Depression and Anxiety Outcomes Among Young Adults Who Self-Reported Experiencing Commercial Sexual Exploitation in Adolescence
Abstract
1. Introduction
2. Background
2.1. Mental Health Issues Among CSE-Impacted Populations
2.2. Guiding Theoretical Framework
2.2.1. Family Structures and Processes Domains
2.2.2. Cognitions Domain
2.2.3. Health-Related Behaviors Domain
2.3. Current Study
3. Materials and Methods
3.1. Study Design and Data
3.2. Sample
3.3. Measures
3.3.1. Dependent Variables
Depression Scale
Depression Diagnosis
Anxious Personality Scale
Anxiety or Panic Disorder
3.3.2. Independent Variables
Domain 1: Family Structure
Domain 2: Family Processes
Domain 3: Cognitions
Domain 4: Health-Related Behaviors
3.3.3. Control Variables
3.4. Data Analysis
4. Results
4.1. Differences and Associations in Mental Health Symptoms
4.1.1. Depression Scores
4.1.2. Anxious Personality Scores
4.2. Differences and Associations in Mental Health Diagnoses
4.2.1. Depression Diagnosis
4.2.2. Anxiety/Panic Disorder Diagnosis
5. Discussion
5.1. Associations Between Social Identity and CSE on Mental Health
5.2. Family Health Development Model
5.2.1. Family Structure
5.2.2. Family Processes
5.2.3. Cognitions
5.2.4. Health-Related Behaviors
5.3. Limitations
5.4. Implications for Research
5.5. Implications for Practice
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ADHD | attention-deficit/hyperactivity disorder |
CSE | commercial sexual exploitation |
IQ | intelligence quotient |
PTSD | posttraumatic stress disorder |
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Variable | M (SD) or n (%) |
---|---|
Age | 15.03 (1.34) |
Gender | |
Female | 164 (32.67%) |
Male | 338 (67.33%) |
Race | |
White | 250 (50.20%) |
Black | 149 (29.92%) |
Latinx, American Indian/Native American, Asian or Pacific Islander | 99 (19.88%) |
Depression symptoms Wave 1 | 3.28 (3.09%) |
Family Structure | |
Two-parent household | |
No | 285 (56.77%) |
Yes | 217 (43.23%) |
Receiving public assistance | |
No | 364 (83.87%) |
Yes | 70 (16.13%) |
Family Processes | |
Mother–child relationship | 4.34 (0.70) |
Father–child relationship | 4.12 (0.79) |
Family belonging | 3.63 (0.90) |
Cognitions | |
Picture vocabulary test | 95.04 (14.99) |
Drug abuse education | |
No | 44 (8.80%) |
Yes | 456 (91.20%) |
Exercise education | |
No | 43 (8.62%) |
Yes | 456 (91.38%) |
Heath-related Behaviors | |
Receipt of health treatment | |
No | 382 (76.40%) |
Yes | 118 (23.60%) |
Receipt of mental health treatment | |
No | 385 (77.31%) |
Yes | 113 (22.69%) |
Engaged in exercise | |
No | 92 (18.36%) |
Yes | 409 (81.64%) |
Trouble relaxing | |
No | 264 (52.69%) |
Yes | 237 (47.31%) |
Substance use | |
No | 150 (29.88%) |
Yes | 352 (70.12%) |
Variable | M (SD) or n (%) |
---|---|
Age at Wave IV | 27.99 (1.44) |
Depression symptoms | 3.13 (2.85) |
Anxious personality symptoms | 12.16 (2.87) |
