{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T07:23:54Z","timestamp":1785223434102,"version":"3.55.0"},"reference-count":79,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Aging"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>\n                    Mild cognitive impairment, a precursor of Alzheimer\u2019s disease, poses a significant public health challenge among older adults, particularly those who have experienced forced displacement. Studies indicate that socioeconomic increases can offer protective effects against cognitive impairment; however, the pattern of marginalization-related diminished returns (MDR) demonstrates that these benefits are not universal, with marginalized groups experiencing diminished health returns from socioeconomic advancements. This study examined the relationship between socioeconomic status (SES)\u2014measured by poverty level and educational attainment\u2014and self-reported cognitive difficulty (CD) in a nationally representative sample of older adult refugees, further nuanced by focusing on the moderating effect of Bhutanese ethnicity, chosen for their unique migration and resettlement experiences. Utilizing the 2021 Public Use Microdata Samples of the American Community Survey 5-year estimates and official refugee counts by the U.S. Department of Homeland Security, this study analyzed a sample of 5,666 resettled refugees. Binary logistic regression analysis showed that high school completion was associated with a 48% decrease in the odds of CD among refugees (AOR\u2009=\u20090.52,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u2009.001, 95% CI [0.39, 0.70]). Bhutanese ethnicity was also significantly associated with a more than threefold increase in odds of CD compared to other refugee groups (AOR\u2009=\u20093.52,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u2009.001, 95% CI [2.28, 5.44]). The interaction between Bhutanese ethnicity and poverty level suggested that higher income did not protect Bhutanese refugees from CD, providing evidence of the MDR pattern. Findings underscore the importance of nuanced analysis within marginalized groups to uncover specific social determinants of cognitive health.\n                  <\/jats:p>","DOI":"10.1177\/30495334251356739","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T09:40:37Z","timestamp":1752572437000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Socioeconomic Status Among Older Resettled Refugees in the United States: Older Bhutanese Refugees\u2019 Diminished Returns on Cognitive Health"],"prefix":"10.1177","volume":"11","author":[{"given":"Katherine","family":"Kitchens","sequence":"first","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9764-0586","authenticated-orcid":false,"given":"Jaclyn","family":"Kirsch","sequence":"additional","affiliation":[{"name":"University of Texas at Arlington, Arlington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitra","family":"Naseh","sequence":"additional","affiliation":[{"name":"Washington University, St. Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"e_1_3_2_2_1","volume-title":"Epidemiology of mental health, suicide and post-traumatic stress disorder among Bhutanese refugees in Ohio, 2014","author":"Adhikari S. B.","year":"2015","unstructured":"Adhikari S. B., Yotebieng K., Acharya J. N., Kirsch J. (2015). Epidemiology of mental health, suicide and post-traumatic stress disorder among Bhutanese refugees in Ohio, 2014. Ohio Department of Mental Health and Addiction Services."