A large body of evidence indicates that U.S. honor states exhibit higher suicide rates than do dignity states. Research into one potential precipitating factor, depression, has yielded conflicting evidence, with support for an honor–depression association observed by some researchers but not by others. The present research (a) reassessed this association using more robust measures, (b) extended prior work by also examining suicidal ideation, and (c) examined the associations among honor, depression, and suicidal ideation at both the state and individual levels. Study 1 showed that, after controlling for relevant covariates, state-level honor was associated with higher levels of depression (both major depressive episodes and lifetime depression diagnoses), especially among non-Hispanic White adults. Furthermore, we found the strongest evidence for the honor–depression association using the continuous honor index. We also found that the honor–suicidal ideation association was mediated by depression. Study 2 (N = 4,235) showed that individual-level honor endorsement was positively associated with depression and suicidal ideation, but not anxiety. Moreover, the individual-level honor–suicidal ideation association was also mediated by depression. We discuss the theoretical and clinical implications of these findings.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
2.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
3.
AnestisM. D.HoutsmaC. (2018). The association between gun ownership and statewide overall suicide rates. Suicide and Life-Threatening Behavior, 48(2), 204–217.
4.
BarnesC. D.BrownR. P.LenesJ.BossonJ.CarvalloM. (2014). My country, my self: Honor, identity, and defensive responses to national threats. Self and Identity, 13(6), 638–662.
5.
BarnesC. D.BrownR. P.OstermanL. L. (2012a). Don’t tread on me: Masculine honor ideology in the US and militant responses to terrorism. Personality and Social Psychology Bulletin, 38(8), 1018–1029.
6.
BarnesC. D.BrownR. P.TamborskiM. (2012b). Living dangerously: Culture of honor, risk-taking, and the non-randomness of “accidental” deaths. Social Psychology and Personality Science, 3, 100–107.
7.
BeydounH. A.BeydounM. A.KaufmanJ. S.LoB.ZondermanA. B. (2012). Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis. Social Science & Medicine, 75(6), 959–975.
8.
BockJ. E.BrownR. P.GreenK. (2019). Aging with honor: Examining ambivalent ageism and interpersonal risk-factors for suicide as explanations for the honor-suicide link. Journal of Social and Clinical Psychology, 38(9), 721–750.
9.
BockJ. E.BrownR. P.PomerantzA. L.RajA. (2024). Preliminary validation of two brief measures of masculine and feminine honor endorsement. Journal of Personality Assessment, 106(4), 522–531.
10.
BockJ. E.TuckerR. P.BrownR. P.FosterS.AnestisM. D. (2023). Veteran suicide rates mirror, but do not account for, elevated suicide rates among the general population in US cultures of honor. Suicide and Life-Threatening Behavior, 53(4), 692–701.
11.
BockJ. E.TuckerR. P.BrownR. P.HarringtonE. E.BauerB. W.DaruwalaS. E.CapronD. W.AnestisM. D. (2021). Factors contributing to honor-endorsing men’s suicide capability: Firearm ownership, practical capability, and exposure to painful and provocative events. Suicide and Life-Threatening Behavior, 51, 1247–1258.
12.
BrownR. P. (2016). Honor bound: How a cultural ideal has shaped the American psyche. Oxford University Press.
13.
BrownR. P.BaughmanK.CarvalloM. (2018). Culture, masculine honor, and violence toward women. Personality and Social Psychology Bulletin, 44(4), 538–549.
14.
BrownR. P.CarvalloM.ImuraM. (2014a). Naming patterns reveal cultural values patronyms, matronyms, and the US culture of honor. Personality and Social Psychology Bulletin, 40(2), 250–262.
15.
BrownR. P.ImuraM.MayeuxL. (2014b). Honor and the stigma of mental healthcare. Personality and Social Psychology Bulletin, 40(9), 1119–1131.
16.
BrownR. P.ImuraM.OstermanL. L. (2014c). Gun culture: Mapping a peculiar preference for firearms in the commission of suicide. Basic and Applied Social Psychology, 36(2), 164–175.
17.
