Adverse childhood experiences and mental health outcomes among women in sex work and social care

A cross-sectional study

Bibliographic Data

ID22080318
AuthorsFranziska Kroehn-Liedtke (St. Hedwig-Krankenhaus), Anastasiia Lotysh (St. Hedwig-Krankenhaus), Olivia Kalinowski (St. Hedwig-Krankenhaus), Gizem Kaya (0000-0002-6870-7219, St. Hedwig-Krankenhaus), Hristiana Mihaylova (St. Hedwig-Krankenhaus), Martina Hernek (St. Hedwig-Krankenhaus), Wulf Rössler (0000-0003-0049-4533, St. Hedwig-Krankenhaus), Meryam Schouler-Ocak (St. Hedwig-Krankenhaus), Meryam Schouler‐Ocak (0000-0002-1846-3500, Department of Psychiatry and Neurosciences, Psychiatric University Clinic of Charité at St. Hedwig Hospital)
Year2026
Volume14
Pages1786872-1786872
Publication date2026-04-10
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2026.1786872
PMID42040132
OpenAlexW7153214115
LanguageEN
References cited30

Introduction: Adverse childhood experiences (ACEs) are well-established risk factors for mental disorders, yet their impact within vulnerable occupational groups remains insufficiently understood. Women engaged in sex work and social care are disproportionately exposed to violence and emotional stressors, potentially compounding the effects of early-life adversity. Methods: We conducted a mixed-methods study in Berlin, Germany, including 560 women (403 engaged in sex work, 157 in social care). Childhood adversity was assessed using the Childhood Trauma Questionnaire (CTQ-SF), and current psychiatric disorders were diagnosed via structured clinical interviews (MINI-DIPS). Severe ACE exposure was defined as moderate-to-severe trauma in at least two CTQ domains. Multivariable logistic regression models examined associations between ACE exposure and mental health outcomes, adjusting for age, socioeconomic indicators, and occupational stressors. In addition, 10 semi-structured interviews explored experiences with mental health care, coping strategies, and resilience. Results: Severe ACE exposure was reported by 47% of women in sex work and 16% of women in social care work. Higher ACE exposure was associated with increased odds of depression [adjusted OR (aOR) 3.8, 95% CI 2.3-6.3], panic disorder (aOR 2.7, 95% CI 1.6-4.7), post-traumatic stress disorder (aOR 5.7, 95% CI 3.1-10.7), and substance use disorders (aOR 4.0, 95% CI 2.3-7.1). Qualitative findings highlighted the interplay of early adversity and occupational stress, alongside resilience through peer support and advocacy. Discussion: ACEs substantially contribute to psychiatric morbidity among women in violence- and stress-exposed occupations. Trauma-informed approaches that integrate early-life adversity and occupational context are essential for prevention and care in these high-risk groups

Logistic regression · Mental health · Occupational safety and health · Poison control · Psychosocial · Social support · Socioeconomic status · Suicide prevention · Child Abuse and Trauma · Sex work and related issues · Sexual Assault and Victimization Studies

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