},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-16-3864-0_15"},{"key":"e_1_3_2_4_1","doi-asserted-by":"crossref","unstructured":"Al-Rousan T. Kamalyan L. Bernstein Sideman A. Miller B. AlHeresh R. Moore A. Marquine M. J. Argeros G. Ajrouch K. J. (2023). Migration and cognitive health disparities: The Arab American and refugee case. Journals of Gerontology Series B 78(1) 111\u2013123. https:\/\/doi.org\/10.1093\/geronb\/gbac129","DOI":"10.1093\/geronb\/gbac129"},{"key":"e_1_3_2_5_1","unstructured":"Alzheimer\u2019s Association. (2022). More than normal aging: Understanding mild cognitive impairment [Special Report]. https:\/\/www.alz.org\/media\/Documents\/alzheimers-facts-and-figures-special-report-2022.pdf"},{"key":"e_1_3_2_6_1","doi-asserted-by":"crossref","unstructured":"Alzheimer\u2019s Association. (2023a). 2023 Alzheimer\u2019s disease facts and figures. Alzheimer\u2019s & Dementia 19(4) 1596\u20131695. https:\/\/doi.org\/10.1002\/alz.13016","DOI":"10.1002\/alz.13016"},{"key":"e_1_3_2_7_1","unstructured":"Alzheimer\u2019s Association. (2023b). Mild cognitive impairment (MCI). https:\/\/alz.org\/alzheimers-dementia\/what-is-dementia\/related_conditions\/mild-cognitive-impairment"},{"key":"e_1_3_2_8_1","unstructured":"Alzheimer\u2019s Association. (2023c). Abuse. https:\/\/www.alz.org\/help-support\/caregiving\/safety\/abuse"},{"key":"e_1_3_2_9_1","doi-asserted-by":"crossref","unstructured":"Assari S. (2014). Cross-country variation in additive effects of socioeconomics health behaviors and comorbidities on subjective health of patients with diabetes. Journal of Diabetes & Metabolic Disorders 13(1) 36. https:\/\/doi.org\/10.1186\/2251-6581-13-36","DOI":"10.1186\/2251-6581-13-36"},{"key":"e_1_3_2_10_1","doi-asserted-by":"crossref","unstructured":"Assari S. (2017). Unequal gain of equal resources across racial groups. International Journal of Health Policy and Management 7(1) 1\u20139. https:\/\/doi.org\/10.15171\/ijhpm.2017.90","DOI":"10.15171\/ijhpm.2017.90"},{"key":"e_1_3_2_11_1","doi-asserted-by":"crossref","unstructured":"Assari S. (2018a). Health disparities due to diminished return among Black Americans: Public policy solutions. Social Issues and Policy Review 12(1) 112\u2013145. https:\/\/doi.org\/10.1111\/sipr.12042","DOI":"10.1111\/sipr.12042"},{"key":"e_1_3_2_12_1","doi-asserted-by":"crossref","unstructured":"Assari S. (2018b). Socioeconomic status and self-rated oral health; diminished return among Hispanic whites. Dental Journal 6(2) 11. https:\/\/doi.org\/10.3390\/dj6020011","DOI":"10.3390\/dj6020011"},{"key":"e_1_3_2_13_1","doi-asserted-by":"crossref","unstructured":"Assari S. (2019). Education attainment and Obesity: Differential returns based on sexual orientation. Behavioral Sciences 9(2) 16. https:\/\/doi.org\/10.3390\/bs9020016","DOI":"10.3390\/bs9020016"},{"key":"e_1_3_2_14_1","doi-asserted-by":"crossref","unstructured":"Assari S. (2020). Income and mental well-being of middle-aged and older Americans: Immigrants\u2019 diminished returns. International Journal of Travel Medicine and Global Health 8(1) 37\u201343. https:\/\/doi.org\/10.34172\/ijtmgh.2020.06","DOI":"10.34172\/ijtmgh.2020.06"},{"key":"e_1_3_2_15_1","doi-asserted-by":"crossref","unstructured":"Assari S. Akhlaghipour G. Boyce S. Bazargan M. Caldwell C. H. (2020). Parental human capital and adolescents\u2019 executive function: Immigrants\u2019 diminished returns. Medical Research Archives 8(10) 1\u201319. https:\/\/doi.org\/10.18103\/mra.v8i10.2235","DOI":"10.18103\/mra.v8i10.2235"},{"key":"e_1_3_2_16_1","doi-asserted-by":"crossref","unstructured":"Assari