Mental Health and Functioning in School Age Children of Female Entertainment Workers in Cambodia
Main Article Content
Abstract
Globally, approximately 10% - 20% of children and adolescents experience mental health problems and the majority of them are living in low- and middle-income countries. Children of female sex workers are often exposed to unsafe environments, traumatic experiences and a mentally ill parent, putting them at risk for developing mental health problems themselves. Research on the mental health and functioning of children of female sex workers during their school age is limited. This paper will explore the mental health and functioning of female sex workers’ children. Method: The study included 160 female entertainment workers (FEWs) and 60 of their children from four provinces of Cambodia. FEW’s mental health, and children’s mental health and functioning were measured. Result: FEWs demonstrated high rates of depression (67%) and anxiety (61%), and 54.38% reported symptoms of post-traumatic stress disorder. Of the 60 children, the majority got their education at primary school (68%) and secondary school (25%). 46.7% of them reported symptoms of functional impairment, 18.33% suffered from psychological distress, and 36.67% have PTSD symptoms above the clinical threshold. Children’s psychological distress was significantly predicted by mothers’ early childhood traumatic experiences, mothers’ current mental health problems, mothers’ anxiety and PTSD. Mother’s PTSD predicted children’s psychological distress [β = 0.282, R2 = 0.079] and functioning [β = 0.285, R2 = 0.081]. Conclusion: School age children of FEWs have high rates of depression, anxiety and PTSD. Children’s psychological problems impair their functioning at school and home. FEW’s PTSD predicts their children’s psychological distress and functioning. Further research on the mental health and functioning of FEW’s children should be continued with a larger sample size. Mental health professionals and educators should provide mental health care for FEWs and their children, and develop evidence-based approaches to improving children’s mental health and functioning
Keywords:
Children of Female Entertainment Worker, child mental health, functioning
References
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[2] UNICEF, Findings from Cambodia’s Violence against Children Survey 2013, UNICEF, Cambodia, 2014.
[3] J. H. Burack, D. Bangsberg, Epidemiology and HIV Transmission in Injection Drug Users. http://hivinsite.ucsf.edu/InSite?page=kb-07-04-01, 1998 (accessed 16 January 2017).
[4] W. Rossler, U. Koch, C. Lauber, A.-K. Hass, M. Altwegg, V. A. Gross, K. Landolt, The mental health of female sex workers, Acta Psychiatr Scand. 122 (2010) 143-152.
[5] B. Chudakov, K. Ilan, and R. H. Belmaker, The motivation and mental health of sex workers. Journal of Sex & Marital Therapy. 28(4) (2002) 305-315.
[6] Y. Hong, X. Li, X. Fang, and R. Zhao, Depressive symptoms and condom use with clients among female sex workers in China. Sex Health. 4(2) (2007) 99-104.
[7] M. Hengartner, M. N. Islam, H. Haker, and W. Rossler, Mental health and functioning of female sex workers in Chittangond, Bangladesh. Frontiers in Psychiatry. 176(6) (2015)
[8] United Nation Children Fund, Situation Analysis of Youth in Cambodia. United Nations in Cambodia. Cambodia, 2009.
[9] S. A. Sumner, J. A. Mercy, J. Saul, N. M. Nzuza, G. Kwesigabo, R. Buluma, L. H. arceling, H. Lina, M. Shawa, M. Moloney-Kitts, T. Kilbane, C. Sommarin, D. P. Ligiero, K. Brookmeyer, L. Chiang, V. Lea, J. Lee, H. Kress, S. D. Hillis. Prevalence of sexual violence against children and use of social services – seven countries 2007 – 2013. Centers for Disease Control and Prevention. 64 (21) (2015) 565-569.
[10] S. Yi, K. C. Poudel, J. Yasuoka, S. Yi, P. H. Palmer, M. Jimba, Exposure to violence in relation to depressive symptoms among male and female adolescent students in Cambodia. Soc Psychiatry Psychiatr Epidemiol. 48 (2013) 397–405.
