U.S. Policy as a Pathogen: A Systematic Review of Somatic and Psychological Distress Among Immigrants.

U.S. immigration policies function as structural determinants of health, yet their impacts across multiple domains remain poorly integrated. Following PRISMA guidelines, this systematic review of 45 empirical studies (2010-2025) across PubMed, PsycINFO, and Web of Science considers the impact that U.S. immigration and enforcement policies have on the psychological and somatic health of immigrants, refugees, and asylum seekers. Findings are organized into four thematic clusters: Detention and Trauma, Caregiving Disruptions and Family Separation, Migration and Resettlement Stress, and Policy and Geographic Risks. Results illustrate how pre-migration, transit, and post-migration stressors intersect with restrictive policies and detention environments, contributing to elevated rates of PTSD, depression, anxiety, and somatic distress. This review demonstrates how enforcement-driven family separation, and the consistent threat of it, functions conceptually as a structural pathogen that is linked to intergenerational health burdens regardless of legal status. These findings underscore the need to recognize immigration policy as a critical social determinant of health and highlight the importance of policy-level interventions to mitigate systemic harm and preserve family health and unity.