The research objectives are:

1. To examine the psychosocial issues of human trafficking victims.
2. To explore the challenges experienced by victims in overcoming fear, distrust, and social isolation often stemming from manipulation and control tactics employed by traffickers.
3. To analyze the practical difficulties victims encounter, such as securing safe housing, obtaining legal documentation, and re-entering the workforce.

In many parts of the US, human trafficking victims have limited or no access to specially trained providers who help meet their specific psychological needs. Multiple and persistent traumas experienced by victims require long-term assistance as people lose their ability to perform many tasks and may even suffer from negative consequences throughout their whole lives [2,4]. The purpose of this research is to explore the processes that contribute to the development of the unique needs of human trafficking victims and ways of addressing them upon returning home or reintegrating into the community.

The research questions are:

1. What are the needs of human trafficking survivors when adjusting to society?
2. What social, emotional, and practical hurdles hinder the reintegration of human trafficking survivors?
3. What are the most effective interventions to properly reintegrate human trafficking victims into society?

Trafficking is implied to denote terms that are used interchangeably, referring to a crime whereby traffickers exploit or profit at an individual’s expense by compelling him or her to engage in commercial sex or perform labor [2]. When an individual aged below 18 is used to perform a commercial sex act, it is always a crime, regardless of whether it occurs because of fraud, force, or coercion. The most common types of human trafficking are sex trafficking and forced labor, and the latter includes domestic servitude and forced child labor [2]. Human trafficking, sexual trafficking in particular, significantly affects mental health as survivors have experienced multiple forms of trauma, for instance, psychological abuse, violence, sexual abuse, and extortion. A high accumulation of negative traumatic experiences exposes victims to increased rates of major depression, mental health disorders, and physical health problems [5]. Mental health services, life skills training, and stable housing are vital in recovery. To provide comprehensive and effective services that meet the unique needs of human trafficking survivors, it is critical to understand them in the context of society, along with personal and professional life.

LITERATURE REVIEW

Mental Health Implications

The analysis of literary sources has shown that the question of mental health among the victims of human trafficking and their unique needs has not received sufficient scientific attention. Human trafficking victims experience psychological abuse that has a long-lasting impact on their lives if they survive. Notably, it affects interpersonal relationships and victims’ inability to trust people. Often, victims enter subordinate relationships with their perpetrators to prevent violence towards themselves, and it significantly contributes to traumatic experiences [3]. Physical and social pain inflicted on human trafficking victims can illuminate the psychological distress, thus enhancing the experience of increased levels of social stigma and discrimination, which results in isolation and issues associated with building relationships. When victims heal from spiritual and health impairment inflicted by traffickers, many of them must recover from a destroyed sense of relationship, which significantly affects their life in the community.

Depression

The most common psychological health issues experienced by human trafficking victims after returning home are depression, anxiety, PTSD, self-injurious behavior, suicidal thoughts, substance abuse, and dissociative disorders. Additionally, victims often report that they experience feelings of loneliness and worthlessness after they return home; they may also feel fear, rage, shame, despair, guilt, shock, distress, and helplessness [3]. Depression is a psychological symptom faced most often by female human trafficking victims [6]. It identifies with time as the negative experience victims had gradually contributed to physical and psychological health issues. Tortured victims and victims who have experienced increasingly traumatic events are prone to severe depression. Analysis of literature sources indicates that depression is often combined with other psychological symptoms, such as anxiety and PTSD [3]. Removal from a dangerous situation and returning home does not mean the level of depression is reduced, and symptomatic anxiety and other psychological disorders keep affecting the victim [5]. Psychological trauma leaves scars in the lives of victims, and the use of effective and personally tailored interventions may help them regain their mental health.

