{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:29:07Z","timestamp":1787027347858,"version":"build-2736575974"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sex workers provide sexual services in exchange for monetary compensation, encompassing a range of activities such as escorting, pornography and street-based or online sex work. Individuals doing sex work are frequently referred to as a vulnerable group when it comes to their mental health. Despite the legality of sex work in Germany, there are significant risk factors associated with negative impact on the mental health, such as stigmatization, precarious working conditions and experienced violence. The aim of this study was to examine specific sex work settings. It was hypothesized that sex workers report high levels of structural stress and psychological distress and that specific work-related factors (e.g., stigma, safety concerns, interactions with clients) would significantly predict mental health outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Since the majority of sex workers is female, the mental health of 403 women engaged in sex work was assessed in this study using quantitative interviews with standardized instruments. To acquire prevalence rates of mental disorders and compare them with others engaged in high-stress environments a control group of 157 female social workers was interviewed. To investigate the hypotheses descriptive analyses, Chi\n                      <jats:sup>2<\/jats:sup>\n                      -tests, logistic regression and cluster analysis were used. This study employs a cross-sectional design to equally reflect the different characteristics of the heterogeneous groups such as age, educational level, background and different work settings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      As expected, mental disorder prevalences were higher among sex workers than in the general population and in the control group. However, logistic regression identified risk factors for mental illness, including residence status (OR\u202f=\u202f1.33, CI\u202f=\u202f1.05\u20131.69,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.018; Ref\u202f=\u202fno), homelessness (OR\u202f=\u202f0.11, CI\u202f=\u202f0.02\u20130.48,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003; Ref\u202f=\u202fyes), income status (OR\u202f=\u202f0.50, CI\u202f=\u202f0.25\u20130.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.042; Ref\u202f=\u202flow), perceived threat or control (OR\u202f=\u202f0.15, CI\u202f=\u202f0.03\u20130.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.030; Ref\u202f=\u202fno) and work-related stress (OR\u202f=\u202f2.83, CI\u202f=\u202f1.11\u20137.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.029; Ref\u202f=\u202flow) emerging psychological and structural stressors as crucial factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings highlight the need for special health care services and improved economic and legal security of sex workers. Policy changes focusing on improved medical and psychological care and structural interventions aiming economic and social needs while fostering societal acceptance and understanding are required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1590151","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T04:11:12Z","timestamp":1756440672000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["A quantitative study on female sex workers\u2019 mental health in Germany"],"prefix":"10.3389","volume":"13","author":[{"given":"Franziska","family":"Kroehn-Liedtke","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charit\u00e9 at St. Hedwig Hospital","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Kalinowski","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charit\u00e9 at St. Hedwig Hospital","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gizem","family":"Kaya","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charit\u00e9 at St. Hedwig Hospital","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasiia","family":"Lotysh","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charit\u00e9 at St. Hedwig Hospital","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hristiana","family":"Mihaylova","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charit\u00e9 at St. Hedwig Hospital","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krisztina","family":"Sipos","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charit\u00e9 at St. Hedwig Hospital","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Strunk","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charit\u00e9 at St. Hedwig Hospital","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Zerbe","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charit\u00e9 at St. Hedwig Hospital","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wulf","family":"R\u00f6ssler","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charit\u00e9 at St. Hedwig Hospital","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meryam","family":"Schouler-Ocak","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charit\u00e9 at St. Hedwig Hospital","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"296","DOI":"10.21706\/tg-15-4-296","article-title":"Sexarbeit und psychische Gesundheit","volume":"15","author":"B\u00fcttner","year":"2021","journal-title":"Trauma Gewalt"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1111\/acps.13559","article-title":"Invisible and stigmatized: a systematic review of mental health and risk factors among sex workers","volume":"148","author":"Martin-Romo","year":"2023","journal-title":"Acta