S. Bazargan M. (2019a). Educational attainment and self-rated oral health among American older adults: Hispanics\u2019 diminished returns. Dental Journal 7(4) 97. https:\/\/doi.org\/10.3390\/dj7040097","DOI":"10.3390\/dj7040097"},{"key":"e_1_3_2_17_1","doi-asserted-by":"crossref","unstructured":"Assari S. Bazargan M. (2019b). Protective effects of educational attainment against cigarette smoking; diminished returns of American Indians and Alaska natives in the National Health Interview Survey. International Journal of Travel Medicine and Global Health 7(3) 105\u2013110. https:\/\/doi.org\/10.15171\/IJTMGH.2019.22","DOI":"10.15171\/ijtmgh.2019.22"},{"key":"e_1_3_2_18_1","doi-asserted-by":"crossref","unstructured":"Assari S. Bazargan M. (2019c). Educational attainment and subjective health and well-being; diminished returns of lesbian gay and bisexual individuals. Behavioral Sciences 9(9) 90. https:\/\/doi.org\/10.3390\/bs9090090","DOI":"10.3390\/bs9090090"},{"key":"e_1_3_2_19_1","doi-asserted-by":"crossref","unstructured":"Assari S. Bazargan M. (2019d). Education level and cigarette smoking: Diminished returns of lesbian gay and bisexual individuals. Behavioral Sciences 9(10) 103. https:\/\/doi.org\/10.3390\/bs9100103","DOI":"10.3390\/bs9100103"},{"key":"e_1_3_2_20_1","doi-asserted-by":"crossref","unstructured":"Assari S. Boyce S. Bazargan M. Caldwell C. H. (2020). Mathematical performance of American youth: Diminished returns of educational attainment of Asian-American parents. Education Sciences 10(2) 32. https:\/\/doi.org\/10.3390\/educsci10020032","DOI":"10.3390\/educsci10020032"},{"key":"e_1_3_2_21_1","doi-asserted-by":"crossref","unstructured":"Assari S. Cobb S. Cuevas A. G. Bazargan M. (2020). Diminished health returns of educational attainment among immigrant adults in the United States. Frontiers in Psychiatry 11 535624. https:\/\/doi.org\/10.3389\/fpsyt.2020.535624","DOI":"10.3389\/fpsyt.2020.535624"},{"key":"e_1_3_2_22_1","doi-asserted-by":"crossref","unstructured":"Assari S. Lankarani M. M. (2015). Does multi-morbidity mediate the effect of socioeconomics on self-rated health? Cross-country differences. International Journal of Preventive Medicine 6 85. https:\/\/doi.org\/10.4103\/2008-7802.164413","DOI":"10.4103\/2008-7802.164413"},{"key":"e_1_3_2_23_1","doi-asserted-by":"crossref","unstructured":"Assari S. Perez M. U. Johnson N. Williams N. R. Carrillo E. Garcia L. Hollis X. T. (2020). Education level and self-rated health in the United States: Immigrants\u2019 diminished returns. International Journal of Travel Medicine and Global Health 8(3) 116\u2013123. https:\/\/doi.org\/10.34172\/ijtmgh.2020.20","DOI":"10.34172\/ijtmgh.2020.20"},{"key":"e_1_3_2_24_1","doi-asserted-by":"crossref","unstructured":"Bakhtiari E. (2022). Diminished returns in Europe: Socioeconomic status and ethno-racial health disparities across 30 countries in the European Social Survey. Journal of Racial and Ethnic Health Disparities 9(6) 2412\u20132426. https:\/\/doi.org\/10.1007\/s40615-021-01178-2","DOI":"10.1007\/s40615-021-01178-2"},{"key":"e_1_3_2_25_1","doi-asserted-by":"crossref","unstructured":"Bennett G. G. Merritt M. M. Sollers J. J. Edwards C. L. Whitfield K. E. Brandon D. T. Tucker R. D. (2004). Stress coping and health outcomes among African-Americans: A review of the John Henryism hypothesis. Psychology and Health 19(3) 369\u2013383. https:\/\/doi.org\/10.1080\/0887044042000193505","DOI":"10.1080\/0887044042000193505"},{"key":"e_1_3_2_26_1","doi-asserted-by":"crossref","unstructured":"Betancourt T. S. Berent