Prolonged Immigration Detention Tied to Poor Health, PTSD, and Mental Illness

Detained immigrants exhibited an elevated prevalence of mental illness, poor self-rated health (SRH), and posttraumatic stress disorder (PTSD) following their release, according to new study findings, with those imprisoned for 6 months or longer experiencing significantly higher rates of these outcomes.1

The authors of the JAMA Network Open study highlighted that immigration detention facilities and deportation proceedings operate under civil law. Therefore, detained people lack certain protections granted by criminal law. For example, there are few limits on the length of immigration detention, making prolonged and indefinite custody the norm for those fighting their removal cases.

The length of detention is one way carceral systems contribute to people’s worsening health.2 In both the immigration and criminal contexts, longer periods of imprisonment increase exposure to subpar health care systems that can directly cause harm, as well as to confinement conditions that can inflict harm both directly and indirectly.

Although studies from other countries with mandatory and indefinite immigration detention policies have found a link between prolonged detention and poor health outcomes, few US studies have explored this relationship.1 To address this gap, the researchers evaluated the association between detention duration in US immigration facilities and subsequent health outcomes.

Prolonged immigration detention is significantly associated with worsened self-rated health (SRH), along with high rates of posttraumatic stress disorder (PTSD) and mental illness. | Image Credit: josefkubes - stock.adobe.com

They evaluated this relationship by analyzing telephone survey data from immigrants detained by US Immigration and Customs Enforcement (ICE) and then released in the US under court orders during 2020 and 2021. The American Civil Liberties Union (ACLU) led these court cases and provided contact information for 355 eligible people.

Of these people, 221 (62.3%) completed full surveys, 44 (12.4%) were ineligible, 21 (5.9%) declined to participate, and 52 (14.6%) could not be reached. The participants resided in 27 states, with most living in California (n = 157; 78.5%).

The 93-question survey asked about health and access to care before, during, and after detention. Other topics addressed included detention and postrelease experiences, demographic background, and work and legal history. After participants provided informed consent, surveys were conducted in English or Spanish and lasted 48 minutes on average (median length, 45 minutes; range, 24-96).

The researchers used multivariable regression analysis to evaluate the association between detention duration and SRH, mental illness, and PTSD. To evaluate SRH, participants used a Likert scale, ranging from excellent to poor, to describe their health during detention. The researchers then created a binary measure of poor health (poor or fair health = 1; good, very good, or excellent health = 0).

Also, mental health was evaluated using the Kessler 6-Item (K6) psychological distress scale; items are summed to obtain a total score ranging from 0 to 24. A score of 13 or greater is considered a strong indicator of a diagnosable mental illness with considerable disability. Additionally, the researchers measured PTSD using the Primary Care-PTSD-5 Screen; scores above 4 demonstrated high levels of PTSD diagnostic accuracy.

They then calculated the likelihood of experiencing each outcome, controlling for covariates like ethnicity, age, and gender. The researchers conducted sensitivity analyses to check for robustness, using detention duration as a continuous measure.

The final sample consisted of 200 participants, the majority of whom were male (n = 75; 87.5%) and Hispanic (n = 149; 74.5%). The mean (SD) age was 40.3 (10.0) years. Also, most participants had at least a high school education (n = 123; 61.5%) and a criminal record (n = 143; 71.5%).

The mean (SD) length of detention was 9.9 (11.2) months (median, 6.0 months; IQR, 3.0-12.0) among the sample, and the mean time since release was 9.9 months (IQR, 8-12). Before detention, 40% (n = 80) self-assessed their health as poor or fair.

Post release, almost half of the participants rated their health as poor or fair (n = 81; 40.5%). About one-third reported experiencing mental illness (n = 59; 29.5%), with a mean (SD) K6 score of 9.5 (6.3). Also, nearly half of the sample met the screening threshold for PTSD (n = 96; 48.0%).

Multivariable regression analyses revealed high rates of poor SRH, mental illness, and PTSD among all participants, with a statistically significant additional health burden observed in those detained for 6 months or longer.

Therefore, compared with those detained less than 6 months, participants in custody for 6 months or longer had a significantly higher likelihood of poor or fair SRH (49.1% [95% CI, 40.5-57.6] vs 30.4% [95% CI, 21.8-39.1]; P < .001), mental illness (37.0% [95% CI, 28.2-45.8] vs 20.7% [95% CI, 12.6-28.7]; P < .001), and PTSD (59.3% [95% CI, 50.3-68.3] vs 34.8% [95% CI, 25.3-44.3]; P < .001).

The sensitivity analysis confirmed the robustness of these findings, demonstrating that longer detention duration was significantly associated with mental illness (OR, 1.11; 95% CI, 1.02-1.20; P = .01) and PTSD (OR, 1.11; 95% CI, 1.03-1.20; P = .005) in the adjusted models. While an association with poor SRH was observed in the unadjusted analysis (OR, 1.08; 95% CI, 1.00-1.16; P = .04), it was not significant in the adjusted analysis (OR, 1.08; 95% CI, 1.00-1.17; P = .05).

The researchers acknowledged their study’s limitations, including the use of self-reported data, which may be impacted by inadequate health literacy, observational bias, desirability effect, or recall bias. Despite their limitations, they expressed confidence in their study and suggested a potential area for action based on their findings.

“Our findings suggest that the current practice of detention is associated with health harms of all detained people, and especially those who are held for longer periods of time,” the authors concluded. “Policymakers should urgently consider alternatives to detention to optimize health for detained immigrants and their communities.”

References

1. Saadi A, Patler C, Langer P. Duration in immigration detention and health harms. JAMA Netw Open. 2025;8(1):e2456164. doi:10.1001/jamanetworkopen.2024.56164
2. Bakely L, Correa-Salazar C, Rangel Gómez MG, et al. Exploring the association between detention conditions, detention-related abuse, and mental health among deported Mexican migrants. J Health Care Poor Underserved. 2023;34(3):1021-1036. doi:10.1353/hpu.2023.a903060