[11] K. I. C. Ong, S. Yi, S. Tuot, P. Chhoun, A. Shibanuma, J. Yasuoka, and M. Jimba, What are the factors associated with depressive symptoms among orphans and vulnerable children in Cambodia? BMC Psychiatry. 15 (178) (2015) 1-8.
[12] B. Jegannathan, G. Kullgren, Gender differences in suicidal expressions and their determinants among young people in Cambodia, a post-conflict country. BMC Psychiatry. 11:47 (2011) 1-8.
[13] S. Yi, K. C. Poudel, J. Yasuoka, P. H. Palmer, S. Yi, & M. Jimba. Risk vs. protective factors for substance use among adolescents in Cambodia. 16 (1) (2011) 14-26
[14] World Health Organization. HIV/AIDS among men who have sex with men and transgender populations in South-East Asia. 2010.
[15] NCHADS, Standard Operating Procedures (SoP) for Boosted Continuum of Prevention to Care and Treatment for Most at Risk Population in Cambodia. Ministry of Health. National Center for HIV/AIDS, Dermatology, and STD. Cambodia, 2013.
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[18] K. Kroenke, R. L. Spitzer, J. B. W. Williams. The PHQ-9: Validity of a Brief Depression Severity Measure. JGIM Journal. 16 (2001) 606-613.
[19] S. E. Julian, Translated mental health screening tools in refugee populations. (2016) 1-6.
[20] R. L. Spitzer, K. Kroenke, J. B. W. Williams, B. Lowe, A brief measure for assessing generalized anxiety disorder. Arch. Intern. Med. 166 (2006) 1092–1097.
[21] D. Chibanda, R. Verhey, L. Gibson, E. Munetsi, D. Machando, S. Rusakaniko, R. Munjoma, R. Araya, H. A. Weiss, M. Abas. Validation of screening tools for depression and anxiety disorders in a primary care population with high HIV prevalence in Zimbabwe. Journal of Affective Disorder. 198 (2016) 50-55.
[22] C. A. Blevins, F. W. Weathers, M. T. Davis, T. K. Witte, & J. L. Domino. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. Journal of Traumatic Stress, 29 (2016) 1–10.
[23] National Center for Post-traumatic Stress Disorder, Using the PTSD Checklist for DSM-5 (PCL-5), 2015.
[24] V. J. Felitti, R. F. Anda, D. Nordenberg, D. F. Williamson, A. M. Spitz, V. Edwards, M. P. Koss. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine. 14 (1998) 245-258.
[25] A. Murphy, M. Steele, S. R. Dube, J. Bate, K. Bonuck, P. Meissner, H. Goldman, H. Steele. Adverse Childhood Experiences (ACEs) Questionnaire and Adult Attachment Interview (AAI): Implications for parent child relationships. Child Abuse & Neglect, 38 (2014) 224-233.
[26] K. Wingenfeld, I. Schafer, K. Terfehr, H. Grabski, M. Driessen, H. Grabe, B. Lowe, C. Spitzer. The reliable, valid and economic assessment of early traumatization: first psychometric characteristics of the German version of the Adverse Childhood Experiences Questionnaire (ACE). Psychother Psychosom Med Psychol. 2011 Jan; 61(1) (2011) e10-e14.
[27] L. van Domburgh, K. Sovandara, P. Tim, A. Christophersen, S. Ann, & E. Palmer, The Child Psychosocial Distress Screener and the Child Functional Impairment Scale: Development and validation of two Cambodian mental health screening measures. Royal University of Phnom Penh: Phnom Penh, Cambodia, 2016.
[28] R. Goodman,The Strengths and Difficulties Questionnaire: A Research Note. Journal of Child Psychology and Psychiatry, 38(5) (1997) 581-586.
