Asylum seekers reported better mental health and lower PTSD symptoms than non-asylum seekers in shared displacement contexts, yet showed higher nail cortisol levels and higher blood pressure, suggesting that the asylum process itself constitutes 'a significant social determinant of health.'
Key Findings
Results
Asylum seekers reported better mental and physical health and lower PTSD-related symptoms compared to non-asylum seekers sharing the same displacement context.
Study population included asylum seekers aged 18–55 years (n = 242) across three asylum centers in Serbia.
PTSD-related symptoms were assessed using the RHS-15 (Refugee Health Screener-15) and IES-R (Impact of Event Scale-Revised).
Comparisons were made between asylum seekers and non-asylum seekers within a shared displacement context, controlling for shared environmental conditions.
The mixed-methods study design combined quantitative biomarker collection with self-reported mental well-being measures.
Results
There was no significant difference between asylum seekers and non-asylum seekers in recent perceived stress as measured by PSS scores.
Perceived stress was measured using the PSS (Perceived Stress Scale).
Despite differences in PTSD symptoms and self-reported health, recent perceived stress levels were comparable between the two groups.
This divergence between perceived stress and other mental health indicators suggests that the PSS may capture a different dimension of stress experience than PTSD-related measures.
Results
Asylum seekers had higher fingernail cortisol levels compared to non-asylum seekers.
Fingernail cortisol was used as a physiological marker of chronic psychosocial stress exposure.
Nail cortisol reflects cumulative cortisol exposure over weeks to months, providing a longer-term stress biomarker than blood or salivary cortisol.
Higher nail cortisol in asylum seekers was observed despite their reporting better self-rated mental health, indicating a dissociation between subjective and physiological stress markers.
The sample included participants aged 18–55 years (n = 242).
Results
Asylum seekers had higher systolic and diastolic blood pressure compared to non-asylum seekers.
Both systolic and diastolic blood pressure were measured as physiological markers relevant to chronic psychosocial stress.
Elevated blood pressure in asylum seekers, alongside higher nail cortisol, suggests greater physiological stress burden despite better self-reported mental health outcomes.
Blood pressure differences were found in a sample sharing the same residential asylum center context, helping to control for some environmental confounders.
Discussion
The asylum process was characterized as a significant social determinant of health, with distinct physiological stress signatures observed in those undergoing it.
The study emphasizes that 'the asylum process is more than just a legal or bureaucratic procedure — it is a significant social determinant of health.'
Physiological stress markers (nail cortisol, blood pressure) were elevated in asylum seekers despite their better self-reported mental health relative to non-asylum seekers.
The authors attribute physiological stress to 'forced displacement, extended legal uncertainty, and structural constraints' inherent to the asylum process.
The study was cross-sectional, which limits causal inference.
Methods
The study used a mixed-methods design collecting socio-demographic, migration- and asylum-related variables, self-reported mental well-being measures, and physiological biomarkers from asylum centers in Serbia.
Data were collected from participants at three asylum centers in Serbia.
Sample included asylum seekers and non-asylum seekers aged 18–55 years (n = 242 total).
Physiological markers collected included fingernail cortisol and blood pressure measurements.
Self-reported mental health instruments included the RHS-15, IES-R, and PSS.
Key socio-demographic, migration-related, and asylum-related variables were also collected.
What This Means
This research suggests that going through the formal asylum process has measurable effects on the body, even when people are living in similar conditions. The study compared asylum seekers (people formally applying for legal protection) with non-asylum seekers (displaced people not in the asylum system) who were living in the same asylum centers in Serbia. Interestingly, asylum seekers reported feeling mentally and physically healthier and had fewer symptoms related to trauma than non-asylum seekers — but their bodies told a different story: they had higher levels of a stress hormone measured in their fingernails and higher blood pressure, both signs of prolonged physical stress.
This gap between how people feel and what their bodies show is an important finding. It suggests that the legal uncertainty and bureaucratic demands of the asylum process — waiting for decisions, navigating complex systems, facing an uncertain future — create a kind of hidden physical toll even when people may feel relatively hopeful or supported compared to those without any legal pathway at all. The fingernail cortisol measurement is particularly useful because it captures stress hormone levels accumulated over weeks or months, not just in the moment.
This research suggests that the asylum process itself functions as a major influence on people's health — what scientists call a 'social determinant of health.' The findings point to a need for systemic reforms and health interventions aimed at reducing the prolonged stress that comes with legal uncertainty during displacement, as the physiological effects may have long-term health consequences even when people report feeling okay in the short term.
Jankovic-Rankovic J, Oka R, Meyer J, Gettler L. (2026). Mental Health and Physiological Biomarkers Under Legal Uncertainty: Evidence From Asylum Centers in Serbia.. American journal of human biology : the official journal of the Human Biology Council. https://doi.org/10.1002/ajhb.70284