Correlates of mental health and the cascade of care among in-transit migrants in two border cities in Mexico

Background Migrants and asylum seekers transiting through Mexico face cumulative stressors and limited access to services, heightening their risk of mental health problems. Characterizing demographic and migration-related correlates of mental health and psychosocial problems is essential to identifying opportunities to reduce their risk and improve safety and wellbeing during this phase of the migration journey. Methods We conducted a cross-sectional analysis of baseline data from a cohort of 301 in-transit migrants recruited in Tapachula (n=164) and Tijuana (n=137), Mexico, between June 2024 and March 2025. We examined demographic and migration-related correlates of moderate-to-severe depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms, assessed with validated instruments (PHQ-9, GAD-7, PC-PTSD-5), using Firth penalized logistic regression. Using a cascade-of-care framework we characterized need recognition, help seeking, and the use of various support services. Results Overall, 31.6% met threshold for depression, 27.2% for anxiety, and 43.3% for PTSD, with the highest symptom burden found among women in Tapachula. Female participants had higher odds of depression and PTSD symptoms and gender-diverse participants exhibited higher odds of PTSD symptoms. Exposure to community violence and unmet basic needs, were associated with higher odds of PTSD or depression symptoms and having family or friends in the city with lower odds of PTSD symptoms. The number of adversity domains experienced showed a graded association with PTSD symptoms. No factor was significantly associated with anxiety symptoms. Among the 60% screened positive, 49.7% perceived a need for mental health support, 35.4% sought these services, and 33.0% received them. Conclusion Mental health needs among in-transit migrants in Mexico are substantial, but effective access to care is limited. Cascade-of-care analyses identify system gaps, emphasizing the necessity for proactive, context-specific service delivery focused on individuals exposed to violence and deprivation.