{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:09:44Z","timestamp":1788494984628,"version":"build-2803163510"},"reference-count":154,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2020,11,27]],"date-time":"2020-11-27T00:00:00Z","timestamp":1606435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p><jats:bold>Objectives:<\/jats:bold>Marginalization-related diminished returns (MDRs) refer to weaker health effects of educational attainment for socially marginalized groups compared to the socially privileged groups. Most of the existing literature on MDRs, however, has focused on marginalization due to race, ethnicity, and sexual orientation. Thus, very limited information exists on MDRs of educational attainment among immigrant populations in the United States.<\/jats:p><jats:p><jats:bold>Aims:<\/jats:bold>Building on the MDRs framework and using a nationally representative sample of US adults, we compared immigrant and native-born adults for the effects of educational attainment on psychological distress, self-rated health (SRH), and chronic diseases (CDs).<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold>The 2015 National Health Interview Survey (NHIS) has enrolled 33,672 individuals who were either immigrant (<jats:italic>n<\/jats:italic>= 6,225; 18.5%) or native born (<jats:italic>n<\/jats:italic>= 27,429; 81.5%). The independent variable (IV) was educational attainment, which was treated as a categorical variable. The dependent variables included psychological distress, SRH, and CDs, all of which were dichotomous variables. Age, gender, race, ethnicity, and region were confounders. Immigration (nativity status) was the moderator.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold>Higher educational attainment was associated with lower odds of psychological distress, poor SRH, and CDs. However, immigration showed a significant statistical interaction with college graduation on all outcomes, which were suggestive of smaller protective effects of college graduation on psychological distress, poor SRH, and CDs for immigrant than native-born adults.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold>In the US, the associations between educational attainment and psychological distress, SRH, and CDs are all weaker for immigrant than native-born adults. To prevent health disparities, it is essential to decompose health inequalities that are due to low educational attainment from those that are due to diminished returns of educational attainment (i.e., MDRs). There is a need to help highly educated immigrant adults secure positive health outcomes, similar to their native-born counterparts. Such changes may require bold and innovative economic, public, and social policies that help immigrant adults to more effectively mobilize their educational attainment to secure tangible outcomes. Elimination of health disparities in the US requires efforts that go beyond equalizing access to education.<\/jats:p>","DOI":"10.3389\/fpsyt.2020.535624","type":"journal-article","created":{"date-parts":[[2020,11,27]],"date-time":"2020-11-27T04:24:32Z","timestamp":1606451072000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":23,"title":["Diminished Health Returns of Educational Attainment Among Immigrant Adults in the United States"],"prefix":"10.3389","volume":"11","author":[{"given":"Shervin","family":"Assari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Cobb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adolfo G.","family":"Cuevas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsen","family":"Bazargan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2020,11,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1016\/S0140-6736(05)71146-6","article-title":"Social determinants of health inequalities","volume":"365","author":"Marmot","year":"2005","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"crossref","DOI":"10.1111\/j.1740-9713.2004.00058.x","volume-title":"The Status Syndrome: How Social Standing Affects Our Health and Longevity","author":"Marmot","year":"2004"},{"key":"B3","unstructured":"Economic and social determinants of disease9889 MarmotM 11693982Bull World Health Organ.792001"},{"key":"B4","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.socscimed.2013.07.031","article-title":"Race, life course socioeconomic position, racial discrimination, depressive symptoms and self-rated health","volume":"97","author":"Hudson","year":"2013","journal-title":"Soc Sci Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1007\/s00127-015-1010-9","article-title":"Educational inequalities in major depressive and generalized anxiety disorders: results from the French national SIP study","volume":"50","author":"Murcia","year":"2015","journal-title":"Soc Psychiatry Psychiatr Epidemiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e123","DOI":"10.1016\/j.amepre.2017.04.010","article-title":"Differences in U.S. Suicide Rates by Educational Attainment, 2000-2014","volume":"53","author":"Phillips","year":"2017","journal-title":"Am J Prev Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1080\/15374416.2017.1326122","article-title":"Socioeconomic status, amygdala volume, and internalizing symptoms in children and adolescents","volume":"47","author":"Merz","year":"2018","journal-title":"J Clin Child Adolesc Psychol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.psyneuen.2017.01.020","article-title":"Socioeconomic status, hair cortisol and internalizing symptoms in parents and children","volume":"78","author":"Ursache","year":"2017","journal-title":"Psychoneuroendocrinology."},{"key":"B9","doi-asserted-by":"publisher","first-page":"76","DOI":"10.15171\/ijer.2019.14","article-title":"Race, education attainment, and happiness in the United States","volume":"6","author":"Assari","year":"2019","journal-title":"Int. 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