Mental Health and Physiological Biomarkers Under Legal Uncertainty: Evidence From Asylum Centers in Serbia

Asylum, grounded in international law, provides protection to individuals fleeing persecution, war, or violence by ensuring legal residency, fundamental rights, and pathways to integration, while reflecting the global commitment to human dignity, justice, and solidarity. Using data from asylum seekers and non-asylum seekers within a shared context of displacement in three asylum centers in Serbia, we examined the associations between the asylum process, mental health, and physiological markers.

In this mixed-methods study of asylum seekers (aged 18-55 years, n = 242), we collected key socio-demographic information, migration- and asylum-related variables, and self-reported measures of mental well-being, along with physiological markers relevant to exposure to chronic psychosocial stress (fingernail cortisol and blood pressure measures).

We found that asylum seekers reported better mental and physical health and lower PTSD-related symptoms (assessed with the RHS-15 and IES-R) compared to non-asylum seekers, while there was no significant difference between the groups in recent perceived stress (measured by PSS scores). We also found that asylum seekers had higher nail cortisol levels as well as higher systolic and diastolic blood pressure compared to their non-asylum seeker peers.

Although our study is cross-sectional, it emphasizes that the asylum process is more than just a legal or bureaucratic procedure. It is a significant social determinant of health. The physiological stress observed in asylum seekers highlights an urgent need for systemic reforms and targeted health interventions to reduce both the psychological and physiological effects of forced displacement, extended legal uncertainty, and structural constraints.