Depression diagnosis ever | |
No | 281 (80.06%) |
Yes | 70 (19.94%) |
Anxiety or panic disorder ever | |
No | 309 (88.03%) |
Yes | 42 (11.97%) |
Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Independent Variable | b (SE) | b | b (SE) | b | b (SE) | b | b (SE) | b | b (SE) | b |
Age | −0.14 (0.16) | −0.05 | −0.11 (0.16) | −0.04 | −0.16 (0.16) | −0.06 | −0.17 (0.16) | −0.06 | −0.22 (0.16) | −0.08 |
Gender (female) | 0.20 (0.32) | 0.03 | 0.07 (0.39) | 0.01 | 0.14 (0.33) | 0.02 | 0.13 (0.33) | 0.02 | 0.02 (0.32) | 0.00 |
Race (White—ref.) | ||||||||||
Black | 0.22 (0.35) | 0.03 | −0.05 (0.36) | −0.01 | 0.09 (0.37) | 0.01 | −0.12 (0.39) | −0.02 | 0.06 (0.39) | 0.01 |
Latinx, American Indian/Native American, Asian/Pacific Islander | −0.41 (0.42) | −0.06 | −0.53 (0.41) | −0.07 | −0.45 (0.42) | −0.06 | −0.70 (0.42) | −0.09 | −0.42 (0.43) | −0.06 |
Depression Symptoms (Wave I) | 0.60 (0.17) *** | 0.20 | 0.56 (0.17) *** | 0.18 | 0.44 (0.19) * | 0.14 | 0.38 (0.19) * | 0.19 | 0.19 (0.20) | 0.06 |
Family Structure | ||||||||||
Two-parent household | −0.08 (0.32) | −0.01 | −0.02 (0.33) | −0.00 | −0.02 (0.33) | −0.00 | 0.19 (0.33) | 0.03 | ||
Receiving public assistance | 1.31 (0.43) ** | 0.17 | 1.28 (0.43) ** | 0.17 | 1.20 (0.44) ** | 0.16 | 1.49 (0.45) *** | 0.19 | ||
Family Processes | ||||||||||
Mother–child relationship | 0.12 (0.20) | 0.04 | 0.13 (0.19) | 0.04 | 0.21 (0.19) | 0.07 | ||||
Father–child relationship | 0.01 (0.20) | 0.00 | 0.02 (0.20) | 010 | 0.07 (0.20) | 0.02 | ||||
Family belonging | −0.37 (0.22) | −0.12 | −0.50 (0.23) * | −0.17 | −0.53 (0.23) * | −0.17 | ||||
Cognitions | ||||||||||
Picture vocabulary test | −0.36 (0.18) * | −0.11 | −0.34 (0.18) | −0.11 | ||||||
Drug abuse education | −0.92 (0.65) | −0.08 | −0.80 (0.65) | −0.07 | ||||||
Exercise education | 0.04 (0.64) | 0.00 | 0.00 (0.64) | 0.00 | ||||||
Heath-related Behaviors | ||||||||||
Receipt of health treatment | −0.62 (0.36) | −0.02 | ||||||||
Receipt of mental health treatment | −0.79 (0.39) * | −0.01 | ||||||||
Exercise | −0.86 (0.39) * | −0.02 | ||||||||
Trouble relaxing | 0.63 (0.32) * | 0.10 | ||||||||
Substance use | −0.15 (0.37) | −0.15 | ||||||||
Model Fit | ||||||||||
Adj. R2 | 0.0315 | 0.0544 | 0.0556 | 0.0670 | 0.0981 | |||||
Model likelihood ratio χ2 (df, p-value) | 3.27 (5, 0.0001) | 5.18 (2, 0.0001) | 1.14 (3, 0.0001) | 2.39 (3, 0.0001) | 3.31 (5, 0.0001) |
Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Independent Variable | b (SE) | b | b (SE) | b | b (SE) | b | b (SE) | b | b (SE) | b |
Age | −0.30 (0.15) * | −0.10 | −0.28 (0.15) | −0.10 | −0.30 (0.16) | −0.10 | −0.30 (0.16) | −0.10 | −0.32 (0.17) | −0.12 |
Gender (female) | 1.32 (0.31) *** | 0.31 | 1.24 (0.31) *** | 0.21 | 1.18 (0.32) *** | 0.10 | 1.15 (0.32) *** | 0.20 | 1.08 (0.33) *** | 0.18 |
Race (White—ref.) | ||||||||||