J. M. Freeman J. Frounfelker R. L. Brennan R. T. Abdi S. Maalim A. Abdi A. Mishra T. Gautam B. Creswell J. W. Beardslee W. R. (2020). Family-based mental health promotion for Somali Bantu and Bhutanese refugees: Feasibility and acceptability trial. Journal of Adolescent Health 66(3) 336\u2013344. https:\/\/doi.org\/10.1016\/j.jadohealth.2019.08.023","DOI":"10.1016\/j.jadohealth.2019.08.023"},{"key":"e_1_3_2_27_1","doi-asserted-by":"crossref","unstructured":"Blackmore R. Boyle J. A. Fazel M. Ranasinha S. Gray K. M. Fitzgerald G. Misso M. Gibson-Helm M. (2020). The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis. PLoS Medicine 17(9) e1003337. https:\/\/doi.org\/10.1371\/journal.pmed.1003337","DOI":"10.1371\/journal.pmed.1003337"},{"key":"e_1_3_2_28_1","unstructured":"Centers for Disease Control and Prevention (CDC). (n.d.a). Provisional mortality statistics 2018 through last week request. CDC Wonder. https:\/\/wonder.cdc.gov\/"},{"key":"e_1_3_2_29_1","unstructured":"Centers for Disease Control and Prevention (CDC). (n.d.b). Immigrant and refugee health: Bhutanese refugee health profile. https:\/\/www.cdc.gov\/immigrantrefugeehealth\/profiles\/bhutanese\/index.html"},{"key":"e_1_3_2_30_1","doi-asserted-by":"crossref","unstructured":"Chen A. Panter-Brick C. Hadfield K. Dajani R. Hamoudi A. Sheridan M. (2019). Minds under siege: Cognitive signatures of poverty and trauma in refugee and non-refugee adolescents. Child Development 90(6) 1856\u20131865. https:\/\/doi.org\/10.1111\/cdev.13320","DOI":"10.1111\/cdev.13320"},{"key":"e_1_3_2_31_1","doi-asserted-by":"crossref","unstructured":"Chen R. Weuve J. Kubzansky L. Williams D. (2020). Racial disparities in cognitive function: The roles of cumulative stress exposures across the life course. Innovation in Aging 4(Suppl 1) 504. https:\/\/doi.org\/10.1093\/geroni\/igaa057.1627","DOI":"10.1093\/geroni\/igaa057.1627"},{"issue":"26","key":"e_1_3_2_32_1","first-page":"533","article-title":"Suicide and suicidal ideation among Bhutanese refugees\u2014United States, 2009\u20132012","volume":"62","author":"Cochran J.","year":"2013","unstructured":"Cochran J., Geltman P. L., Ellis H., Brown C., Anderton S., Montour J., Vargas M., Komatsu K., Senseman C., Lopes Cardozo B., Sivilli T. I., Blanton C., Shetty S., Taylor E., Lankau E., Ao T. (2013). Suicide and suicidal ideation among Bhutanese refugees\u2014United States, 2009\u20132012. Morbidity and Mortality Weekly Report, 62(26), 533\u2013536","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"e_1_3_2_33_1","doi-asserted-by":"crossref","unstructured":"Dallo F. J. Kindratt T. B. Zahodne L. (2021). Prevalence of self-reported cognitive impairment among Arab American immigrants in the United States. Innovation in Aging 5(1) igaa058. https:\/\/doi.org\/10.1093\/geroni\/igaa058","DOI":"10.1093\/geroni\/igaa058"},{"key":"e_1_3_2_34_1","unstructured":"Department of Homeland Security. (2023). Yearbook of immigration statistics 2022. https:\/\/www.dhs.gov\/ohss\/topics\/immigration\/yearbook\/2022"},{"key":"e_1_3_2_35_1","doi-asserted-by":"crossref","unstructured":"Emdad R. Sondergaard H. P. Theorell T. (2005). Impairments in short-term memory and figure logic in PTSD patients compared to healthy controls with the same ethnic background. Stress and Health 21 33\u201344. https:\/\/doi.org\/10.1002\/smi.1034","DOI":"10.1002\/smi.1034"},{"key":"e_1_3_2_36_1","doi-asserted-by":"crossref","unstructured":"Evans R. (2010). The perils of being a borderland people: On the Lhotshampas of Bhutan. Contemporary South Asia 18(1) 