Abstract
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 different risks than, for example, 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, and reported socio-medical 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, and 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, such as 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 wellbeing of sex workers across different environments.