Black | −0.64 (0.34) | −0.10 | −0.75 (0.35) * | −0.12 | −0.75 (0.37) * | −0.12 | −0.70 (0.39) | −0.11 | −0.69 (0.40) | −0.11 |
Latinx, American Indian/Native American, Asian/Pacific Islander | −0.81 (0.40) * | −0.11 | −0.88 (0.40) * | −0.12 | −0.88 (0.41) * | −0.12 | −0.95 (0.42) * | −0.13 | −0.94 (0.43) * | −0.12 |
Depression Symptoms (Wave I) | 0.38 (0.17) * | 0.12 | 0.36 (0.17) * | 0.11 | 0.29 (0.19) | 0.09 | 0.28 (0.19) | 0.09 | 0.24 (0.20) | 0.08 |
Family Structure | ||||||||||
Two-parent household | −0.03 (0.31) | −0.01 | 0.03 (0.32) | 0.01 | 0.05 (0.32) | 0.01 | 0.08 (0.33) | 0.01 | ||
Receiving public assistance | 0.87 (0.42) * | 0.11 | 0.92 (0.43) * | 0.12 | 0.99 (0.44) * | 0.13 | 1.14 (0.46) ** | 0.15 | ||
Family Processes | ||||||||||
Mother–child relationship | −0.19 (0.19) | −0.06 | −0.19 (0.19) | −0.06 | −0.18(0.19) | −0.57 | ||||
Father–child relationship | −0.04 (0.20) | −0.01 | −0.02 (0.20) | −0.01 | −0.02 (0.20) | −0.01 | ||||
Family belonging | −0.01 (0.22) | −0.00 | −0.05 (0.23) | −0.02 | −0.05 (0.23) | −0.02 | ||||
Cognitions | ||||||||||
Picture vocabulary test | 0.04 (0.18) | 0.01 | 0.05 (0.19) | 0.02 | ||||||
Drug abuse education | −0.72 (0.66) | −0.06 | −0.76 (0.66) | −0.07 | ||||||
Exercise education | 0.15 (0.64) | 0.01 | 0.13 (0.65) | 0.01 | ||||||
Heath-related Behaviors | ||||||||||
Receipt of health treatment | −0.10 (0.36) | −0.02 | ||||||||
Receipt of mental health treatment | −0.06 (0.39) | −0.01 | ||||||||
Exercise | −0.12 (0.39) | −0.02 | ||||||||
Trouble relaxing | 0.56 (0.32) | 0.10 | ||||||||
Substance use | −0.09 (0.38) | −0.01 | ||||||||
Model Fit | ||||||||||
Adj. R2 | 0.10 | 0.10 | 0.10 | 0.09 | 0.09 | |||||
Model likelihood ratio χ2 (df, p-value) | 8.11 (5, 0.0001) | 2.30 (2, 0.0001) | 0.48 (3, 0.0001) | 0.42 (3, 0.0001) | 0.61 (5, 0.0001) |
Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Independent Variable | OR | SE | [95% CI] | OR | SE | [95% CI] | OR | SE | [95% CI] | OR | SE | [95% CI] | OR | SE | [95% CI] |
Demographics | |||||||||||||||
Age | 0.86 | 0.13 | [0.64–1.15] | 0.84 | 0.13 | [0.63, 1.13] | 0.81 | 0.13 | [0.60, 1.10] | 0.82 | 0.13 | [0.60, 1.12] | 0.74 | 0.13 | [0.53, 1.04] |
Gender (female) | 1.86 * | 0.55 | [1.04, 3.32] | 1.80 | 0.54 | [1.00, 3.25] | 1.98 * | 0.62 | [1.07, 3.66] | 1.92 * | 0.61 | [1.03, 3.59] | 1.93 * | 0.64 | [1.01, 3.70] |
Race (White—ref.) | |||||||||||||||
Black | 0.38 * | 0.14 | [0.19, 0.78] | 0.29 * | 0.11 | [0.13, 0.61] | 0.29 * | 0.11 | [0.13, 0.63] | 0.27 * | 0.11 | [0.12, 0.61] | 0.34 ** | 0.15 | [0.14, 0.80] |
Latinx, American Indian/Native American, Asian/Pacific Islander | 0.32 * | 0.15 | [0.13, 0.80] | 0.28 * | 0.23 | [0.11, 0.71] | 0.29 * | 0.14 | [0.11, 0.75] | 0.20* | 0.10 | [0.07, 0.55] | 0.24 ** | 0.13 | [0.08, 0.71] |
Depression Symptoms (Wave I) | 2.08 * | 0.33 | [1.53, 2.83] | 2.02 * | 0.31 | [1.49, 2.74] | 1.89 * | 0.33 | [1.35, 2.66] | 1.92 * | 0.34 | [1.35, 2.73] | 1.68 ** | 0.32 | [1.16, 2.43] |