25\u201342. https:\/\/doi.org\/10.1080\/09584930903561598","DOI":"10.1080\/09584930903561598"},{"key":"e_1_3_2_37_1","doi-asserted-by":"crossref","unstructured":"Evans W. Fitzgerald D. (2017). The economic and social outcomes of refugees in the United States: Evidence from the ACS [Working Paper]. National Bureau of Economic Research. https:\/\/doi.org\/10.3386\/w23498. Accessed December 15 2023.","DOI":"10.3386\/w23498"},{"key":"e_1_3_2_38_1","doi-asserted-by":"crossref","unstructured":"Frounfelker R. L. Mishra T. Dhesi S. Gautam B. Adhikari N. Betancourt T. S. (2020). \u201cWe are all under the same roof\u201d: Coping and meaning-making among older Bhutanese with a refugee life experience. Social Science & Medicine 264 113311. https:\/\/doi.org\/j.socscimed.2020.113311","DOI":"10.1016\/j.socscimed.2020.113311"},{"key":"e_1_3_2_39_1","doi-asserted-by":"crossref","unstructured":"Gautam R. Mawn B. E. Beehler S. (2018). Bhutanese older adult refugees recently resettled in the United States: A better life with little sorrows. Journal of Transcultural Nursing 29(2) 165\u2013171. https:\/\/doi.org\/10.1177\/1043659617696975","DOI":"10.1177\/1043659617696975"},{"key":"e_1_3_2_40_1","doi-asserted-by":"crossref","unstructured":"Gautam R. Rydberg J. Ho I. Siwakoti B. Chadbourne W. Mawn B. E. (2022). Psychological distress among Bhutanese refugees living in the northeast region of the United States. Journal of Refugee Studies 34(4) 4010\u20134033. https:\/\/doi.org\/10.1093\/jrs\/feab025","DOI":"10.1093\/jrs\/feab025"},{"key":"e_1_3_2_41_1","doi-asserted-by":"crossref","unstructured":"Glymour M. M. Manly J. J. (2008). Lifecourse social conditions and racial and ethnic patterns of cognitive aging. Neuropsychology Review 18 223\u2013254. https:\/\/doi.org\/10.1007\/s11065-008-9064-z","DOI":"10.1007\/s11065-008-9064-z"},{"key":"e_1_3_2_42_1","doi-asserted-by":"crossref","unstructured":"Hale J. M. Schneider D. C. Mehta N. K. Myrskyl\u00e4 M. (2020). Cognitive impairment in the U.S.: Lifetime risk age at onset and years impaired. SSM - Population Health 11 100577. https:\/\/doi.org\/10.1016\/j.ssmph.2020.100577","DOI":"10.1016\/j.ssmph.2020.100577"},{"key":"e_1_3_2_43_1","doi-asserted-by":"crossref","unstructured":"Hamilton T. G. Palermo T. Green T. L. (2015). Health assimilation among Hispanic immigrants to the United States: The impact of ignoring arrival-cohort effects. Journal of Health and Social Behavior 56(4) 460\u2013477. https:\/\/doi.org\/10.1177\/0022146515611179","DOI":"10.1177\/0022146515611179"},{"key":"e_1_3_2_44_1","unstructured":"Human Rights Watch. (2007 May 16). Last hope: The need for durable solutions for Bhutanese refugees in Nepal and India. https:\/\/www.hrw.org\/report\/2007\/05\/16\/last-hope\/need-durable-solutions-bhutanese-refugees-nepal-and-india"},{"key":"e_1_3_2_45_1","doi-asserted-by":"crossref","unstructured":"Im H. Neff J. (2021). Spiral loss of culture: Cultural trauma and bereavement of Bhutanese refugee elders. Journal of Immigrant & Refugee Studies 19(2) 99\u2013113. https:\/\/doi.org\/10.1080\/15562948.2020.1736362","DOI":"10.1080\/15562948.2020.1736362"},{"key":"e_1_3_2_46_1","doi-asserted-by":"crossref","unstructured":"James S. A. (1994). John Henryism and the health of African-Americans. Culture Medicine and Psychiatry 18(2) 163\u2013182. https:\/\/doi.org\/10.1007\/BF01379448","DOI":"10.1007\/BF01379448"},{"key":"e_1_3_2_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10560-022-00858-0"},{"key":"e_1_3_2_48_1","doi-asserted-by":"crossref","unstructured":"Johnsen G. E. Kanagaratnam