Background: Few studies examine the mechanisms by which immigration prisons serve as a catalyst for worsening health. In a sample of California-based detained immigrants, we examine (1) prevalence of exposure to harmful immigration prison conditions; (2) extent to which conditions are associated with psychological stress, diagnosed mental health conditions, and worsening general health during detention; and (3) cumulative impact of conditions on these health outcomes.

Methods: We analyzed cross-sectional data from the 2013-2014 Rodriguez Survey. Harmful prison conditions were binary variables of (1) sleep deprivation; (2) difficulty accessing family visitation; (3) experienced harassment (i.e. formal discipline, physical or verbal abuse by guards or staff); (4) witnessed harassment; (5) difficulty accessing medical services; and (6) difficulty accessing mental health services. We created (7) a sum index of conditions. We conducted adjusted multivariable regression to assess associations between these conditions and health outcomes.

Results: Respondents (n=567; 92% male, 85% Hispanic, mean age=37.3 years, SD 9.44) experienced on average 2.7 conditions (SD 1.5, range: 0-6). In multivariate analysis, while each condition independently increased likelihood of one or more negative health outcome, there was also a cumulative effect. For each additional condition, the log odds of greater psychological stress increased by 110.6%, diagnosis of mental health condition increased by 25.4%, and worsening general health rose by 19.7%.

Conclusion: There is detrimental, cumulative impact of immigration prison conditions on health. Policies seeking to improve specific conditions may remove some risks of harm but policy responses considering alternatives to detention are likely to be most effective.