Suicide as a fatal injury in U.S. immigration and customs enforcement detention: proportionate mortality and comparison with non-suicide detainee deaths

Abstract Background Suicide in civil immigration detention is a fatal injury outcome and marker of custodial safety. Public ICE death reports may support surveillance but incompletely capture cause, manner, mechanism, and prevention-related information. Methods I conducted a retrospective case series and proportionate mortality analysis of 113 ICE detainee deaths occurring from 2018 to 2026 for which a publicly available Detainee Death Report was identified. Structured abstraction captured demographics, custody timing, suicide-risk documentation, mechanism, and classification ascertainment. Deaths were classified as suicide, non-suicide, or indeterminate from public records. Crude and age- and sex-adjusted proportionate mortality ratios (PMRs) used 2024 U.S. mortality as the reference. Results Among 113 deaths, 22 (19.5%) met the study definition of suicide, 81 were non-suicide, and 10 were indeterminate from public records. Suicide decedents were younger than non-suicide decedents (mean age, 37.1 vs. 47.7 years) and died earlier in custody (median, 27 vs. 52 days). The crude PMR was 12.3; the age- and sex-adjusted PMR was 2.28 (95% CI, 1.43–3.45). More than half of suicide deaths occurred within 30 days of ICE custody start, and hanging or ligature was documented in 21 of 22. Across all 113 deaths, a final cause was unavailable in 95 deaths, and an official manner-of-death determination was unavailable in 104. Conclusions Suicide accounted for approximately one-fifth of included ICE detainee deaths and remained disproportionately represented after age and sex adjustment, with 2.3 times as many suicide deaths as expected. Findings support early and repeated suicide-risk assessment, ligature-risk reduction, and standardized death reporting.