Immigrants’ Diminished Protective Effects of Educational Attainment against Depressive Symptoms in the National Health and Nutrition Examination Survey (NHANES 2005-2016)

Background: Socioeconomic Status (SES) indicators such as educational attainment protect people against health problems, including but not limited to depressive symptoms. However, according to the marginalization-related Diminished Returns Framework (MDRs), SES indicators such as educational attainment show weaker health effects for marginalized than for socially privileged groups. We conducted this study-built on the MDRs-with two aims: First, to test the association between educational attainment and depressive symptoms, and second, to test variation in this association by immigration status. Methods: This cross-sectional study used the National Health and Nutrition Examination Survey (NHANES 2005-2016) data. Participants included 28,682 adults who were either non-immigrant (US-born) or immigrant. Demographic factors (age, sex, race, ethnicity, and marital status), SES (educational attainment), and depressive symptoms (Patient Health Questionnaire-9 scale) were measured. Weighted Negative Binomial Regression (NBREG) models were used in Stata to adjust for the complex sample design of the NHANES. Models without and with interaction terms were estimated in the pooled sample and by immigration status. Results: Overall, high educational attainment showed an inverse association with depressive symptoms. However, as documented by statistical interactions between educational and immigrant status showed that immigrants with college education or above had experienced higher depressive symptoms (IRR: 1.26; CI: 1.08-1.48) than US-born individuals with college education or above. Conclusion: Educational attainment may have a differential association with the depressive symptoms of immigrant and non-immigrant people. Immigrant people report high depressive symptoms despite their high education.