[29] R. Goodman, Psychometric Properties of the Strengths and Difficulties Questionnaire, Journal of American Academy of Child and Adolescent Psychiatry. 40 (11) (2001) 1337-1345
[30] Y. Du, J. Kou, and D. Coghill, The validity reliability and normative scores of the parent, teacher and self report versions of the Strengths and Difficulties Questionnaire in China, Child and Adolescent Psychiatry and Mental Health 2 (8) (2008) 1-15 http://doi:10.1186/1753-2000-2-8
[31] Youthinmind, Downloadable SDQs and Related Items. http://www.sdqinfo.org/py/sdqinfo/b3.py?language=Khmer, 2014 (accessed 12 January 2017).
[32] E. B. Foa, K. M. Johnson, N. C. Feeny, K. R. H. Treadwell, The Child PTSD Symptom Scale: A Preliminary Examination of its Psychometric Properties, Journal of Clinical Child Psychology. 30 (3) (2001) 376-384
[33] E. B. Foa, A. Asnaani, Y. Zang, S. Capaldi, and R. Yeh, Psychometrics of the Child PTSD Symptoms Scale for the DSM-5 for Trauma-Exposed Children and Adolescents, Journal of Clinical Child & Adolescent Psychology 00(00) (2017) 1-9. https://doi.org/10.1080/15374416.2017.1350962
[34] O. G. Gudino and L. A. Rindlaub, Psychometric Properties of the Child PTSD Symptom Scale in Latino Children, Journal of Traumatic Stress, 27 (2014) 27-34.
[35] D. M. Seponski, C. J. Lahar, S. Khann, S. Kao, and T. Schunert, Four decades following the Khmer rouge: sociodemographic factors impacting depression, anxiety and PTSD in Cambodia. Journal of Mental Health. (2018) http://DOI:10.1080/09638237.2018.1466039.
[36] H. L. Surratt, S. P. Kurtz, J. C. Weaver, J. A. Inciardi, The Connections of Mental Health Problems Violent Life Experiences, and the Social Milieu of the “Stroll” with the HIV Risk Behaviors of Female Street Sex Workers. Journal of Psychology & Human Sexuality. 17:1-2 (2005) 23-44.
[37] Y. Hong, X. Li, X. Fang, and R. Zhao, Depressive symptoms and condom use with clients among female sex workers in China. Sex Health. 4(2) (2007) 99-104.
[38] Pandiyan, K., Chandrasekhar, H., Madhusudhan, S. (2009). Psychological morbidity among female commercial sex workers with alcohol and drug abuse. Indian Journal of Psychiatry. 54:4.349-351
[39] J. E. Drughon Moret, A. W. Carrico, J. L. Evans, E. S. Stein, M. Couture, L. Maher, K. Page. The impact of violence on sex risk and drug use behavior among women engaged in sex work in Phnom Penh, Cambodia. Drug and Alcohol Dependence (2016)
[40] International HIV/AIDS Alliance. Sex Work, Violence and HIV: A guide for programmes with sex workers. International HIV/AIDS Alliance (2008)
[41] A. Roxburgh, L. Degenhardt, and J. Copeland, Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia. BMC Psychiatry. 6:24 (2006) 1-12.
[42] H. H. Dang, B. Weiss, L. T. Trung. Functional impairment and mental health functioning among Vietnamese children. Soc Psychiatry Psychiatr Epidemiol. 51 (2016) 39-47.
[43] J. McFarlane, L. Symes, B. K. Binder, J. Maddoux, and Paulson. Maternal-Child Dyads of Functioning: the Intergenerational Impact of Violence Against Women on Children. Matern Child Health J. 18 (2014) 2236-2243.
[44] A. A. Levendosky, A. C. Huth-Bocks, D. L. Shapiro, and M. A. Semel. The Impact of Domestic Violence on the Maternal-Child Relationship and Preschool-Age Chldren’s Functioning. Journal of Family Psychology. 3 (2003) 275-287.
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