Psychiatr Scand"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1514","DOI":"10.1080\/13691058.2021.1974562","article-title":"Sex workers' self-reported physical and mental health in Greece. A repeated cross-sectional study in 2009, 2013 and 2019","volume":"24","author":"Drydakis","year":"2022","journal-title":"Cult Health Sex"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1007\/s40653-022-00467-0","article-title":"An exploratory investigation of childhood sexual abuse and other theory-driven predictors of sex work among women with and without childhood ADHD","volume":"15","author":"Halkett","year":"2022","journal-title":"J Child Adolesc Trauma"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1971","DOI":"10.3390\/ijerph182211971","article-title":"Intersections of sex work, mental ill-health, IPV and other violence experienced by female sex workers: findings from a cross-sectional community-centric National Study in South Africa","volume":"18","author":"Jewkes","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref6","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-47027-2","volume-title":"Women who sell sex \u2013 a review of psychological research with clinical implications","author":"Krumrei Mancuso","year":"2020"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"32","DOI":"10.3389\/fpsyt.2019.00032","article-title":"Stigma as a barrier to mental health service use among female sex Workers in Switzerland","volume":"10","author":"Zehnder","year":"2019","journal-title":"Front Psych"},{"key":"ref8","volume-title":"Sexarbeit in Dtld","author":"D\u00f6ring","year":"2020"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1464307","DOI":"10.3389\/fpubh.2024.1464307","article-title":"An explorative qualitative study of barriers to the use of health and mental health services among migrant female sex workers in Germany and needs for action","volume":"12","author":"Lotysh","year":"2024","journal-title":"Front Public Health"},{"key":"ref10","volume-title":"Sex work in Europe: a mapping of the prostitution scene in 25 European countries","author":"Brussa","year":"2009"},{"key":"ref11","volume-title":"Prostitution in Deutschland\u2013Fachliche Betrachtung komplexer Herausforderungen","author":"Czarnecki","year":"2014"},{"key":"ref12","year":""},{"key":"ref13","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1007\/s11524-019-00410-z","article-title":"Entry to sex trade and long-term vulnerabilities of female sex workers who enter the sex trade before the age of eighteen","volume":"97","author":"Footer","year":"2020","journal-title":"J Urban Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1186\/s12905-017-0491-y","article-title":"Burden and correlates of mental health diagnoses among sex workers in an urban setting","volume":"17","author":"Puri","year":"2017","journal-title":"BMC Womens Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e1003297","DOI":"10.1371\/journal.pmed.1003297","article-title":"Mental health problems among female sex workers in low- and middle-income countries: a systematic review and meta-analysis","volume":"17","author":"Beattie","year":"2020","journal-title":"PLoS Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1080\/15299732.2019.1572044","article-title":"A systematic review of dissociation in female sex workers","volume":"20","author":"Tschoeke","year":"2019","journal-title":"J Trauma Dissociation"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1055\/a-1829-6948","article-title":"Mental health situation of sex workers in Europe: a scoping review","volume":"85","author":"Muhlen","year":"2023","journal-title":"Gesundheitswesen"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1071\/SH17213","article-title":"Effects of traumatic events on sex workers' mental health and suicide intentions in Burkina Faso: a trauma-informed approach","volume":"16","author":"Cange","year":"2019","journal-title":"Sex Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"10383","DOI":"10.1177\/0886260519884694","article-title":"Cumulative violence and PTSD symptom severity among urban street-based female sex workers","volume":"36","author":"Park","year":"2021","journal-title":"J Interpers Violence"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e42","DOI":"10.2105\/AJPH.2014.301909","article-title":"A systematic review of the correlates of violence against sex workers","volume":"104","author":"Deering","year":"2014","journal-title":"Am J Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1111\/j.1600-0447.2009.01533.x","article-title":"The mental health of female sex workers","volume":"122","author":"R\u00f6ssler","year":"2010","journal-title":"Acta Psychiatr Scand"},{"key":"ref22","year":""},{"key":"ref23","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1007\/s001150050623","article-title":"Lebenszeitpr\u00e4valenz psychischer St\u00f6rungen in der erwachsenen Allgemeinbev\u00f6lkerung Ergebnisse der TACOS-Studie: Ergebnisse der TACOS-Studie","volume":"71","author":"Meyer","year":"2000","journal-title":"Nervenarzt"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/s00481-024-00815-8","article-title":"Healthcare for sex workers\u2014access, barriers, and needs: an exploratory qualitative interview study","volume":"36","author":"Faissner","year":"2024","journal-title":"Ethik Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1455999","DOI":"10.3389\/fpubh.2024.1455999","article-title":"Prevalence, risk and resilience factors of mental health conditions among female sex workers: a systematic review and