BrownR. P.OstermanL. L. (2012). Culture of honor, violence. In The Oxford handbook of evolutionary perspectives on violence, homicide, and war (pp. 218–232).
18.
CapronD. W.FitchK.MedleyA.BlaggC.MallottM.JoinerT. (2012). Role of anxiety sensitivity subfactors in suicidal ideation and suicide attempt history. Depression and Anxiety, 29(3), 195–201.
19.
Centers for Disease Control and Prevention. (2023). BRFSS Prevalence & Trends Data [online]. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. http://www.cdc.gov/brfss/brfssprevalence/
20.
CohenD. (1998). Culture, social organization, and patterns of violence. Journal of Personality and Social Psychology, 75, 408–419.
21.
CrowderM. K.KemmelmeierM. (2014). Untreated depression predicts higher suicide rates in US honor cultures. Journal of Cross-Cultural Psychology, 45(7), 1145–1161.
22.
CrowderM. K.KemmelmeierM. (2017). New insights on cultural patterns of suicide in the United States: The role of honor culture. Cross-Cultural Research, 51(5), 521–548.
EversonS. A.MatyS. C.LynchJ. W.KaplanG. A. (2002). Epidemiologic evidence for the relation between socioeconomic status and depression, obesity, and diabetes. Journal of Psychosomatic Research, 53(4), 891–895.
25.
FigueiredoA. R.AbreuT. (2015). Suicide among LGBT individuals. European Psychiatry, 30(S1), 1–1.
26.
FischerD. H. (1989). Albion’s seed: Four British folkways in America. Oxford University Press.
27.
FosterS.AlbrightA.BockJ. (2024). The role of emotional suppression and emotional beliefs in explaining the honor-suicide link. Suicide and LifeThreatening Behavior, 54(4), 690–701.
28.
FosterS.BockJ. (2025). Perceived reputation moderates the link between honor concerns and depressive symptoms. The Journal of Social Psychology, 1–10.
29.
FosterS.BockJ. E.CarvalloM.PolletC. L.SternW. (2022). Honor-endorsing women and relational aggression: Evidence for the presence of feminine aggression norms in southern US women. Personality and Individual Differences, 194, 111668.
30.
FosterS.CarvalloM.LeeJ.BernierI. (2021). Honor and seeking mental health services: The roles of stigma and reputation concerns. Journal of Cross-Cultural Psychology, 52(2), 178–183.
31.
FranklinJ. C.RibeiroJ. D.FoxK. R.BentleyK. H.KleimanE. M.HuangX.NockM. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187–232.
32.
GülP.CrossS. E.UskulA. K. (2021). Implications of culture of honor theory and research for practitioners and prevention researchers. American Psychologist, 76(3), 502–515.
33.
GünsoyC.JooM.CrossS. E.UskulA. K.GulP.WastiS. A.YeginA. (2020). The influence of honor threats on goal delay and goal derailment: A comparison of Turkey, Southern US, and Northern US. Journal of Experimental Social Psychology, 88, 103974.
34.
HayesA. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Publications.
35.
Health Resources & Services Administration. (2005). Selected statistics on health professional shortage areas, 2000–2004. Bureau of Health Professions, Health Resources and Services Administration.
36.
Health Resources & Services Administration. (2012). Designated health professional shortage areas statistics. http://www.statehealthfacts.org
37.
JoinerT. (2005). Why people die by suicide. Harvard University Press.
38.
KanwarA.MalikS.ProkopL. J.SimL. A.FeldsteinD.WangZ.MuradM. H. (2013). The association between anxiety disorders and suicidal behaviors: A systematic review and meta-analysis. Depression and Anxiety, 30(10), 917–929.
39.
KlonskyE. D.MayA. M.SafferB. Y. (2016). Suicide, suicide attempts, and suicidal ideation. Annual Review of Clinical Psychology, 12, 307–330.
40.
KlonskyE. D.PachkowskiM. C.ShahnazA.MayA. M. (2021). The three-step theory of suicide: Description, evidence, and some useful points of clarification. Preventive Medicine, 152, 106549.
41.