P. Asbj\u00f8rnsen A. E. (2011). Patients with posttraumatic stress disorder show decreased cognitive control: Evidence from dichotic listening. Journal of the International Neuropsychological Society 17 344\u2013353. https:\/\/doi.org\/10.1017\/S1355617710001736","DOI":"10.1017\/S1355617710001736"},{"key":"e_1_3_2_49_1","unstructured":"Kim D. (2021). Too well-off to seek help?: The model minority myth of Asian Americans. Anxiety and Depression Association of America. https:\/\/adaa.org\/learn-from-us\/from-the-experts\/blog-posts\/professional\/too-well-seek-help-model-minority-myth-asian"},{"key":"e_1_3_2_50_1","doi-asserted-by":"crossref","unstructured":"Kim Y. K. Maleku A. Lim Y. Kagotho N. Scott J. Ketchum M. M. (2022). Financial challenges and capacity among African refugees in the Southern USA: A study of socio-demographic differences. British Journal of Social Work 52(3) 1529\u20131551. https:\/\/doi.org\/10.1093\/bjsw\/bcab008","DOI":"10.1093\/bjsw\/bcab008"},{"key":"e_1_3_2_51_1","doi-asserted-by":"crossref","unstructured":"Kindratt T. B. Dallo F. J. Zahodne L. B. (2022). Cognitive disability among Arab Americans by nativity status and arrival year: Lack of evidence for the healthy migrant effect. Journal of Racial and Ethnic Health Disparities 9(5) 2056\u20132062. https:\/\/doi.org\/10.1007\/s40615-021-01144-y","DOI":"10.1007\/s40615-021-01144-y"},{"key":"e_1_3_2_52_1","doi-asserted-by":"crossref","unstructured":"Kirsch J. Maleku A. Kim Y. K. Aziz T. Dada S. Haran H. Kitchens K. (2024). The correlates of collective and individual trauma on mental health outcomes among Afghan refugees: A study of sociodemographic differences. Community Mental Health Journal 60 1255\u20131270. https:\/\/doi.org\/10.1007\/s10597-024-01283-6","DOI":"10.1007\/s10597-024-01283-6"},{"key":"e_1_3_2_53_1","doi-asserted-by":"crossref","unstructured":"Lewis J. L. (2020). Social capital matters for older Bhutanese refugees\u2019 integration. Journal of Immigrant and Minority Health 22 1295\u20131303. https:\/\/doi.org\/10.1007\/s10903-020-01057-8","DOI":"10.1007\/s10903-020-01057-8"},{"key":"e_1_3_2_54_1","doi-asserted-by":"crossref","unstructured":"Lynch K. S. Lachman M. E. (2020). The effects of lifetime trauma exposure on cognitive functioning in midlife. Journal of Traumatic Stress 33(5) 773\u2013782. https:\/\/doi.org\/10.1002\/jts.22522","DOI":"10.1002\/jts.22522"},{"key":"e_1_3_2_55_1","doi-asserted-by":"crossref","unstructured":"Meyerhoff J. Rohan K. J. Fondacaro K. M. (2018). Suicide and suicide-related behavior among Bhutanese refugees resettled in the United States. Asian American Journal of Psychology 9(4) 270\u2013283. https:\/\/doi.org\/10.1037\/aap0000125","DOI":"10.1037\/aap0000125"},{"key":"e_1_3_2_56_1","doi-asserted-by":"crossref","unstructured":"Mujahid M. S. James S. A. Kaplan G. A. Salonen J. T. (2017). Socioeconomic position John Henryism and incidence of acute myocardial infarction in Finnish men. Social Science & Medicine 173 54\u201362. https:\/\/doi.org\/10.1016\/j.socscimed.2016.11.034","DOI":"10.1016\/j.socscimed.2016.11.034"},{"key":"e_1_3_2_57_1","doi-asserted-by":"crossref","unstructured":"Naseh M. Lehman Held M. Gilbertson A. Shrestha L. (2023). Multidimensional deprivation amongst refugees in the USA. British Journal of Social Work 53(4) 2120\u20132139. https:\/\/doi.org\/10.1093\/bjsw\/bcac200","DOI":"10.1093\/bjsw\/bcac200"},{"key":"e_1_3_2_58_1","unstructured":"National Institute on Aging. (2021). What is mild cognitive