Psychological consequences of child trafficking: An historical cohort study of trafficked children in contact with secondary mental health services

<div><p>Background</p><p>Child trafficking is the recruitment and movement of people aged younger than 18 for the purposes of exploitation. Research on the mental health of trafficked children is limited, and little is known about the use of mental health services by this group. This study aimed to investigate the mental health and service use characteristics of trafficked children in contact with mental health services in England.</p><p>Methods & findings</p><p>The study employed an historical cohort design. Electronic health records of over 250,000 patients were searched to identify trafficked children, and a matched cohort of non-trafficked children was randomly selected. Data were extracted on the socio-demographic and clinical characteristics, abuse history, and trafficking experiences of the trafficked children. Logistic and linear random effects regression models were fitted to compare trafficked and non-trafficked children on their clinical profiles and service use characteristics. Fifty-one trafficked children were identified, 78% were female. The most commonly recorded diagnoses for trafficked children were post-traumatic stress disorder (PTSD) (22%) and affective disorders (22%). Records documented a high prevalence of physical violence (53%) and sexual violence (49%) among trafficked children. Trafficked children had significantly longer duration of contact with mental health services compared to non-trafficked controls (b = 1.66, 95% CI 1.09–2.55, p<0.02). No significant differences were found, however, with regards to pathways into care, prevalence of compulsory psychiatric admission, length of inpatient stays, or changes in global functioning.</p><p>Conclusions</p><p>Child trafficking is associated with high levels of physical and sexual abuse and longer duration of contact with mental health services. Research is needed on most effective interventions to promote recovery for this vulnerable group.</p></div

Logistic random effects regression analyses comparing care pathways of trafficked and matched non-trafficked children in contact with secondary mental health services^a.

<p>Logistic random effects regression analyses comparing care pathways of trafficked and matched non-trafficked children in contact with secondary mental health services<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0192321#t003fn001" target="_blank">^a</a>.</p

Kaplan-Meier plot of treatment delay.

<p>Kaplan-Meier plot of treatment delay.</p

Accuracy statistics for algorithms to predict lifetime research diagnosis from multiple HES records, based on review of 246 cases.

<p>Numbers of cases given for each diagnostic group predicted by stated algorithm (explained in methods). PPV = positive predictive value, NPV = negative predictive value.</p

Rate of secondary diagnoses recorded in HES and found in research diagnosis.

<p>Rate of secondary diagnoses recorded in HES and found in research diagnosis.</p

Inter-rater reliability for primary diagnoses of index and lifetime formulations in 80 cases (160 formulations).

<p>Inter-rater reliability for primary diagnoses of index and lifetime formulations in 80 cases (160 formulations).</p

Hierarchy diagram showing the diagnoses considered in this study, with different levels of detail.

<p>Hierarchy diagram showing the diagnoses considered in this study, with different levels of detail.</p

Inpatient Hospital Episode Statistics pathway from patient to researcher.

<p>Inpatient Hospital Episode Statistics pathway from patient to researcher.</p

Flow chart of cases used to derive gold-standard diagnoses.

<p>Schizophrenia (ICD-10 F20); wSS = wider schizophrenia spectrum disorder (ICD-10 F21-29); BPAD = bipolar affective disorder (ICD-10 F30-31); depression = unipolar depression (ICD-10 F32-33).</p

Patient characteristics based on diagnosis in HES record by which they were selected.

<p>Patient characteristics based on diagnosis in HES record by which they were selected.</p