Adverse Childhood Experiences, Re-Trafficking Vulnerability, and Mental Health Outcomes Among Human Trafficking Survivors in Kampala, Uganda: A Cross-Sectional Analysis

Background and Purpose: Globally, Human trafficking disproportionately affects the health of women and girls, exposing them to severe exploitation and long-term psychological, social, and economic harm. While global efforts to prevent trafficking have intensified, the risk of re-trafficking remains a critical yet understudied issue in low-resource settings, particularly in Uganda. Uganda’s limited data on the effects of adverse childhood and re-trafficking vulnerabilities on the long-term mental health outcomes of survivors of trafficking limits the design of evidence-based interventions to improve survivors’ health. Our study examined the link between ACEs, re-trafficking vulnerability, and long-term mental health outcomes among female survivors of human trafficking in Central Uganda.

Methods: A cross-sectional study was conducted among 350 consenting female survivors of human trafficking aged 18-35 years, receiving rehabilitation services at seven (7) sites in Kampala, Central Uganda, in January 2025. Same sex face-to-face interviews were conducted by trained research assistants in English or Luganda- the local language. Data on participants’ socio-demographic characteristics such as ; age, marital status, education, religion, adverse childhood experiences (ACEs) using the 10-item Adverse Childhood Experiences-International Questionnaire (ACE-IQ) with a cut-off score of 8.0 for positive ACE screen, human trafficking vulnerability (AHTST) using the 8-item Adult Human Trafficking Screening Tool (AHTST) with a cut-off score of >=5.0 for AHTST positive screen, anxiety symptoms using the Generalized Anxiety Disorder screen (GAD-7) with a cutoff score of >=10 for positive screen, depression symptoms using the 9-item validated measure PHQ-9 tool with a cutoff score of >=10 for positive screen, and PTSD symptoms using the Diagnostic and Statistical Manual of Mental Health (MH) DSM-PCL-5 scale with a cutoff score of >=33 for positive PTSD screen were collected. Bivariate and multivariable modified regression models with robust standard errors were performed using Stata version 17.0 for analysis.

Results: Of the 350 participants interviewed, more than half (63.7%) reported experience of ACEs, 53.7% screened positive for human trafficking vulnerability, 57.1%, 56%, and 40.9% identified with anxiety, depression, and PTSD symptoms respectively. Experience of ACEs strongly correlated with a 5%, 4%, and 6% increased risk of experiencing anxiety (aRR = 1.05, 95% CI: 1.02-1.08), depression (aRR = 1.04, 95% CI: 1.01-1.06), and PTSD (aRR =1.06, 95% CI: 1.03-1.09) symptoms respectively. Additionally, age and education were strongly linked to a heightened risk of experiencing mental health (MH) symptoms among this population. Furthermore, trafficking vulnerabilities were paradoxically associated with lower symptom severity of all three MH conditions in this population.

Conclusion and Implications: Our study highlights a strong link between ACEs, re-trafficking vulnerability, and MH risks among survivors of in this setting. High ACE exposure significantly increased the risk of anxiety, depression, and PTSD symptoms in this population. There is an urgent need for trauma-informed interventions addressing ACEs and mental health to reduce re-trafficking risks and promote survivor resilience.