Anxiety

Human trafficking victims face multiple unpleasant consequences, and one of them is anxiety. It causes difficulties in functioning, communicating, and performing daily duties, and this feeling is hard to manage. Nervousness, fearfulness, and extreme tension are anxious symptoms that prevent victims from interacting with family members, friends, and the community. After escaping from the traffickers, victims were reported to be increasingly irritated and annoyed [5]. Chronic stress, insufficient confidence, decreased self-esteem, nervousness, and isolation are the leading causes of anxiety among victims. Research conducted by Suwetty [7]. shows that female victims experience anxiety and related psychological issues more often compared to male victims. At the same time, men are often ashamed and feel highly uncomfortable that they come back home without money and require support. Moreover, victims are ashamed of having been trafficked for sexual exploitation as it may be unaccepted in their community. It makes human trafficking victims, both males and females, face multiple negative consequences, anxiety in particular. Anxiety has different forms and may be represented as separation anxiety disorder, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, and social anxiety disorder [5]. Irrespective of the anxiety form, it requires professional guidance and treatment to reduce the load of negative thoughts and memories that prevent victims from leading everyday lives. The threat of being psychologically or physically surpassed is not manageable to overcome [5]. Thus, anxiety is among the most common feelings experienced by human trafficking victims after they return to their usual lives.

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder is another mental health issue commonly experienced by the victims of human trafficking not only in the custody of their traffickers but also after they manage to escape and return home. The analysis of literature sources has shown that nearly 80% of human trafficking victims experience PTSD [5]. Long-term exposure to trauma causes this disorder and makes victims avoid trauma-inducing flashbacks, stimuli, hypervigilance, and hyperarousal states, for instance, sleep disorders [7]. Victims who have PTSD show such comorbid symptoms as memory loss and inability to trust others; they also tend to blame themselves for what has occurred and have negative expectations regarding everything and everyone surrounding them. However, social stressors can exacerbate PTSD symptoms.  Research implies that many human trafficking victims have PTSD, which is the result of their entrapment with the traffickers [7]. It is a common practice of traffickers to engage in small kindness acts towards their victims to continue building a bond and loyalty that victims are unable to break [8]. In the scientific literature, such action is referred to as Stockholm syndrome; it helps explain why abductors develop a psychological bond with the victims, and it is the result of specific circumstance that indicates the power imbalances contained in human trafficking, hostage-taking, or abusive relationships [8]. Unfortunately, psychological violence in conjunction with small kindness acts tends to make human trafficking victims feel an increased attachment to their traffickers after they manage to escape. Thus, the continuous victimization of people exposed to human trafficking makes their life after escape challenging as they begin to question their own beliefs, community norms, and interpersonal relationships.  It has been found that sex trafficking victims experience higher PTSD rates compared with the victims trafficked for other reasons. Research indicates that PTSD requires sufficient treatment, and a complex trauma approach is most appropriate due to the nature of the trauma experienced [8]. PTSD may be caused by a single or a series of events, but human trafficking victims tend to experience complex symptoms. Most victims suffer from persistent traumatic and violent experiences while trafficked and often face trauma that predates their time trafficked, which can be physical or emotional abuse, domestic or sexual abuse. Those who experience continuous violent and traumatic events through different forms of abuse usually exhibit more severe symptoms associated with the PTSD diagnosis [9]. Hence, complex PTSD refers to the diagnosis that comes from extreme stress forms. Human trafficking victims who experience complex trauma may suffer from self-perception, affect, consciousness, self-regulation, relationships with other people, and changes that occur around them [10]. Individuals with these symptoms are prone to engaging in maladaptive behaviors, for instance, eating disorders, substance abuse, self-injury, and suicidal ideations. Factors that help determine the psychopathology extent associated with complex PTSD are determined by the severity of trauma experienced, traumatic experience (continuous and persistent), community reaction to a victim, and the defensive response of a victim to the traumatic experiences [10]. Research implies that teenagers and children who suffer from human trafficking tend to experience complex PTSD more often compared to adult victims [9]. Irrespective of the symptoms experienced by victims and the severity of PTSD or any other psychological issues, such people require support, treatment, and understanding.

Theoretical Framework

The work with human trafficking victims requires a proper understanding of their behavior and actions. Grounded theory helps comprehend their emotional condition, identify unique needs, and detect challenges they experience in reintegration into society [11]. The research method deals with theory generation, focusing on systematically collected and analyzed data. It assists in conducting research to uncover social relationships and behaviors of separate individuals and groups of people, known as social processes [12]. The meticulous implementation of essential grounded theory methods accomplishes the analysis, leading to a comprehensive and integrated grounded theory that enhances the explanation of a process associated with a particular phenomenon.