meta-analysis","volume":"12","author":"Kalinowski","year":"2024","journal-title":"Front Public Health"},{"key":"ref26","volume-title":"Sex work and mental health. Access to mental health services for people who sell sex in Germany, Italy, Sweden and UK","author":"Macioti","year":"2021"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"75S","DOI":"10.1177\/13505068221076386","article-title":"Moral exposures, public appearances: contested presences of non-normative sex in pandemic Berlin","volume":"29","author":"Probst","year":"2022","journal-title":"Eur J Women Stud"},{"key":"ref28","volume-title":"Prek\u00e4re Freiz\u00fcgigkeiten: Sexarbeit im Kontext von mobilen Lebenswelten osteurop\u00e4ischer Migrant* innen in Berlin","author":"Probst","year":"2023"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1007\/s13178-020-00448-8","article-title":"Barriers and enablers to sex workers\u2019 uptake of mental healthcare: a systematic literature review","volume":"18","author":"Reynish","year":"2021","journal-title":"Sexual Res Soc Policy"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med Care"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.psychres.2012.04.009","article-title":"Self-stigma of mental illness scale\u2014short form: reliability and validity","volume":"199","author":"Corrigan","year":"2012","journal-title":"Psychiatry Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/S0145-2134(02)00541-0","article-title":"Development and validation of a brief screening version of the childhood trauma questionnaire","volume":"27","author":"Bernstein","year":"2003","journal-title":"Child Abuse Negl"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1207\/s15327558ijbm0401_6","article-title":"You want to measure coping but your protocol's too long: consider the brief COPE","volume":"4","author":"Carver","year":"1997","journal-title":"Int J Behav Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1016\/S0092-6566(03)00046-1","article-title":"Ten-item personality inventory","volume":"37","author":"Gosling","year":"2003","journal-title":"J Res Pers"},{"key":"ref35","first-page":"590","article-title":"Mini-DIPS open access","volume-title":"Aufl.","author":"Margraf","year":"2017"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e085202","DOI":"10.1136\/bmjopen-2024-085202","article-title":"Major financial problems, low mental well-being and reduced HIV\/STI testing among sex workers in the Netherlands during the COVID-19 pandemic: a repeated cross-sectional survey","volume":"14","author":"Kloek","year":"2024","journal-title":"BMJ Open"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1471-244X-6-24","article-title":"Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area","volume":"6","author":"Roxburgh","year":"2006","journal-title":"Austr BMC Psychiatry"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1080\/03630242.2016.1186781","article-title":"Violence, stigma and mental health among female sex workers in China: a structural equation modeling","volume":"57","author":"Zhang","year":"2017","journal-title":"Women Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"10778012241307332","DOI":"10.1177\/10778012241307332","article-title":"The subjective experience of social stigma on mental health among cisgender women sex Workers in Colombia","author":"Perdomo Sandoval","year":"2024","journal-title":"Violence Against Women"},{"key":"ref40","volume-title":"Methodische Grundlagen f\u00fcr professionelles Handeln im Bereich Prostitution Sozialmagazin 3 -4\/2020","author":"Albert","year":"2020"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1080\/00926230290001439","article-title":"The motivation and mental health of sex workers","volume":"28","author":"Chudakov","year":"2002","journal-title":"J Sex Marital Ther"},{"key":"ref42","volume-title":"Integrating social care into the delivery of health care: moving upstream to improve the nation's health","year":"2019"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1186\/s12939-017-0655-2","article-title":"Sex workers as peer health advocates: community empowerment and transformative learning through a Canadian pilot program","volume":"16","author":"Benoit","year":"2017","journal-title":"Int J Equity Health"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1002\/sgp2.12112","article-title":"I don't think I can help you anymore. Sex workers' experiences of accessing mental health services in Ireland","volume":"7","author":"Ryan","year":"2024","journal-title":"Sexual Gender Policy"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/s13178-018-0338-9","article-title":"Governing in the name of caring\u2014the Nordic model of prostitution and its punitive consequences for migrants who sell sex","volume":"16","author":"Vuolaj\u00e4rvi","year":"2019","journal-title":"Sexual Res Soc Policy"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1007\/s10611-018-9795-6","article-title":"No model in practice: a \u2018Nordic model\u2019to respond to prostitution?","volume":"71","author":"Kingston","year":"2019","journal-title":"Crime Law Soc Change"}],"updated-by":[{"DOI":"10.3389\/fpubh.2026.1777357","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000}}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1590151\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T16:44:51Z","timestamp":1769532291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1590151\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":46,"alternative-id":["10.3389\/fpubh.2025.1590151"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1590151","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]},"article-number":"1590151"}}