Distress among Child Trafficking Survivors

Children who have been trafficked for forced labor or sexual exploitation suffer high rates of mental health difficulties, self-harm, and suicide attempts, new figures reveal.

A team from the London School of Hygiene & Tropical Medicine, UK, worked with the International Organization for Migration on the research. They carried out interviews with 387 children and adolescents in post-trafficking services in Cambodia, Thailand, and Vietnam.

The participants were aged 10 to 17 years, and the majority (82 percent) were female. Just over half (52 percent) had been exploited for sex work. Boys were usually trafficked for street begging (29 percent) and fishing (19 percent). Fifteen girls were trafficked to China as brides. Participants were interviewed within two weeks of entering services from October 2011 through May 2013.

Dr. Cathy Zimmerman and her team said this is the largest survey of its kind. They found that physical or sexual violence was experienced by one-third of the boys and girls while they were trafficked. Among this group, 23 percent suffered a serious injury.

In terms of mental health, 56 percent of the survivors had depression, 33 percent had an anxiety disorder, and 26 percent had post-traumatic stress disorder. In the previous month, 12 percent had tried to harm or kill themselves and 16 percent had suicidal thoughts.

Full results appear in the journal JAMA Pediatrics.

Dr. Zimmerman said, “It is extraordinarily sad to learn that so many children in our study attempted to kill or harm themselves. These findings are especially disturbing given estimates that each year thousands, if not millions of children are trafficked and suffer severe abuse, such as being beaten up, tied or chained, choked, burned, cut with a knife, and subjected to sexual violence.

“Not surprisingly, our study shows these abuses profoundly affect children’s mental health, resulting in depression, anxiety, and suicidal thoughts,” she said. “For many, going home does not promise an end to their distress, as more than half of the young interviewees said they worried about how they would be treated when they returned home, and said they felt guilty or ashamed.

“We urge post-trafficking service providers to screen trafficked children carefully for severe mental health problems, especially possible suicide, and to provide age-appropriate psychological support.”

Team member Dr. Ligia Kiss, also from the London School of Hygiene & Tropical Medicine, added, “A fifth of the children in our study reported physical or sexual violence at home before migrating, often perpetrated by a family member. This highlights the value of understanding a child’s pre-trafficking experience, because children’s symptoms of depression, anxiety, posttraumatic stress disorder, suicide attempts, and self-harm were associated with abuses at home.

“Reintegrating a child into society or reuniting them with their family may not always be a straightforward process. Reintegration risk assessments should be carried out, because for many children going home may not be a safe option.”

Despite including children of various ages and nationalities, the researchers point out that there are some limitations to the study, including that their sample only included individuals in post-trafficking services.

Around the world, 5.7 million boys and girls are in estimated to be in situations of forced labor, 1.2 million trafficked, and 1.8 million exploited in the sex industry. So far, evidence has been lacking on the health and well-being of survivors.

These findings build on those from a study by the same researchers published earlier in 2015. The team surveyed 1,102 men, women, and children in post-trafficking services about their experiences and health. All were attending post-trafficking services in Cambodia, Thailand, and Vietnam.

This found that 48 percent experienced physical violence, sexual violence, or both. Almost half (47 percent) were threatened and 20 percent were locked in a room. Most (70 percent) worked every day of the week, with 30 working at least 11 hours per day. Depression was seen in 61 percent of participants, and anxiety in 43 percent. Symptoms of post-traumatic stress disorder were reported in 39 percent.

Depression, anxiety, and post-traumatic stress disorder were most common among those who experienced extremely excessive overtime at work, restricted freedom, bad living conditions, threats, or severe violence.

“Trafficking is a crime of global proportions involving extreme forms of exploitation and abuse,” the experts write. “Violence and unsafe working conditions were common and psychological morbidity was associated with severity of abuse. Survivors of trafficking need access to health care, especially mental health care.”


Kiss, L. et al. Exploitation, violence, and suicide risk among child and adolescent survivors of human trafficking in the Greater Mekong Subregion. JAMA Pediatrics, 8 September 2015, doi: 10.1001/jamapediatrics.2015.2278

Kiss, L. et al. Health of men, women, and children in post-trafficking services in Cambodia, Thailand, and Vietnam: an observational cross-sectional study. The Lancet Global Health, March 2015, doi: 10.1016/S2214-109X(15)70016-1

International Labour Organization, Global Estimate of Forced Labour: Results and Methodology. Geneva, Switzerland: International Labour Organization: 2012 and US Department of State. Trafficking in Persons Report June 2007 U.S. Department of State
Upset child photo by shutterstock.