Migration Policies As Social Determinants of Health: A Systematic Review of Family Separation in the U.S

Background and Purpose: Family separation has been historically used in the U.S. as an oppressive tool against minoritized and racialized groups including immigrants. Migration policies related to border control or migration integration policies can result in “forced family separation” or “family separation by constrained choices.” Forced family separation is often the result of deportation, apprehension, or detention. Family separation by constrained choices often happens when part of the family, usually adults of the working-age, migrate to a foreign country while being unable to bring the rest of the family, usually children and older adults, to the new country or visit them when needed. This study aimed to systematically review and document the impact of family separation as a result of migration policies on the health of impacted families in the U.S.

Methods: The study followed Cochrane guidelines (Higgins et al., 2019) and the PRISMA checklist for systematic reviews to conduct a systematic literature search and review, complete quality assessment for included studies in the review using the risk of bias tools, and extract data from the included studies. Retrieved studies through a systematic search in social science, social work, medical, and interdisciplinary databases were reviewed by two independent researchers using Covidence systematic review software.

Results: Out of the 1,855 retrieved studies through the study search, 62 with health and family separation data in the U.S. were included in the review. Included studies in this review had qualitative and quantitative health data on children, adults, and older adults impacted by forced family separation and family separation by constrained choices. Quality assessment of the reviewed studies showed that most of the included papers in the review had a high risk of bias in design. Extracted data from the included studies in this review indicated that forced family separation and family separation by constrained choices are both associated with negative health outcomes including anxiety, behavioral problems in children, depression, post-traumatic stress or post-traumatic stress disorder, sleep disturbance, and stress. Few studies also showed evidence supporting a possible association between family separation and suicidal ideation.

Limitations: This systematic review was based on published literature and this created two limitations. First, most of the included studies in this review were qualitative with relatively small sample sizes, limiting generalizability. Second, the majority of the studies were focused on immigrants from Mexico and Central America. Future quantitative studies with rigorous design on different groups of immigrants are needed to further explore the health implications of family separation.

Conclusions and Implications: Findings of the study call for further attention to migration policies as social determinants of health. Family separation can result in negative health outcomes among impacted families and can have long-term and even generational impacts on the wellbeing and health of the communities.

References:

Higgins, J. P., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2019). Cochrane handbook for systematic reviews of interventions. John Wiley & Sons.