Adverse childhood experiences, re-trafficking vulnerability, and mental health outcomes among women survivors of human trafficking in Kampala, Uganda: A cross-sectional analysis

Abstract

Background: Globally, human trafficking disproportionately affects women and girls, exposing them to severe exploitation and long-term psychological, social, and economic harm. While global efforts to prevent trafficking have intensified, the risk of re-trafficking remains a critical yet understudied issue in low-resource settings, particularly in Uganda. Uganda’s limited data on the effects of adverse childhood and re-trafficking vulnerabilities on the long-term mental health outcomes of survivors of trafficking limits the design of evidence-based interventions to improve survivors’ health. Our study examined the link between Adverse Childhood Experiences (ACE), re-trafficking vulnerability, and lasting mental health consequences among female survivors of human trafficking in Uganda Methods: A cross-sectional study was conducted among 350 female survivors of human trafficking in Kampala, Central Uganda, in January 2025. Trained female research assistants conducted one-on-one interviews in English or Luganda, a local language. Data on participants’ socio-demographic characteristics, adverse childhood experiences (ACE-IQ), human trafficking vulnerability (AHTST), anxiety (GAD-7), depression (PHQ-9), and PTSD were collected. Bivariate and multivariable modified regression models with robust standard errors were performed using Stata version 17.0 for analysis Results: Of the 350 female survivors of trafficking interviewed in Central Uganda, more than half (63.7%) reported experience of ACEs, 63.4% screened positive for human trafficking vulnerability, 57.1%, 56%, and 40.9% identified with anxiety, depression, and PTSD symptoms, respectively. Experience of ACEs strongly correlated with a 5%, 4%, and 6% increased risk of experiencing anxiety (aRR = 1.05, 95% CI: 1.02-1.08), depression (aRR = 1.04, 95% CI: 1.01-1.06), and PTSD (aRR =1.06, 95% CI: 1.03-1.09) symptoms, respectively. Additionally, age and education were strongly linked to a heightened risk of experiencing mental health (MH) symptoms among this population. Furthermore, trafficking vulnerabilities were paradoxically associated with lower symptom severity of all three MH conditions in this population Conclusion: This study highlights the strong link between adverse childhood experiences (ACEs), re-trafficking vulnerability, and MH risks among trafficking survivors in Uganda. High ACE exposure significantly increases anxiety, depression, and PTSD risk. The results reveal the immediate need for trauma-informed interventions addressing ACEs and mental health to reduce re-trafficking risks and promote survivor resilience. Unexpectedly, greater trafficking vulnerability correlated with lower symptom severity, warranting further investigation.

Publication information

Originally published in PLOS ONE on 2025-11-18. Original DOI: 10.1371/journal.pone.0334419.

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