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

## TL;DR

Asylum seekers exposed to the 'Remain in Mexico' policy reported significantly higher trauma and PTSD during migration compared to those before the policy started.

## Contribution

This study provides empirical evidence linking the MPP policy to increased trauma among asylum seekers.

## Key findings

- 64% of MPP-exposed asylum seekers reported trauma during migration, compared to 12% before 2019.
- 95% of MPP-exposed participants had PTSD, versus 42% in the pre-2019 group.
- The study suggests restrictive border policies may have negative health consequences for migrants and broader public health implications.

## Abstract

Was exposure to the Migrant Protection Protocols (MPP; the “Remain in Mexico” policy) associated with higher rates of trauma during migration among asylum seekers?

In this cohort study of 94 asylum seekers evaluated between 2016 and 2022, 14 of 22 participants (64%) in the MPP group reported trauma during migration compared with 3 of 26 (12%) in the pre-2019 group. This result was statistically significant.

These findings suggest that restrictive border policies may have unintended consequences on migrant health, with downstream implications for US public health and security.

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.

To evaluate whether exposure to the MPP was associated with trauma reported during migration.

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.

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.

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.

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).

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.

This cohort study evaluates whether exposure to the Migrant Protection Protocols was associated with trauma reported during migration among asylum seekers between 2016 and 2022.