Seven-year data trends in mental health of refugees in transit: a repeated cross-sectional study.

Background: The mental health of refugees in transit-an inherently unstable and high-risk context-remains underresearched in the field of refugee research. This study aimed to address this gap by providing insights into the mental health of refugees in transit, identifying vulnerable subgroups, and documenting mental health trends over a seven-year period. Methods: Seven annually repeated cross-sectional studies with comparable methodologies were conducted, with data collected from 2017 to 2023. Official population data were used to weight the sample for each year by gender, age, and geographical region, improving alignment with population sociodemographic characteristics. A total of 1375 refugees, 87.2% male (1200/1377), average age 25.66 years (SD = 8.33), originating from the Middle East and Africa and residing in Serbia as a case study of a transit context along the route to Europe, participated in the study. They completed the Refugee Health Screener-15 (RHS-15), which assesses symptoms of depression, anxiety, PTSD, distress, and coping capacity, and a sociodemographic questionnaire. Findings: Results revealed 90.5% (1246/1377) of participants screened positive for mental health problems. Most participants experienced severe distress and moderate symptoms of depression, anxiety, and PTSD. Interestingly, despite this, most participants perceived themselves as able to cope with challenges, with 50.3% (693/1377) reporting they feel able to cope with most or any challenge. Mental health symptoms showed a complex, non-linear trajectory across years, with peaks in 2017, 2020-2021, and again in 2023. Acute or chronic health problems were positively related with higher levels of symptoms, while international protection status, education, gender, age, having children or partner, employment status, and duration of time in transit were not associated with mental health outcomes. Interpretation: The findings highlight the substantial mental health burden faced by refugees in transit, pointing to specific vulnerable groups and illustrating how broader socio-political events are mirrored in psychological trends (e.g., mass border closures, the COVID-19 pandemic). The study underscores the need for systemic, timely, and context-sensitive mental health interventions, and calls for attention to the transit phase as a unique and critical point in the refugee journey. Funding: This study is part of the projects that PIN-Psychosocial Innovation Network implemented with the support of UNHCR Serbia, Open Society Foundation, IOM and Swiss Agency for Development and Cooperation, and Karl Kahane Foundation. Maša Vukčević Marković, Irena Stojadinović Vujičić, and Jana Dimoski receive institutional support from Ministry of Education, Science and Technological Development of the Republic of Serbia (No. 451-03-137/2025-03/200163).