Migration-Related Trauma Among Asylum Seekers Exposed to the Migrant Protection Protocols

Importance: The Migrant Protection Protocols (MPP) were introduced in January 2019 and changed US asylum procedures by requiring certain asylum seekers to remain in Mexico while awaiting immigration proceedings. Understanding the association of MPP with trauma is important for informing immigration and health policy. Objective: To evaluate whether exposure to the MPP was associated with trauma reported during migration. Design, Setting, and Participants: This retrospective cohort study of forensic medical evaluations in both the US and Mexico was conducted from 2016 to 2022. The study included 94 asylum seekers who underwent forensic medical evaluations between January 1, 2016, and December 31, 2022, categorized into 3 groups: pre-2019 asylum seekers (n = 26), 2019-2022 asylum seekers exposed to the MPP (n = 22), and 2019-2022 asylum seekers not subjected to the MPP (n = 46). Statistical analysis was performed from January 2023 to May 2025. Exposures: Exposure to the MPP, a US immigration policy implemented in January 2019 that required certain asylum seekers to remain in Mexico during their immigration proceedings. Main Outcomes and Measures: The primary outcome was traumatic experiences during migration. Secondary outcomes included posttraumatic stress disorder (PTSD) based on the forensic examiner's diagnosis and subgroup analyses by geographic region. Logistic regression was used to assess differences in reported trauma. Qualitative narratives were included to contextualize the quantitative findings. Results: Among 94 participants, the mean (SD) age was 33.1 (10.1) years, 56 (60%) were men, and 68 (72%) were from Latin America. Traumatic migration events were reported by 14 of 22 participants (64%) in the MPP group compared with 3 of 26 (12%) in the pre-2019 group (odds ratio, 9.20; 95% CI, 2.12-39.89). PTSD was observed in 21 of 22 (95%) in the MPP group compared with 11 of 26 (42%) in the pre-2019 group (odds ratio, 28.64; 95% CI, 3.33-246.25). Conclusions and Relevance: In this cohort study, exposure to MPP was associated with higher rates of trauma during migration among asylum seekers. Such policies may be associated with adverse health outcomes for asylum seekers, with potential downstream implications for US public health and security.