Risk and resilience in the red lights: a mini-review on sex worker lived experiences and mental health outcomes.

Sex workers experience disproportionately high rates of multiple mental health conditions across global contexts.

• Conditions identified include depression, anxiety, PTSD, suicidality, dissociation, and substance use.
• These elevated rates are observed 'across global contexts,' indicating this is not limited to specific regions or legal environments.
• The review characterizes these rates as 'disproportionately high' relative to other populations.

Mental health risk consistently increases in criminalized environments and in settings characterized by reduced safety and autonomy.

• Legal frameworks are identified as structural determinants of sex workers' mental health outcomes.
• Sex work occurs across indoor, outdoor, and digital settings, with workers often moving fluidly between contexts.
• Criminalized environments are specifically linked to heightened psychological risk compared to other legal frameworks.

Stigma functions as a central mechanism linking criminalization, discrimination, and healthcare avoidance to psychological distress.

• The review draws on Goffman's stigma framework to analyze these dynamics.
• Both external and internalized stigma are identified as relevant mechanisms.
• Stigma is linked specifically to healthcare avoidance as one pathway to psychological distress.
• Compounded stigma effects are identified for LGBTQIA+ and BIPOC sex workers.

Masculine sexual entitlement is identified as a proximal interpersonal stressor strongly predictive of PTSD symptoms.

• It is characterized as a 'proximal interpersonal stressor,' distinguishing it from more distal structural factors.
• The review gives 'particular attention' to this factor among interpersonal dynamics affecting mental health.
• It is described as 'strongly predictive of PTSD symptoms' specifically.

Multiple factors are associated with elevated mental health burden in sex workers.

• Violence exposure is identified as a risk factor for elevated mental health burden.
• Poverty, early entry into sex work, and low workplace control are also associated with elevated burden.
• These factors span structural, economic, and occupational domains.

Peer and community networks function as robust protective factors for sex workers' mental health.

• These networks are described as 'robust protective factors' across studies.
• Protective mechanisms include enhancing safety, autonomy, and access to care.
• Community networks are identified as a key resilience resource despite elevated risk profiles.

The review identifies work venue as a determinant of sex workers' psychological outcomes.

• Indoor, outdoor, and digital settings are each recognized as distinct work contexts.
• Workers often move fluidly between these contexts rather than remaining fixed in one venue.
• Work venue is categorized alongside legal frameworks, stigma, and interpersonal dynamics as a shaping factor for mental health.

The review recommends sex work-affirming, trauma-informed clinical care and community-partnered research as practice implications.

• Clinical care recommendations emphasize both affirmation of sex work and trauma-informed approaches.
• Community-partnered research is identified as a methodological implication.
• These recommendations follow from findings on stigma-driven healthcare avoidance and the protective role of community networks.