KlonskyE. D.SafferB. Y.BryanC. J. (2018). Ideation-to-action theories of suicide: A conceptual and empirical update. Current Opinion in Psychology, 22, 38–43.
42.
KroenkeK.SpitzerR. L.WilliamsJ. B.LöweB. (2009). An ultra-brief screening scale for anxiety and depression: the PHQ–4. Psychosomatics, 50(6), 613–621.
43.
LeeB. (2023). National, state-level, and county-level prevalence estimates of adults aged ≥ 18 years self-reporting a lifetime diagnosis of depression—United States, 2020. MMWR. Morbidity and Mortality Weekly Report, 72(24), 644–650.
44.
LeungA. K. Y.CohenD. (2011). Within-and between-culture variation: Individual differences and the cultural logics of honor, face, and dignity cultures. Journal of Personality and Social Psychology, 100(3), 507–526.
45.
LopezH. N.BockJ. E.BrownR. P.CrossS. E. (2024). Beyond the dichotomy: Creation and validation of a continuous statewide index of U.S. honor culture. Personality and Social Psychology Bulletin. https://doi.org/10.1177/01461672241255494
46.
MayA. M.KlonskyE. D. (2016). What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors. Clinical Psychology: Science and Practice, 23(1), 5–20.
47.
MillerL.WickramaratneP.GameroffM. J.SageM.TenkeC. E.WeissmanM. M. (2012). Religiosity and major depression in adults at high risk: A ten-year prospective study. American Journal of Psychiatry, 169(1), 89–94.
48.
NisbettR. E.CohenD. (1996). Culture of honor: The psychology of violence in the South. Westview Press.
O’DeaC. J.JardinE.SaucierD. A. (2022). The masculinity-based model of Aggressive Retaliation in Society (MARS). Psychology of Men & Masculinities, 23(2), 160–172.
51.
OnraetE.Van HielA.DhontK. (2013). The relationship between right-wing ideological attitudes and psychological well-being. Personality and Social Psychology Bulletin, 39(4), 509–522.
52.
OstermanL. L.BrownR. P. (2011). Culture of honor and violence against the self. Personality and Social Psychology Bulletin, 37(12), 1611–1623.
53.
PerlisR. H.SimonsonM. D.GreenJ.LinJ.SafarpourA.TrujilloK. L.. . . BaumM. A. (2022). Prevalence of firearm ownership among individuals with major depressive symptoms. JAMA Network Open, 5(3), e223245.
54.
PourmotabbedA.MoradiS.BabaeiA.GhavamiA.MohammadiH.JaliliC.. . .MiraghajaniM. (2020). Food insecurity and mental health: A systematic review and meta-analysis. Public Health Nutrition, 23(10), 1778–1790.
55.
RibeiroJ. D.HuangX.FoxK. R.FranklinJ. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: Meta-analysis of longitudinal studies. The British Journal of Psychiatry, 212(5), 279–286.
56.
Rodriguez MosqueraP. M. (2016). On the importance of family, morality, masculine, and feminine honor for theory and research. Social and Personality Psychology Compass, 10(8), 431–442.
57.
Substance Abuse and Mental Health Services Administration. (2023). State Data Tables and Reports. Percentage of persons aged 18 or older with a past year major depressive episode (MDE), United States and by State, 2005-2019. https://pdas.samhsa.gov/saes/state
UskulA. K.CrossS. E. (2020). Socio-ecological roots of cultures of honor. Current Opinion in Psychology, 32, 177–180.
70.
UskulA. K.OysermanD.SchwarzN. (2010). Cultural emphasis on honor, modesty, or self-enhancement: Implications for the survey response process. In: BraunM., et al (Eds.), Survey Methods in Multinational, Multiregional and Multicultural Context (pp. 191–202). John Wiley.
71.
VandelloJ. A.CohenD. (1999). Patterns of individualism and collectivism across the United States. Journal of Personality and Social Psychology, 77(2), 279–292.
72.
Van OrdenK. A.WitteT. K.CukrowiczK. C.BraithwaiteS. R.SelbyE. A.JoinerT. E.Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600.
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