Half of trafficking survivors meet criteria for depression or anxiety — screen everyone you identify

Design

systematic review, random-effects meta-analysis and meta-regression; PROSPERO registered

Population

18 quantitative studies of survivors of trafficking involving sexual exploitation, published 2000 to 2025

Primary outcome

pooled prevalence of PTSD, depression, anxiety and suicide attempts

Effect

PTSD 44.0% (95% CI 30.3 to 58.7); depression 50.5%; anxiety 52.3%; attempted suicide 19.1%; I² 96.9 to 98.9%

Eighteen quantitative studies published between 2000 and 2025 were pooled with random-effects models to estimate the psychiatric burden among survivors of trafficking for sexual exploitation. Pooled prevalence was 44.0 per cent for PTSD (95% CI 30.3 to 58.7, 15 studies), 50.5 per cent for depression (16 studies), 52.3 per cent for anxiety (14 studies) and 19.1 per cent for attempted suicide (4 studies).

Heterogeneity was extreme — I² between 96.9 and 98.9 per cent, and the prediction interval for PTSD ran from 7.0 to 89.1 per cent. Region explained some variation, and only for depression. Two of the eighteen studies reported usable service-use data; none operationalised the structural determinants of care. So the literature can say the burden is very high and cannot yet say how high in any given setting.

That is still enough to change a pathway. Wherever survivors are identified — emergency departments, sexual health and antenatal services, shelters, police referrals, NGO partnerships — psychiatric screening and a trauma-informed follow-up route should be standing components of the response, not something arranged case by case. In India, where identification usually happens through NGOs and protective homes rather than health services, the practical work is agreeing in advance who does the mental health assessment and where the person goes next.

• Build PTSD, depression, anxiety and suicide screening into every survivor identification pathway
• Assume one in five has attempted suicide and ask accordingly
• Agree the referral route with local shelters, NGOs and protective homes before a case arrives
• Plan for sustained follow-up — a single assessment does not constitute trauma-informed care
• Use these figures for service planning, not to estimate an individual's probability of illness

Why it matters

It converts a burden everyone assumes is high into a number that justifies a standing pathway rather than ad hoc referral.

Don't overread it

These are pooled prevalence figures with extreme heterogeneity — they should guide service planning, not be quoted as population rates.

The statistics, in plain English

An I² near 98 per cent means the studies are not estimating one common figure, and a prediction interval of 7 to 89 per cent for PTSD says the next study could land almost anywhere. The pooled point estimates are therefore useful as an argument for capacity, not as an expected rate in your own clinic. The suicide figure rests on four studies.

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