Mental Health
Social cohesion, social support, and mental health diagnosis and care access: Findings from a community-based cohort of sex workers in Vancouver, Canada (2019-2024) Hannah Barca* Hannah Barca Barca Barca Barca Barca Barca Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University
Background: Sex workers (SWs) experience disproportionate health inequities, including mental health challenges largely driven by criminalization. While social cohesion interventions effectively reduce HIV/STIs, mental health impacts of support across occupational and community contexts are understudied. Thus, we examined associations between social cohesion, social support, and anxiety and depression diagnoses and care access among SWs.
Methods: We analyzed semi-annual questionnaires collected with women SWs enrolled in the prospective An Evaluation of Sex Workers Health Access (AESHA) cohort from 2019-2024 (≥2 interviews). We used logistic regression with inverse probability of treatment weights to analyze associations between 6-month time-lagged 1. SW social cohesion and 2. social support (overall, affectionate, emotional/informational, positive social interaction, and tangible) and: depression and anxiety diagnosis and mental healthcare access.
Results: Between 2019-2024, the overall prevalence of recent anxiety diagnosis was 3.5% and depression 4.9%; 35.4% experienced barriers to mental healthcare, and most SWs had medium-high social support scores (65.9%). Higher social cohesion was associated with fewer recent diagnoses for depression (aOR = 0.69, 95%CI: 0.49, 0.96) and greater use of anxiety care (aOR= 1.26, 95%CI: 1.01, 1.56). Higher affectionate support was associated with fewer recent anxiety (aOR = 0.21, 95%CI: 0.08, 0.51) and depression diagnoses (aOR = 0.43, 95%CI: 0.22, 0.82), and more use of depression care (aOR = 1.72, 95%CI: 1.01, 2.92). Emotional/informational and overall social support were significantly protective against recent depression.
Conclusions: Social cohesion and support may protect against developing depression and anxiety and reduce barriers to care. Implementation and evaluation of community-based, sex worker-tailored interventions to strengthen social connections across occupational and community contexts is needed.
