title: Socio-ecological factors associated with depression, suicidal ideation and suicidal attempt among female injection drug users who are sex workers in China.
abstract: OBJECTIVE
  Female injection drug users who are also sex workers (FSW-IDUs) occupy a pivotal population in HIV transmission, whereas their mental health problems are largely overlooked. We aimed to investigate prevalence and associated socio-ecological factors of depression, suicidal ideation and suicidal attempts among FSW-IDUs in China.
  
  
  METHODS
  Using snowball sampling methods, 200 FSW-IDUs were recruited from communities in Liuzhou, China. Anonymous face-to-face interviews were administered by trained doctors.
  
  
  RESULTS
  Thirty-nine percent of participants had severe or extremely severe depression, 44.7% had suicidal ideation in the last six months and 26.8% had suicidal attempts in the last six months. After adjusting for background variables, self-stigma was significantly associated with severe or extremely severe depression (OR=1.18, 95% CI: 1.07-1.31). Self-stigma (OR=1.08, 95% CI: 1.01-1.15), depression (OR=1.11, 95% CI: 1.05-1.18), having completely broken up with family (OR=2.60, 95% CI: 1.35-5.02) and having been abused by clients or gatekeepers (OR=2.15, 95% CI: 1.32-3.50) were associated with suicidal ideation in the last six months, while self-stigma (OR=1.03, 95% CI: 1.10-1.16), depression (OR=1.12, 95% CI: 1.04-1.20) and being abused by clients or gatekeepers (OR=2.15, 95% CI: 1.09-4.24) were associated with suicidal attempt in the last six months. In mediation analyses, the associations between self-stigma and the two suicidal outcomes were fully mediated by depression.
  
  
  CONCLUSIONS
  There are unmet mental health needs of FSW-IDUs. Screening of mental health problems should be integrated into current HIV-related services. Psychological intervention efforts should include components such as self-stigma, family support and abuse.
authors.affiliation: School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, Guangdong 510275, China. Electronic address: gujing5@mail.sysu.edu.cn.
authors.forename: Jing
authors.initials: J
authors.lastname: Gu
authors.affiliation: Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, Guangdong 510275, China; Center for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Joseph T F
authors.initials: JT
authors.lastname: Lau
authors.affiliation: Center for Disease Prevention and Control, Liuzhou, Guangxi 545007, China.
authors.forename: Mingqiang
authors.initials: M
authors.lastname: Li
authors.affiliation: Pediatric Prevention Research Center, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Haochu
authors.initials: H
authors.lastname: Li
authors.affiliation: Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Gao
authors.affiliation: Center for Disease Prevention and Control, Liuzhou, Guangxi 545007, China.
authors.forename: Xianxiang
authors.initials: X
authors.lastname: Feng
authors.affiliation: Center for Disease Prevention and Control, Liuzhou, Guangxi 545007, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Bai
authors.affiliation: School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Hao
authors.affiliation: School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
authors.forename: Yuantao
authors.initials: Y
authors.lastname: Hao
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D055030:Drug Users / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D060386:Sex Workers / Q000523:psychology*; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology*
keywords: China; Depression; Injection drug users; Sex workers; Suicide