Reviewer ’s report  
 
Title: BURDEN AND CORRELATES OF MENTAL HEALTH DIAGNOSES AMONG SEX  
WORKERS IN AN URBAN SETTING  
 
Version: 0 Date: 31 Dec 2016  
 
Reviewer: Suzanne Wenzel  
 
Reviewer's report:  
 
This interesting study points out the limited evidence describing the mental health of women 
who engage in sex work, and seeks to evaluate the burden and correlates of mental health 
problems among a probability sample of such women in Vancouver, Canada.  T he authors point 
in particular to structural factors as uninvestigated correlates of mental health in this population 
and state that this evidence is needed  to develop and implement effective intervention 
approaches.  
 
 
The authors present a model they had previously used to understand HIV related risk but it is not 
clear why this model is applicable to understanding mental health status.  The variables 
hypothesized to be independent variables predicting mental illness do not seem to be sufficiently 
substant iated.  
 
 
In the Methods, the authors refer readers to what they had "previously described" in another 
study. While providing a reference to previous research for additional details is fine, it is wise to 
ensure that all necessary details for understanding t he current study  are provided in the paper at 
hand.   
 
 
It is particularly problematic that mental health is measured as any self -reported mental health 
problem during the lifetime, for the obvious reasons of unclear temporal ordering (thus 
complicating sp eculation about cause and effect associations) and lack of specificity in 
intervention approaches for various mental health disorders which range from depression, PTSD, 
schizophrenia, ADHD, and personality disorder.  Authors cannot "examine the effects of these 
determinants on mental health," as they had proposed, nor can they confidently suggest 
intervention approaches with any satisfactory level of specificity.  
 
 
All this said, I applaud the authors for their focus on this important population of women bu t see 
flaws as described above. It may be helpful to try to frame the paper somewhat differently or to 
craft the analyses (data permitting) and paper to permit greater specificity in framing the analyses 
and in making recommendations.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to a ssess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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