impairment? https:\/\/www.nia.nih.gov\/health\/what-mild-cognitive-impairment"},{"key":"e_1_3_2_59_1","unstructured":"National Institute on Aging. (2023). Elder abuse. https:\/\/www.nia.nih.gov\/health\/elder-abuse"},{"key":"e_1_3_2_60_1","doi-asserted-by":"crossref","unstructured":"Parajuli J. Horey D. Avgoulas M. (2019). Resettlement challenges and dilemmas: An in-depth case study of Bhutanese refugee women in Australia. Australian Journal of Anthropology 30(3) 309\u2013323. https:\/\/doi.org\/10.1111\/taja.12334","DOI":"10.1111\/taja.12334"},{"key":"e_1_3_2_61_1","unstructured":"Patient Protection and Affordable Care Act. (2010). 42 U.S.C. \u00a7 18001 et seq. https:\/\/www.congress.gov\/bill\/111th-congress\/house-bill\/3590"},{"key":"e_1_3_2_62_1","doi-asserted-by":"crossref","unstructured":"Porter M. Haslam N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. Journal of the American Medical Association 294(5) 602\u2013612. https:\/\/doi.org\/10.1001\/jama.294.5.602","DOI":"10.1001\/jama.294.5.602"},{"key":"e_1_3_2_63_1","doi-asserted-by":"crossref","unstructured":"Prieto S. Moody J. N. Valerio K. E. Hayes J. P. (2022). Posttraumatic stress disorder symptom severity is associated with reduced Montreal cognitive assessment scores in a sample of Vietnam war veterans. Journal of Traumatic Stress 35(4) 1282\u20131290. https:\/\/doi.org\/10.1002\/jts.22830","DOI":"10.1002\/jts.22830"},{"key":"e_1_3_2_64_1","doi-asserted-by":"crossref","unstructured":"Prieto S. Nolan K. E. Moody J. N. Hayes S. M. Hayes J. P. (2023). Posttraumatic stress symptom severity predicts cognitive decline beyond the effect of Alzheimer\u2019s disease biomarkers in veterans. Translational Psychiatry 13(1) 102\u2013109. https:\/\/doi.org\/10.1038\/s41398-023-02354-0","DOI":"10.1038\/s41398-023-02354-0"},{"key":"e_1_3_2_65_1","unstructured":"Rinker J. A. Khadka N. (2018). Bhutanese refugees: On understanding the links between trauma displacement and community resilience. Global Journal of Peace Research and Praxis 2(1) https:\/\/libjournal.uncg.edu\/prp\/article\/view\/1662"},{"key":"e_1_3_2_66_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1999.tb08172.x"},{"key":"e_1_3_2_67_1","doi-asserted-by":"crossref","unstructured":"Sellers S. L. Neighbors H. W. (2008). Effects of goal-striving stress on the mental health of Black Americans. Journal of Health and Social Behavior 49(1) 92\u2013103. https:\/\/doi.org\/10.1177\/002214650804900107","DOI":"10.1177\/002214650804900107"},{"key":"e_1_3_2_68_1","doi-asserted-by":"crossref","unstructured":"Shin J. E. Choi C.-H. Lee J. M. Kwon J. S. Lee S. H. Kim H.-C. Han N. Y. Choi S.-H. Yoo S. Y. (2017). Association between memory impairment and brain metabolite concentrations in North Korean refugees with posttraumatic stress disorder. PLoS One 12(12) e0188953. https:\/\/doi.org\/10.1371\/journal.pone.0188953","DOI":"10.1371\/journal.pone.0188953"},{"key":"e_1_3_2_69_1","doi-asserted-by":"crossref","unstructured":"Smith D. Lovell J. Weller C. Kennedy B. Winbolt M. Young C. Ibrahim J. (2017). A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS One 12(2) e0170651. https:\/\/doi.org\/10.1371\/journal.pone.0170651","DOI":"10.1371\/journal.pone.0170651"},{"key":"e_1_3_2_70_1","doi-asserted-by":"crossref","unstructured":"Soukenik E. Haran H. Kirsch J. Pyakurel S. Maleku A. (2022). Barriers and facilitators of mental health service utilisation among Bhutanese refugees in the USA: Findings from a mixed-methods study. British Journal of Social Work 52(3) 1552\u20131576. https:\/\/doi.org\/10.1093\/bjsw\/bcab123","DOI":"10.1093\/bjsw\/bcab123"},{"key":"e_1_3_2_71_1","doi-asserted-by":"crossref","unstructured":"Sriram