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Women in post-trafficking services in moldova, their mental health
– Reported, February 03, 2012
Trafficking in women is a widespread human rights violation commonly associated with poor mental health. Yet, to date, no studies have used psychiatric diagnostic assessment to identify common forms of mental distress among survivors returning to their home country.
A longitudinal study was conducted of women aged 18 and over who returned to Moldova between December 2007 and December 2008 registered by the International Organisation for Migration as a survivor of human trafficking. Psychiatric diagnoses in women at a mean of 6 months after return (range 2-12 months) were made by a trained Moldavian psychiatrist using the Structured Clinical Interview for DSM-IV, and compared with diagnoses recorded in the same women within 5 days of return. We described the socio-demographic characteristics of the women in the sample including both pre and post-trafficking information. We then described the distribution of mental health diagnoses recorded during the crisis intervention phase (1-5 days after return) and the re-integration phase (2-12 months after return). We compared diagnoses at the patient level between the two time points by tabulating the diagnoses and carrying out a kappa test of agreement and the Stuart-Maxwell test for marginal homogeneity.
120/176 (68%) eligible women participated. At 2-12 months after their return, 54% met criteria for at least one psychiatric diagnoses comprising post-traumatic stress disorder (PTSD) alone (16%); co-morbid PTSD (20%); other anxiety or mood disorder (18%). 85% of women who had been diagnosed in the crisis phase with co-morbid PTSD or with another anxiety or mood disorder sustained a diagnosis of any psychiatric disorder when followed up during rehabilitation.
Trafficked women returning to their country of origin are likely to suffer serious psychological distress that may endure well beyond the time they return. Women found to have co-morbid PTSD or other forms of anxiety and depression immediately post-return should be offered evidenced-based mental health treatment for at least the standard 12-month period of rehabilitation.
Human trafficking is a human rights violation and modern form of slavery that occurs in and between most countries around the world. Trafficking in persons involves the movement of individuals by means of threat, force, coercion, or deception, for the purposes of exploitation or abuse . The most commonly recognized form of human trafficking has been the sale of women and girls for sexual exploitation, but women, men and children are trafficked for various forms of labour, such as farming, manufacturing and begging. Several countries in Eastern Europe, including Moldova, are well-known for high numbers of women who are trafficked for forced sex work . Trafficked persons are frequently subjected to high levels of violence and abuse and at risk for symptoms of post-traumatic stress disorder (PTSD), depression and anxiety.
For survivors of trafficking, there are a growing number of centers around the world that offer post-trafficking care. Support services often include activities to address the mental health needs of individuals. Yet, while there are international calls for better psychological support, there remains limited clinical evidence on the mental health needs of trafficking survivors. In one of the few studies exploring the mental health symptoms of women in post-trafficking assistance centers in Europe, findings based on the Brief Symptom Inventory and the Harvard Trauma Questionnaire indicate that within 0-14 days of entering care, the majority of women reported high symptom levels of PTSD, depression and anxiety. Importantly, no studies to date have employed clinician-administered diagnostic assessment either to describe primary or co-morbid conditions. Notably, research among other groups suggests that co-morbidity in PTSD is common and may adversely affect prognosis .
According to conceptualization of the five stages of the trafficking process (pre-departure; travel and transit; destination; detention, deportation and criminal evidence; and integration and re-integration), women will have different needs at different stages. This study focused on the last of these phases, re-integration, and women returning home. For the purposes of care and assistance the ‘reintegration’ phase may be divided into the ‘crisis intervention’ period, when urgent needs are met and support is aimed at safety and stabilization, and the ‘rehabilitation’ period, when support is aimed at longer-term recovery, rehabilitation and participation. This study aimed to: 1) describe women’s mental health status, specifically psychiatric disorders, during the re-integration phase; and 2) explore changes in women’s psychological symptoms over time, comparing diagnoses two to twelve months after their return, with earlier diagnoses made within five days of their return to Moldova.
The high rate of psychiatric illness identified at the re-integration period is most likely explained by the serious nature of trauma experienced by the women during the trafficking experience. Human trafficking, especially trafficking for sexual exploitation, is renowned for the extreme forms of abuse and intimidation experienced by trafficked persons, including sexual violence, physical violence, threats of harm to themselves and their family and severely restricted movements. Many of the tactics used by traffickers may be compared to those used in situations of torture and are often associated with high levels of PTSD, depression and anxiety. Other factors explaining the high rate of chronic mental disorder may include childhood adversity, personality factors, and socio-economic position .
Post-trafficking support should include mental health assessment and care both in the crisis and the rehabilitation periods. Practitioners should be especially vigilant during the crisis period for women with diagnosable anxiety or mood disorder or co-morbid PTSD, who will be at risk of on-going serious disorders. Services should also be prepared to provide or refer women to detoxification or addiction services for substance misuse problems. As states establish or refine assistance measures for trafficking survivors, including transnational and national referral mechanisms, policy-makers should ensure that adequate funds are dedicated to support healthcare programs that include long-term mental health care.
Caution must be used to avoid burdening trafficked women with additional stigmatizing labels by diagnosing them with a ‘disorder’ given that in many cases, their psychological reactions to such life-threatening violations are normal responses to extraordinarily abnormal events. Approaches to assessment and care should prioritize confidentiality, sensitivity and empowerment to offer women the greatest hope of recovery and a better future.
Credits:Nicolae V Ostrovschi, Martin J Prince, Cathy Zimmerman, Mihai A Hotineanu, Lilia T Gorceag, Viorel I Gorceag, Clare Flach and Melanie A Abas.
More Information at:http://www.biomedcentral.com/1471-2458/11/232
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