Probing the dual burden: assessing psychological distress and substance use among female sex workers in Sonagachi, Kolkata, West Bengal, India
Keywords:
Female sex workers, psychological distress, cannabis abuse, tobacco abuse, alcohol abuse, sustainable developmental goalAbstract
Background. Psychological distress and substance use is a global public health problem. Understanding the mental distress and substance use regarding female sex workers is crucial which is noticeably lacking in India. The authors of this study investigate the prevalence of psychological distress and substance use among female sex workers in Sonagachi.
Methods. Using convenience sampling 149 participants were invited to participate. Tools included socio-demographic proforma, alcohol use disorder identification test to assess the risk of alcohol consumption and patient health questionnaire used to assess anxiety and depression.
Results. Overall, 52.4% reported psychological distress and 66.1% of participants were found to use substances. The factors associated with psychological distress are marital status, education level and number of children. Education, sex under the influence of substances, and number of years working predicted a higher likelihood of substance use such as tobacco, cannabis and alcohol. Additionally, psychological distress was more significant among women who were married, worked for more than 5 years, were forced to enter the sex trade and used condoms inconsistently.
Conclusion. Education, sex under the influence of alcohol, number of years working, marital status, age of working, reason for sex work and condom use emerged as significant predictors of use of tobacco and cannabis, risk of alcohol consumption and psychological distress.
References
1. Institute for Health Metrics and Evaluation (IHME). GBD Results. Available from: https://vizhub.healthdata.org/gbdresults [Last accessed: 2025 Feb 2].
2. World Health Organization (WHO). Mental health. India. Available from: https://www.who.int/india/health-topics/ mental-health [Last accessed: 2025 Feb 2].
3. Ambekar A, Agrawal A, Rao R, Mishra AK, Khandelwal SK, Chadda RK. Magnitude of substance use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India; 2019.
4. Jana Sm, Ray P, Roi S, Piduttia J, Ghose T, Jana Sa. Depression and Its Relation with HIV Risk and Social Well-Being among the Brothel-Based Female Sex Workers in Kolkata, India. Community Med Public Health Care. 2017;4:025. https://doi.org/10.24966/CMPH-1978/100025.
5. Kalinowski O, Lotysh A, Kaya G, Kroehn-Liedtke F, Zerbe LK, Mihaylova H, et al. Prevalence, risk and resilience factors of mental health conditions among female sex workers: a systematic review and meta-analysis. Front Public Health. 2025 Jan 13;12:1455999. doi: 10.3389/fpubh.2024.1455999. PMID: 39877911; PMCID: PMC11773154.
6. Pandiyan K, Chandrasekhar H, Madhusudhan S. Psychological morbidity among female commercial sex workers with alcohol and drug abuse. Indian J Psychiatry. 2012 Oct;54(4):349-51. doi: 10.4103/0019-5545.104822. PMID: 23372238; PMCID: PMC3554967.
7. Beksinska A, Karlsen O, Gafos M, Beattie TS. Alcohol use and associated risk factors among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLOS Glob Public Health. 2023 Jun 13;3(6):e0001216. doi: 10.1371/journal.pgph.0001216. PMID: 37310993; PMCID: PMC10263362.
8. Nguyen AT, Nguyen TH, Pham KC, Le TG, Bui DT, Hoang TL, et al. Intravenous drug use among street-based sex workers: a high-risk behavior for HIV transmission.
Sex Transm Dis. 2004 Jan;31(1):15-9. doi: 10.1097/01. OLQ.0000105002.34902.B5. PMID: 14695953.
9. Li Q, Li X, Stanton B. Alcohol use among female sex workers and male clients: an integrative review of global literature. Alcohol Alcohol. 2010 Mar-Apr;45(2):188-99. doi: 10.1093/alcalc/agp095. Epub 2010 Jan 20. PMID:
20089544; PMCID: PMC2842106.
10. Mbonye M, Nakamanya S, Nalukenge W, King R, Vandepitte J, Seeley J. ‘It is like a tomato stall where someone can pick what he likes’: structure and practices of female
sex work in Kampala, Uganda. BMC Public Health. 2013 Aug 10;13:741. doi: 10.1186/1471-2458-13-741. PMID: 23938037; PMCID: PMC3751244.
11. World Health Organization (WHO). World Health Statistics, 2023. Available from: https://www.who.int/data/gho/data/ themes/topics/topic-details/GHO/world-health-statistics [Last accessed: 2025 Feb 2].
12. Martín‐Romo L, Sanmartín FJ, Velasco J. Invisible andstigmatized: A systematic review of mental health and risk factors among sex workers. Acta Psychiatr Scand. 2023 Sep;148(3):255-264. doi: 10.1111/acps.13559. Epub 2023 Apr 27. PMID: 37105542.
13. Materu J, Kuringe E, Nyato D, Galishi A, Mwanamsangu A, Katebalila M, et al. The psychometric properties of PHQ-4 anxiety and depression screening scale among out of school adolescent girls and young women in Tanzania: a crosssectional study. BMC Psychiatry. 2020 Jun 19;20(1):321. doi: 10.1186/s12888-020-02735-5. PMID: 32560705; PMCID: PMC7304148.
14. Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009 Nov-Dec;50(6):613-21. doi: 10.1176/ appi.psy.50.6.613. PMID: 19996233.
15. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol Use Disorders Identification Test (AUDIT) manual: Guidelines for use in primary care. 2nd Ed. Geneva: World Health Organization; 2001: 4-32 (WHO/MSD/ MSB/01.6a).
16. Patel SK, Saggurti N, Pachauri S, Prabhakar P. Correlates of Mental Depression Among Female Sex Workers in Southern
India. Asia Pac J Public Health. 2015 Nov;27(8):809-19. doi: 10.1177/1010539515601480. Epub 2015 Aug 25. PMID: 26307144.
17. Iaisuklang MG, Ali A. Psychiatric morbidity among female commercial sex workers. Indian J Psychiatry. 2017 Oct-Dec;59(4):465-470. doi: 10.4103/psychiatry.
IndianJPsychiatry_147_16. PMID: 29497189; PMCID: PMC5806326.
18. Hengartner MP, Islam MN, Haker H, Rössler W. Mental Health and Functioning of Female Sex Workers in Chittagong, Bangladesh. Front Psychiatry. 2015 Dec 15;6:176. doi: 10.3389/fpsyt.2015.00176. PMID: 26696911; PMCID: PMC4678216.
19. Yeo EJ, Hlongwane K, Otwombe K, Hopkins KL, Variava E, Martinson N, et al. Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study. PLoS One. 2022 Jan 21;17(1):e0261855. doi: 10.1371/journal.pone.0261855. PMID: 35061728; PMCID: PMC8782394.
20. Beksinska A, Nyariki E, Kabuti R, Kungu M, Babu H, Shah P, et al. Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya. Int J Environ Res Public Health. 2022 Jun 14;19(12):7294. doi: 10.3390/ijerph19127294. PMID: 35742558; PMCID: PMC9223659.
21. UN Women. SDG 5: Achieve gender equality and empower all women and girls. 2022. Available from: https://www.
unwomen.org/en/node/36060 [Last accessed: 2025 Feb and strong policies towards a sustainable development.
2]. Lancet Public Health. 2020 Jan;5(1):e10-e11. doi: 10.1016/
22. Flor LS, Gakidou E. The burden of alcohol use: better data S2468-2667(19)30254-3. PMID: 31910975.
Downloads
Published
Issue
Section
License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.