The choice of grounded theory is dictated by its flexibility and the possibility of learning about an insufficiently investigated phenomenon. It assists in constructing and uncovering a process inherent to the substantive inquiry area. One defining characteristic of grounded theory is the ability to generate a theory grounded on data [13]. It enhanced the development of concepts, relationships, and categories that inform different elements of a theoretical framework. The key constituents of the grounded theory are the process of data coding, categorization, and organization, as well as the constant comparison principle, which implies noting issues of interest and comparing them to establish similarities and contradictions. In addition, grounded theory study results are most effectively communicated as a set of interrelated concepts expressed in the substantive theory production. The grounded theory hallmark is the theory generation from data originated and collected in the study [11]. However, rigor ensures research quality [12]. The researcher’s methodological congruence is substantiated when the researcher’s philosophical position is congruent with the research question and selected methodological approach [14]. Data collection and analytical conceptualization should be rigorous throughout the research process to ensure the grounded theory achieves excellence [11]. Also, careful attention to maintaining data audit, management, and recording is vital for procedural precision. The application of a grounded theory in a study indicates that there is no need for any research hypothesis. Moreover, it provides a researcher with extended flexibility as it allows choosing the most suitable direction in the data collection and data analysis processes [11]. A series of strategies applied to refine the data into comprehensive concepts or themes implies that the theory improves the received conclusion [12]. The quality of a grounded theory directly relates to the researcher’s knowledge, expertise, and skills, in addition to methodological congruence with the investigated questions and procedural precision in the application of methods [11]. A grounded theory relies on data analysis, and the research conclusion is based on supported and valid data.

MATERIALS AND METHODS

The research data is collected through a qualitative grounded theory approach. It helps comprehend the psychological health issues of human trafficking victims, which form unique needs after survivors return home. The theory helps identify the themes that show the psychological impact of human trafficking and the psychological needs of victims. The data for analysis is taken from reliable literature resources published within eight years in reputable journals, official or reliable websites, and reports. The researchers used secondary data sources to answer the research question and meet the research goals.

The articles were limited to these search terms:

1) human trafficking, 2) human trafficking victims, 3) victim’s posttraumatic stress disorder, 4) victim’s anxiety, 5) victim’s depression, and 6) psychological interventions. Articles were excluded if they were available in full text or were published in blogs, newspapers, and other unreliable sources. The researchers reviewed all articles' titles and abstracts to ensure the content was relevant. The search yielded 120 articles that were selected as most suitable for the current study. Hence, the studies that focused on the psychological impacts (anxiety, depression, and PTSD) of human trafficking, psychological traumas of human trafficking, psychological needs of human trafficking victims, and potential interventions for these victims were used in the research. All duplicated articles were eliminated, and 15 articles were generated. Thus, using a grounded theory approach enabled the identification of themes (Table 1) and the collection of secondary data sources for further analysis.

RESULTS AND DISCUSSION

The research results indicate that the issue of human trafficking is significant in scope and crosses global borders. The report provided by the United Nations Office on Drugs and Crime [10] indicates that there are almost 28 million human trafficking victims globally while human traffickers prey on people of different backgrounds, ages, and nationalities, exploiting them for their profit [10]. There are nearly 4.5 million sexual exploitation victims worldwide, and 98% of them are women and girls [14]. The United States (the US) takes one of the leading positions among the countries that have commercial sex markets [10]. However, it is challenging to estimate human trafficking prevalence as the methods of data collection are unreliable and imprecise. According to [10] up to 50,000 individuals are trafficked annually in the US. Traffickers compel their victims to engage in commercial sex and work in either illicit or legal industries, such as traveling sales crews, hospitality, construction, agriculture, landscaping, janitorial services, restaurants, salon services, massage parlors, factories, care for disabled individuals, childcare, domestic work, retail services, begging and peddling, fairs and carnivals, religious institutions, and drug smuggling and distribution [10]. Nearly 80% of all human trafficking is sexual exploitation, and in some parts of the world, female trafficking is considered to be a norm. Forced labor takes 20%, and it is less frequently detected and reported compared to sexual exploitation. Almost 20% of all trafficking victims in the world are children [10]. Unfortunately, in some regions of Africa, children constitute the majority of all human trafficking victims. The study has been conducted to explore the psychological trauma inflicted by traffickers. It has been found that the most common emotional issues experienced by human trafficking survivors are depression, anxiety, and PTSD, which prevent them from successful reintegration into society. After returning home, victims cannot interact with others, meaning they cannot learn, work, or participate in social activities. They experience numerous challenges due to their inability to overcome fear, distrust, and social isolation. However, social, emotional, and practical hurdles can be effectively addressed if survivors get government support, family assistance, and psychological help that considers their characteristics and the type of trauma they experienced. Psychological trauma is among the most enduring traumas for victims as they lose a sense of themselves and are unable to take control over their lives [9]. Thus, to exit the traumatic life, human trafficking victims should undergo specific interventions.

