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The study investigates the prevalence and symptom severity of psychological distress in Phuket in 2021, and examines how suicidal ideation relates to poverty and psychological distress. Survey data are analyzed with SPSS and Smart-PLS, highlighting strong variable associations and mediation by psychological distress, with policy implications.",{"@graph":63,"@context":111},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/poverty-psychological-distress-and-suicidality-among-gay-men-and-transgender-women-sex-workers-during-the-covid-19-pandemic-in-phuket-thailand-introduction/219240/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/poverty-psychological-distress-and-suicidality-among-gay-men-and-transgender-women-sex-workers-during-the-covid-19-pandemic-in-phuket-thailand-introduction/219240.png","ImageObject",442,249,{"name":88,"@type":89},"Alex Sinclair","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-09-27","2026-09-08",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105],{"name":106,"@type":107,"acceptedAnswer":108},"What differences were observed between transgender women sex workers and gay men sex workers?","Question",{"text":109,"@type":110},"Transgender women sex workers scored higher on depression and anxiety compared to gay men sex workers, while most respondents reported symptoms ranging from mild to extremely severe psychological distress.","Answer","https://schema.org",{"og:url":78,"og:type":113,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":115,"canonical":78},"index,follow",{"doc_id":117,"site_id":56},219240,1788863353,{"code":4,"msg":5,"data":120},{"doc_id":117,"user_id":121,"nickname":88,"user_avatar":122,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":123,"file_id":124,"file_url":125,"file_type":126,"file_size":127,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":128,"language":129,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":130,"faqs":131,"seo_title":132,"seo_description":61,"update_tm":118,"read_time":30},1099523882182,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Poverty, Psychological Distress, and Suicidality among Gay Men and Transgender Women Sex Workers during the Covid-19 Pandemic in Phuket, Thailand\nAbstract:\nIntroduction: Thai gay men and transgender women (GM &TGW) sex workers are more likely to suffer from economic harm since the sex tourism industry in Thailand has been hit hard by the Covid-19 pandemic. They also are more likely to experience poverty and mental health issues subsequent to the pandemic as minority groups in conservative Thai society. While their highly problematic social and economic situation would predict a wide range of psychological issues, little is known about their mental health. Hence, this study examined the prevalence and symptom severity of psychological distress among the group as well as the associations between suicidal ideation, poverty, and psychological distress.\nMethods: 270 questionnaire responses were collected online via Google forms in Phuket in 2021. Data analysis was conducted using SPSS and Smart-PLS.\nResults: Based on the results, most respondents had experienced mild to extremely severe symptoms of psychological distress. However, transgender women sex workers scored higher on depression and anxiety compared to gay men sex workers. This study confirmed the prominent associations between the study variables and the mediation effect of psychological distress.\nConclusion: Poverty resulting from the pandemic imposes a substantial human cost for this vulnerable minority beyond the virus itself as it amplifies mental health problems.\nPolicy Implications: The findings further extend our awareness of the discriminatory treatment of Thai GM&TGW sex workers and address a gap in Thai law and policy for prohibiting discrimination against them. It is of urgent necessity for Thai public health and tourism policymakers to establish sound support interventions.\nKeywords: gay men; poverty; psychological distress; sex workers; suicidal ideation; transgender women; travel restrictions\n1. Introduction\nAlthough Thailand is relatively open to LGBT people (lesbian, gay, bisexual, and transgender), persistent discrimination against Thai LGBT groups at all stages of employment directs them to accept jobs in the informal sector with less job security and social protection (Suriyasarn, 2016). As the tourism demand has increased rapidly and boosted the growth of Thailand's tourism industry, many poor transgender women and gay men have moved and worked in the sex industry as their only feasible option (Davis et al., 2019; Ocha, 2020; Statham & Scuzzarello, 2021). Despite being illegal, the sex industry in Thailand employs about 200,000 to more than 1 million sex workers (Amendral, 2021, as cited in McKenzie et al., 2021), which is undoubtedly regarded to be a significant underestimation. Thailand’s GDP amounted to 401.27 billion US dollars in 2015 (Statista, 2022) and the Havocscope’s research report (2015) showed that the sex industry generated 6.4 billion US dollars in 2015, accounting for almost 1.6% of Thailand’s total GDP. Sex work in Thailand not only boosts the economy but also is entwined with the tourism industry and promotes sex tourism. For example, in 2014, out of a total of 26.74 million tourists, 11.23 million were estimated by NGOs to be foreign men who came to Thailand specifically to purchase sexual services (Lines, 2015). The workforce of the Thai sex trade, in particular, has disproportionately many ethnic minority individuals who have no Thai ID (Janyam et al., 2020) and Thai migrants from villages who use the income from sex work to support families in their home communities (Joint United Nations Programme on HIV/AIDS, 2014). However, sex workers in Thailand are not only cisgender women. Many of them are men or transgender women too (Davis et al., 2019; Napatanapong & Saowakhon, 2022; Ocha, 2013, 2020; Statham & Scuzzarello, 2021).\nIn addition to Thai heterosexual women/men sex workers, transgender women and gay men are sex work service pr","cbCaitSEftN2il3Z","https://ap.wps.com/l/cbCaitSEftN2il3Z","docx",149261,45,"English","# 1. Introduction\n## LGBT discrimination and employment in Thailand\n## Sex work, tourism, and vulnerabilities among GM & TGW\n## Covid-19 disruption and mental health consequences\n## Study focus: poverty, psychological distress, and suicidality","[{\"question\":\"What differences were observed between transgender women sex workers and gay men sex workers?\",\"answer\":\"Transgender women sex workers scored higher on depression and anxiety compared to gay men sex workers, while most respondents reported symptoms ranging from mild to extremely severe psychological distress.\"}]","Poverty, Psychological Distress, and Suicidality among Gay Men and Transgender Women Sex Workers during the Covid-19 Pandemic in Phuket, Thailand - Introduction | DOCX"]