# Mental health of at-risk women: the role of structural vulnerabilities and resilience

> **NIH NIH F31** · JOHNS HOPKINS UNIVERSITY · 2020 · $41,300

## Abstract

Project Summary
Female sex workers (FSW) bear a disproportionate burden of depression and post-traumatic stress disorder
(PTSD) compared to the general female population. There is some evidence of the role of structural
vulnerabilities (i.e. homelessness, stigma, poverty) in poor mental health in the general population however
there has been little research on the nature of this relationship FSW, a population that is characterized by a
diverse array of structural vulnerabilities. Resilience has played a promising role in improving mental health in
prior research yet it is unclear the role it may play for FSW. The proposed mentored research will examine
patterns of structural vulnerabilities among a sample of FSW in Baltimore, Maryland collected at baseline
(n=350) and how resilience moderates the relationship between these patterns and mental health at 12-month
follow-up. Semi-structured in-depth interviews with free listing will be used to qualitatively examine how women
(n=20-25) describe dimensions and experiences of resilience in their lives and how they acquire resources to
strengthen resilience, including social support. (Aim 1). Using baseline survey data, latent class analysis (LCA)
will be performed to determine patterns of structural vulnerabilities (Aim 2). Then, LCA with distal outcomes will
be used to predict mental health (depression, PTSD, and co-occurring PTSD and depression) at 12-month
follow-up based on structural vulnerability class (Aim 3). Finally, LCA models with distal outcomes will be used
to explore the moderating role of resilience in the relationship between structural vulnerability class and mental
health (Sub-aim 3a). This study uses a novel mixed methods approach to explore moderating factors that
influence mental health among a population that experiences high rates of mental illness and structural
vulnerabilities. Findings can elucidate the drivers of the mental health disparity between FSW and the general
population. Results can also inform clinical and research interventions for addressing social and structural-level
risks and protective factors among a vulnerable population. This project will prepare the applicant to become a
leading independent researcher in the fields of mental health among vulnerable populations. The culminating
results from this project can help NIMH meet Strategic Objectives 2, 3, and 4 by using advanced LCA methods
to predict classes of risk factors for PTSD and depression in a sample of women who experience significant
mental health disparities; these risk factor classes can better inform mental health prevention and clinical care.

## Key facts

- **NIH application ID:** 9975000
- **Project number:** 5F31MH118817-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Catherine Tomko
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $41,300
- **Award type:** 5
- **Project period:** 2019-07-01 → 2021-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9975000

## Citation

> US National Institutes of Health, RePORTER application 9975000, Mental health of at-risk women: the role of structural vulnerabilities and resilience (5F31MH118817-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/9975000. Licensed CC0.

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