Family Structure | |||||||||||||||
Two-parent household | 0.47 * | 0.15 | [0.25, 0.88] | 0.48 * | 0.16 | [0.25, 0.92] | 0.48 * | 0.16 | [0.25, 0.93] | 0.62 | 0.22 | [0.31, 1.24] | |||
Receiving public assistance | 1.35 | 0.52 | [0.63, 2.89] | 1.26 | 0.50 | [0.58, 2.74] | 1.45 | 0.61 | [0.64, 3.30] | 1.92 | 0.87 | [0.79, 4.66] | |||
Family Processes | |||||||||||||||
Mother–child relationship | 1.26 | 0.23 | [0.88, 1.79] | 1.26 | 0.23 | [0.87, 1.81] | 1.34 | 0.25 | [0.93, 1.94] | ||||||
Father–child relationship | 0.90 | 0.17 | [0.63, 1.29] | 1.00 | 0.19 | [0.69, 1.46] | 1.11 | 0.22 | [0.75, 1.65] | ||||||
Family belonging | 0.81 | 0.18 | [0.52, 1.25] | 0.68 | 0.16 | [0.43, 1.08] | 0.67 | 0.16 | [0.42, 1.06] | ||||||
Cognitions | |||||||||||||||
Picture vocabulary test | 0.90 | 0.17 | [0.63, 1.31] | 0.92 | 0.18 | [0.63, 1.36] | |||||||||
Drug abuse education | 0.16 * | 0.10 | [0.05, 0.54] | 0.15 ** | 0.09 | [0.04, 0.51] | |||||||||
Exercise education | 2.99 | 2.15 | [0.73, 12.27] | 2.73 | 2.02 | [0.64, 11.64] | |||||||||
Health-related Behaviors | |||||||||||||||
Receipt of health treatment | 1.44 | 0.50 | [0.73, 2.86] | ||||||||||||
Receipt of mental health treatment | 2.49 ** | 0.87 | [1.25, 4.95] | ||||||||||||
Exercise | 0.58 | 0.22 | [0.27, 1.23] | ||||||||||||
Trouble relaxing | 1.66 | 0.56 | [0.86, 3.23] | ||||||||||||
Substance use | 1.30 | 0.55 | [0.57, 2.96] | ||||||||||||
McKelvey and Zavoina’s pseudo R2 | 0.37 | ||||||||||||||
Model likelihood ratio χ2 (df, p-value) | 44.57 (5, 0.0001) | 51.89 (7, 0.0001) | 54.45 (10, 0.0001) | 64.91 (13, 0.0001) | 79.31 (18, 0.0001) |
Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Independent Variable | OR | SE | [95% CI] | OR | SE | [95% CI] | OR | SE | [95% CI] | OR | SE | [95% CI] | OR | SE | [95% CI] |
Demographics | |||||||||||||||
Age | 0.99 | 0.18 | [0.68, 1.43] | 0.97 | 0.18 | [0.67, 1.40] | 1.03 | 0.20 | [0.70, 1.51] | 1.03 | 0.20 | [0.70, 1.52] | 0.87 | 0.19 | [0.59, 1.37] |
Gender (female) | 2.75 ** | 1.03 | [1.32, 5.73] | 2.78 ** | 1.05 | [1.33, 5.84] | 2.52 * | 0.99 | [1.17, 5.43] | 2.53 ** | 1.01 | [1.16, 5.52] | 2.61 | 1.10 | [1.14, 5.98] |
Race | |||||||||||||||
Black | 0.16 *** | 0.09 | [0.05, 0.48] | 0.14 *** | 0.08 | [0.04, 0.44] | 0.13 *** | 0.07 | [0.04, 0.40] | 0.12 *** | 0.07 | [0.04, 0.39] | 0.10 *** | 0.07 | [0.03, 0.39] |
Latinx, American Indian/Native American, Asian/Pacific Islander | 0.16 ** | 0.10 | [0.04, 0.58] | 0.15 ** | 0.10 | [0.04, 0.56] | 0.13 ** | 0.09 | [0.03, 0.50] | 0.09 *** | 0.07 | [0.02, 0.39] | 0.07 *** | 0.06 | [0.02, 0.35] |
Depression Symptoms (Wave I) | 1.97 | 0.36 | [1.37, 2.83] | 1.94 *** | 0.36 | [1.35, 2.78] | 2.21 *** | 0.48 | [1.44, 3.40] | 2.27 *** | 0.51 | [1.46, 3.53] | 2.22 *** | 0.55 | [1.37, 3.60] |
Family Structure | |||||||||||||||