INTERVENTIONS FOR HUMAN TRAFFICKING VICTIMS

Human trafficking victims experience a variety of issues after they escape and reintegrate into the community. They require professional assistance and family support, including measures taken to protect victims and their families from further harm. There are cases when traffickers seek retaliation and intimidation. As a result, victims and their families may suffer from privacy breaches, violence, and aggression [9]. Hence, it is critical to provide immediate support to trafficking victims to address their urgent needs in terms of adapting to society, including safe housing, counseling, medical care, psychological support, legal support, and material assistance [12]. In addition, it is necessary to ensure that a victim gets age and gender-appropriate support to meet particular needs. Protection and support lay the foundation for longer-term recovery and reintegration of human trafficking victims. They may be escorted to the destination country in case the victims were engaged in transnational trafficking and have not returned home [12]. Moreover, victims can get assistance in their native countries when they get home. It is critical to develop an intervention that encourages victims to participate voluntarily. Additionally, it is essential to focus on victim-sensitive support and flexibility to meet the specific needs and interests of various victims engaged in different trafficking forms. In addressing human trafficking victims’ needs, it is vital to involve the protection and support of practitioners from different fields, including health care professionals, social workers and social assistants, counselors, psychologists, lawyers, law enforcement, prosecutors, and paralegals [9]. However, it is essential to highlight that although protection is the state's responsibility, many other parties play a vital role in supporting states to help victims and reduce the burden. Interventions should be developed to address the personal needs of victims, considering the reason why they were involved in human trafficking, what kind of violence they experienced, the duration of trauma, and many other personal factors. It will help ensure that victim-based intervention meets unique needs [9]. Such assistance is trauma-informed, which enables the recognition of the impact of trauma and promotes healing environments. Moreover, it is critical to prioritize the victim's wishes, focusing on safety concerns, needs, and interests. The suggested intervention should prioritize a victim's cultural and religious beliefs. Culturally specific characteristics of victims may prevent them from disclosing information due to shame. Moreover, patients may reject help and assistance as it is uncommon for their society to report their worries, issues, and problems [9]. For this reason, culturally appropriate interventions consider the values, norms, and practices of victims to ensure the provision of unconditional support. Irrespective of the increased efforts of government and social organizations, cultural beliefs leave many trafficking victims unprotected and unassisted.  One more potentially effective intervention is mindfulness training. Stress should not be the main focus of work with individuals who have survived traumatic situations. Mindfulness training enables one to learn about the routines formed by trafficking victims while experiencing the traumatic event [12]. Facing traumatic events, victims perform activities that become a habit, which means that the brain part responsible for decision-making is less active. As a result, trauma victims become stuck in the same mindset as in the times of being trafficked. Practicing mindfulness teaches trauma victims to make decisions rather than relying on their habits [14]. Also, practicing mindfulness helps reduce stress and increase the victim’s well-being [12]. Practicing mindfulness and psychological and medical treatments is necessary to achieve better results. Another effective strategy is cognitive-behavior therapy, especially for victims with major depressive disorder. It assists in improving mood and regaining the capability of building interpersonal relationships [16]. However, the most suitable intervention should be chosen with consideration of the unique personal needs of a victim, including physiological issues [12]. Focusing on cultural values and norms may assist victims in experiencing an effective reintegration process (Table 2).

CONCLUSION

This study highlights the significance of the human trafficking issue due to the impact it has not only on victims but also on the global community. The occurrence of human trafficking is continuously increasing, which implies the urgency of the issue. Victims who manage to escape and return home face multiple challenges while adjusting to society. Additionally, the study focuses on the need to improve the quality of services provided for human trafficking victims and the victims’ access to community services. The use of the grounded theory approach has enabled the identification of themes that directly relate to the psychological needs of human trafficking victims, including depression, anxiety, and PTSD. It has been found that human trafficking victims require help and assistance when adjusting to society as they are unable to trust people, establish relationships, and are afraid of interacting with others.

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  Table 1
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  Table 2