ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Mental Health
This article is part of the Research TopicMental Health and Well-being of Sex Workers: Exploring Risks, Resilience and InterventionsView all 7 articles
Quality of Life, Mental Health, and Socio-Demographic Differences Across Sex Work Settings: Implications for Specialized Healthcare and Support Services
Provisionally accepted
Olivia Kalinowski*
Franziska Liedtke
Gizem KayaAnastasiia LotyshHristiana MihaylovaKrisztina Sipos
Lena Karoline Zerbe
Meryam Schouler-Ocak
Wulf Rössler- Department of Psychiatry and Neurosciences, Charité University Medicine Berlin, Berlin, Germany
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Background: Existing research shows that quality of life (QoL), mental health, and working conditions vary widely across sex work settings. Street-based work, for example, involves other risks than e.g. online sex work. Little is known about what drives individuals into specific environments. This study examines whether work setting predicts working conditions, QoL, mental health, as well as reported sociomedical needs and explores factors predicting the work setting. The aim is to inform recommendations for more tailored healthcare and support services. Methods: Data come from PSYCHSEX, a cross-sectional study conducted at the Department of Psychiatry and Neurosciences, Charité University Hospital Berlin (August 2021–August 2024), funded by the German Research Association (DFG). Structured quantitative interviews were conducted with 403 sex workers recruited through quota sampling to represent diverse settings, including private apartments, studios, brothels, massage parlors, clubs, clients' homes, vehicles, guesthouses/hotels, outdoor locations, and online platforms. Results: Work setting was significantly associated with QoL, mental health, and working conditions. Specific settings (e.g., studios, escort work, online platforms) were linked to better QoL, mental health, and working conditions than others. Socio-demographic factors like migration status and homelessness, along with distinct self-reported reasons for entering sex work, e.g. personal preference, lack of alternatives, or funding one´s education, predicted work setting. Reported socio-medical needs differed across settings. Discussion: Sex work is shaped by diverse settings, conditions, and individual pathways. Variation in QoL, mental health, working conditions, and unmet support needs underscores the need for setting-specific healthcare and social services. Structural factors such as housing instability and migration status play a key role and should be addressed through targeted policies and interventions. These findings highlight the importance of context-sensitive, evidence-based support to improve the well-being of sex workers across different environments.
Keywords: sex work1, prostitution2, trafficking3, mental health4, setting5, healthcare service6, quality of life7, support8
Received: 11 Sep 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Kalinowski, Liedtke, Kaya, Lotysh, Mihaylova, Sipos, Zerbe, Schouler-Ocak and Rössler. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Olivia Kalinowski, olivia.kalinowski@charite.de
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