Two-parent household | 0.56 | 0.21 | [0.27, 1.19] | 0.53 | 0.21 | [0.24, 1.17] | 0.53 | 0.22 | [0.24, 1.18] | 0.69 | 0.30 | [0.29, 1.62] | |||
Receiving public assistance | 0.86 | 0.45 | [0.31, 2.41] | 0.96 | 0.51 | [0.34, 2.71] | 1.19 | 0.66 | [0.40, 3.55] | 1.96 | 1.20 | [0.59, 6.52] | |||
Family Processes | |||||||||||||||
Mother–child relationship | 0.74 | 0.16 | [0.49, 1.13] | 0.72 | 0.16 | [0.47, 1.11] | 0.76 | 0.17 | [0.50, 1.18] | ||||||
Father–child relationship | 1.02 | 0.23 | [0.66, 1.59] | 1.17 | 0.28 | [0.74, 1.86] | 1.26 | 0.31 | [0.78, 2.06] | ||||||
Family belonging | 1.58 | 0.47 | [0.89, 2.83] | 1.37 | 0.42 | [0.76, 2.48] | 1.41 | 0.44 | [0.76, 2.61] | ||||||
Cognitions | |||||||||||||||
Picture vocabulary test | 1.02 | 0.23 | [0.65, 1.58] | 0.94 | 0.22 | [0.60, 1.48] | |||||||||
Drug abuse education | 0.22 | 0.17 | [0.05, 0.96] | 0.18 * | 0.14 | [0.04, 0.86] | |||||||||
Exercise education | 4.82 | 4.63 | [0.73, 31.73] | 6.60 | 6.91 | [0.84, 51.49] | |||||||||
Health-related Behaviors | |||||||||||||||
Receipt of health treatment | 2.79 | 1.19 | [1.21, 6.44] | ||||||||||||
Receipt of mental health treatment | 1.60 * | 0.70 | [0.68, 3.78] | ||||||||||||
Exercise | 2.35 | 1.37 | [0.75, 7.38] | ||||||||||||
Trouble relaxing | 2.26 | 1.01 | [0.94, 5.42] | ||||||||||||
Substance use | 1.16 | 0.62 | [0.40, 3.32] | ||||||||||||
McKelvey and Zavoina’s pseudo R2 | 0.52 | ||||||||||||||
Model likelihood ratio χ2 (df, p-value) | 46.63 (5, 0.0001) | 48.97 (7, 0.0001) | 52.44 (10, 0.0001) | 57.48 (13, 0.0001) | 72.50 (18, 0.0001) |
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Godoy, S.M.; Englert, A.R.; Mazursky, N.; Prout, L.; Hall, W.J. Depression and Anxiety Outcomes Among Young Adults Who Self-Reported Experiencing Commercial Sexual Exploitation in Adolescence. Int. J. Environ. Res. Public Health 2025, 22, 1062. https://doi.org/10.3390/ijerph22071062
Godoy SM, Englert AR, Mazursky N, Prout L, Hall WJ. Depression and Anxiety Outcomes Among Young Adults Who Self-Reported Experiencing Commercial Sexual Exploitation in Adolescence. International Journal of Environmental Research and Public Health. 2025; 22(7):1062. https://doi.org/10.3390/ijerph22071062
Chicago/Turabian StyleGodoy, Sarah M., Adam R. Englert, Nofar Mazursky, Luisa Prout, and William J. Hall. 2025. "Depression and Anxiety Outcomes Among Young Adults Who Self-Reported Experiencing Commercial Sexual Exploitation in Adolescence" International Journal of Environmental Research and Public Health 22, no. 7: 1062. https://doi.org/10.3390/ijerph22071062
APA StyleGodoy, S. M., Englert, A. R., Mazursky, N., Prout, L., & Hall, W. J. (2025). Depression and Anxiety Outcomes Among Young Adults Who Self-Reported Experiencing Commercial Sexual Exploitation in Adolescence. International Journal of Environmental Research and Public Health, 22(7), 1062. https://doi.org/10.3390/ijerph22071062