S. K. (2020). Of acculturative stress and integration distress: The resettlement challenges of Bhutanese refugees in Metro Atlanta. South Asian Diaspora 12(1) 93\u2013108. https:\/\/doi.org\/10.1080\/19438192.2019.1609298","DOI":"10.1080\/19438192.2019.1609298"},{"key":"e_1_3_2_72_1","unstructured":"StataCorp. (2023). Stata statistical software: Release 18. https:\/\/www.stata.com"},{"key":"e_1_3_2_73_1","doi-asserted-by":"crossref","unstructured":"Tippens J. A. Erwin S. Eller K. Dutra Gross R. M. Bearss B. Kemp B. Mollard E. Njiru L. Okwarah P. Palmer-Wackerly A. L. Lakati A. (2023). Multisystemic resilience and psychosocial wellbeing among older refugees: A systematic review with implications for Mental Health and Psychosocial Support (MHPSS). Journal of Immigrant and Minority Health 25(5) 1152\u20131170. https:\/\/doi.org\/10.1007\/s10903-023-01516-y","DOI":"10.1007\/s10903-023-01516-y"},{"key":"e_1_3_2_74_1","unstructured":"United Nations Conference of Plenipotentiaries on the Status of Refugees and Stateless Persons. (1954). Convention and protocol relating to the status of refugees (adopted 28 July 1951 entered into force 22 April 1954) 189 UNTS 137) Art. 1A (2). https:\/\/www.unhcr.org\/media\/convention-and-protocol-relating-status-refugees"},{"key":"e_1_3_2_75_1","unstructured":"United Nations High Commissioner for Refugees & U.S. State Department. (2020). Durable solutions: Bureau of population refugees and migration. https:\/\/www.state.gov\/other-policy-issues\/durable-solutions\/"},{"key":"e_1_3_2_76_1","unstructured":"U.S. Census Bureau. (2021). The American Community Survey questionnaire. https:\/\/www2.census.gov\/programs-surveys\/acs\/methodology\/questionnaires\/2021\/quest21.pdf"},{"key":"e_1_3_2_77_1","unstructured":"U.S. Census Bureau. (2022). American Community Survey (ACS) 2017-2021 5-year estimates [Data set]. https:\/\/www2.census.gov\/programs-surveys\/acs\/data\/pums\/2021\/5-Year\/"},{"key":"e_1_3_2_78_1","unstructured":"U.S. Department of Health and Human Services (HHS). (2021). National plan to address Alzheimer\u2019s disease: 2021 update. https:\/\/aspe.hhs.gov\/reports\/national-plan-2021-update"},{"key":"e_1_3_2_79_1","doi-asserted-by":"crossref","unstructured":"Verdelho A. Madureira S. Moleiro C. Santos C. O. Ferro J. M. Erkinjuntti T. Poggesi A. Pantoni L. Fazekas F. Scheltens P. Waldemar G. Wallin A. Inzitari D. (2011). Self-perceived memory complaints predict progression to Alzheimer disease: The LADIS Study. Journal of Alzheimer\u2019s Disease 27(3) 491\u2013498. https:\/\/doi.org\/10.3233\/JAD-2011-110494","DOI":"10.3233\/JAD-2011-110494"},{"key":"e_1_3_2_80_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610216000193"}],"container-title":["Sage Open Aging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/30495334251356739","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/30495334251356739","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/30495334251356739","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T06:57:01Z","timestamp":1777445821000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/30495334251356739"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":79,"alternative-id":["10.1177\/30495334251356739"],"URL":"https:\/\/doi.org\/10.1177\/30495334251356739","relation":{},"ISSN":["3049-5334","3049-5334"],"issn-type":[{"value":"3049-5334","type":"print"},{"value":"3049-5334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]},"article-number":"30495334251356739"}}