at p≤0.05. Participants’ age was =26.28±5.29 years. Prevalence for depression and suicidality among the sex workers were 42.9%, and 21.4% respectively. Pressure, frustration, conflicts, work load, insecurity, financial and health concerns were identified as domains of sex work stress. Occupational stress (r=0.18) age (β = 0.19, t=2.72), educational level (β = -0.14, t=-2.20), and duration of sex work (β = 0.24, t=3.48) independently predicted depression; while perceived occupational stress (R2=0.07, F (7,216= 2.19):, severity of substance use (R2=0.14,F (3,220) =11.46), Openness personality traits (β = -0.15, t=-2.07), age, (β = -0.15, t=-2.15), educational level (β = 0-.20, t=-3.02) and duration of sex work (R2=0.07, F (3,220) =5.86) jointly predicted suicidality. Hypnotherapy was found to be positively effective in reducing depression (t (7) = -3.83)) and suicidality (t (7) = -9.92)) at post- test evaluation. Occupational stress, age, educational level and duration of sex work are important predisposing factors in depression; while openness to experience, age, educational level influenced suicidality among brothel-based female sex workers in Lagos. Hypnotherapy is effective in reducing depression and suicidality and therefore should be considered in psychological management among brothel-based female sex workers in Lagos, Nigeria.