Factors Associated with Physical and Mental Health Outcomes Among Female Trafficking Survivors: A Hierarchical Regression Model

Background: Research on the long-term effects of human trafficking (HT) on survivors is rapidly growing; however, gaps exist in understanding how social services address or improve their long-term physical and mental health needs. Conceptual and qualitative studies have linked services with better physical and mental health outcomes. This study adds to the existing literature by examining the relationship between HT survivors’ experiences in an aftercare program, their socio-demographic variables, and their long-term physical and mental health. We present data from participants who exited services several years on to identify if the services had long-term positive impacts.

Methods: This study is part of longitudinal mixed-method research whose goal was to assess the long-term well-being of female HT survivors who received intervention from a residential care facility in Accra, Ghana. A sample of n=144 participants was recruited through a combination of snowball and convenience sampling techniques. These survivors had exited the program over a five-year period. A hierarchical regression modeling approach was used to assess four models. The Hopkins Symptoms Checklist (HSCL), measuring physical and mental health outcomes, served as the dependent variable. The first model included socio-demographics (age and education level). The second model added the various violence types experienced during trafficking (emotional, verbal, sexual, and physical). The third model incorporated survivors’ individual and communal characteristics of adaptive and mal-adaptive coping skills, (measured by the validated Brief COPE scale) and social support (measured by the validated Multidimensional Scale of Perceived Social Support). The fourth model added three service variables (length of stay in services, perception of readiness to exit programming, and perception of program support).

Results: The full model, incorporating past experiences, individual/communal characteristics, and service level data, was statistically significant, Adj. R²=.491, F(14, 111)=10.58, p<.001. Each progressive model was a statistically significant improvement from the previous model. When service level data (Model 4) was added to internal/communal characteristics (Model 3), Model 4 was found to have a significantly better fit, ∆F=4.345, p<.001. Survivors who experienced sexual violence reported scoring 12.39 points higher on the HSCL than survivors who had not experienced sexual violence (p=.037). Survivors who felt fully ready to exit the program reported scoring 16.387 points lower on the HSCL than survivors who did not feel fully ready to exit the program (p=.008). A lower HSCL score is indicative of better health and mental health outcomes. A 1 point increase on the mal-adaptive coping scale was associated with a 1.72 point increase on the HSCL (p<.001), meaning that higher use of mal-adaptive coping skills was associated with worse outcomes.

Implications: These findings suggest that aftercare services provide an important component in understanding how HT survivors function after exiting intervention programs. Programs should focus on coping skills given their importance within the model. Future studies should examine which services are most helpful in supporting long-term well-being within diverse cultural contexts for survivors and ways in which survivors feel most prepared to exit services. Supporting effective aftercare services is key to providing stability and well-being of HT survivors.