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Poor mental health, self-harm and suicide attempts are common among children and adolescents who have been trafficked for forced labour or sexual exploitation, according to a new study published in .

The research was led by Dr and colleagues at the London School of Hygiene & Tropical Medicine, in collaboration with the , and included interviews with 387 children and adolescents aged 10 to 17 years in post-trafficking services in Cambodia, Thailand and Vietnam.

Researchers found that one third of boys and girls surveyed had experienced physical or sexual violence (or both) while trafficked, and of those 23% had sustained a serious injury. Mental health issues were common: more than half of the young trafficking survivors (56%) screened positive for depression, a third (33%) for an anxiety disorder and a quarter (26%) for posttraumatic stress disorder. 12% reported they had tried to harm or kill themselves in the month before the interview, while 15.8% reported having suicidal thoughts in the past month. A third were still afraid of the trafficker or their associates.

Estimates suggest that globally 5.7 million boys and girls are in situations of forced labour, 1.2 million are trafficked, and approximately 1.8 million are exploited in the sex industry, but there is little evidence to date about the health and wellbeing of child and adolescent survivors of trafficking. The authors believe the new study is the largest survey of its kind to examine this.

95% of the children and adolescents interviewed in the study were older than 13, and the majority were female (82%). Just over half of participants (52%) had been exploited for sex work. Boys were most commonly trafficked for street begging (29%) and fishing (19%). Fifteen girls were trafficked to China as brides.

Sexual violence was more commonly reported by girls (23% compared with 1% of boys) and physical violence more commonly reported by boys (41% compared with 19% for girls). Employers or traffickers were often identified as the perpetrators. 34% of girls trafficked into sex work experienced physical violence, and 71% reported sexual violence by a client.

Researchers found that participants commonly worked seven days a week (53% of girls, 73% of boys). Boys were more likely to report bad living conditions, for example 54% of boys had nowhere to sleep or slept on the floor, and 22% had inadequate drinking water. Serious occupational injuries (such as a deep cut, very bad burn, serious head injury, broken bone) were sustained by 21% of boys and 7% of girls.

Senior author Dr , from the London School of Hygiene & Tropical Medicine, 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. 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."

The researchers also asked participants if they had experienced violence or abuse at home before they were trafficked.

Lead author Dr , Lecturer in Social Epidemiology at the School, said: "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."

The authors note some limitations to the study, including that their sample only included individuals in post-trafficking services and does not represent a general population of trafficked children, although children of various ages and nationalities exploited in different sectors were included. 

The study was funded by the and , with additional support from the , UK. The findings which surveyed more than 1,000 men, women and children in post-trafficking services about their experiences and health.

Publication:

• Ligia Kiss, Katherine Yun, Nicola Pocock, Cathy Zimmerman, , JAMA Pediatrics. DOI: 10.1001/jamapediatrics.2015.2278

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