Depression and correlates of suicidal thoughts among mothers who are female sex workers in three low- and middle-income countries in Sub-Saharan Africa: a cross-sectional application of the Edinburgh postnatal depression scale.

Introduction: Depression is prevalent among female sex workers (FSW) in low- and middle-income countries (LMIC) and poses an elevated risk of suicide. The current study employs the Edinburgh Postnatal Depression Scale (EPDS) as a means of estimating "probable depression" and exploring correlates of suicidal thoughts in Kenyan, Nigerian, and Congolese mothers who are FSW (MFSW). Methods: This cross-sectional study surveyed a convenience sample of MFSW from eight cities in Kenya, Nigeria, and the Democratic Republic of the Congo (DRC). A sociodemographic questionnaire and the EPDS screener were administered. An EPDS cut-off score of 13 was used to define Results: Among 831 MFSW included, the mean age was 27.7 years and the majority had primary childcare responsibilities for up to 4 children. The highest mean EPDS scores were 24.6 in DRC and 23.3 among MFSW aged 18-24 years, respectively. The pooled mean EPDS score was 22.3 and the sample-based prevalence of Discussion: In the absence of more conventional scales for depression diagnosis and severity, the brief, low-cost, and low-resource EPDS screening tool may be useful among MFSW populations and reasonable for depression detection and referral to diagnosis and treatment. Contextual narratives volunteered in response to the EPDS self-harm question offer insights into the correlates of suicidal thoughts. This study highlights the urgent need for targeted interventions, including mental health services, social programs, policies, and legal protections, to address the mental health of MFSW in LMIC.