New study links honor cultures to higher rates of depression, suicidal thoughts

A new study finds that people living in U.S. states with stronger honor cultures are more likely to experience depression and suicidal thoughts, particularly non-Hispanic White residents. The findings shed light on how cultural norms related to reputation and self-reliance may play a role in mental health outcomes.

Honor cultures place a strong emphasis on maintaining personal and family reputation, often through strength, self-reliance, and retaliatory responses to threats or insults. These values are especially prominent in many Southern and Western U.S. states, which researchers often refer to as “honor states.” In contrast, “dignity states,” which are more common in the North and Midwest, tend to emphasize inherent self-worth and individual autonomy, with less focus on social reputation.

Previous research has consistently shown that honor states have higher suicide rates, especially among White men. However, studies investigating whether depression—an important risk factor for suicidal thinking—is more common in honor cultures have produced mixed results. Some found a connection between honor and depression, while others did not. This discrepancy led researchers to revisit the question using updated and more comprehensive methods.

The new study, published in the Journal of Cross-Cultural Psychology, aimed to clarify whether people in honor-oriented environments experience more depression and suicidal ideation than those in dignity-oriented environments. The research team, led by social and cultural psychologist Jesse Bock, conducted two separate studies to examine these links at both the state and individual levels.

“My primary area of research is on suicide and other mental health-related issues in honor cultures. Honor cultures treat as paramount the defense and maintenance of reputation, and, although they are found around the world, they tend to be in southern and western U.S. states,” explained Bock, an assistant professor at the University of Wyoming.

“Much of the work—including my own—that has examined the honor-suicide association has focused on suicide deaths and factors related to these deaths (e.g., firearm accessibility, lack of healthcare access). This work has demonstrated that suicide rates are higher in honor- oriented states compared to dignity-oriented states, particularly among non-Hispanic Whites and among men. Although it is important to understand where and among what demographic of individuals are dying by suicide, very little research had examined mental health factors that commonly precipitate suicide deaths within U.S. honor culture, most notably depression and suicidal ideation.

“With that said, two previous studies did examine the role of depression in explaining the honor-suicide association,” Bock continued. “The first paper on this topic found that honor-oriented states had higher levels of depression and that highly depressed honor-oriented states exhibited higher rates of suicide. The second paper replicated the honorsuicide association, but they found that it was lower rates of anti-depressant prescriptions—not depression rates—that explained said association. Given the importance of understanding mental health issues, these discrepant findings are worthy of investigation. Thus, my team and I aimed to clarify and extend this prior work.”

In the first study, the researchers used publicly available data to examine mental health patterns across all 50 U.S. states. They measured each state’s level of honor orientation using two approaches: a traditional classification dividing states into either honor or dignity categories, and a newer continuous index that scored states on various characteristics associated with honor cultures, such as firearm laws and patriarchal attitudes. They then compared these measures to rates of depression and suicidal ideation using two large national surveys.

Depression was measured in two ways. One was the percentage of adults in each state who had experienced a major depressive episode in the past year, based on symptom reports. The other was the percentage of adults who had ever been diagnosed with depression by a medical professional. The latter measure could also be separated by race, which allowed for more precise comparisons.

The results showed that, after accounting for factors like poverty, education, access to healthcare, and population density, states with higher honor scores also had higher levels of depression. This relationship was strongest when using the continuous honor index and when focusing specifically on non-Hispanic White adults.

“State-level honor culture was not associated with depression rates among U.S. Hispanic adults,” Bock told PsyPost. “Of course, it is important to keep in mind that no culture and/or ethnicity is a monolith, but there is some literature suggesting that honor culture is also prominent among Hispanics. That honor culture was strongly predictive of depression rates among non-Hispanic White adults but not Hispanic adults suggests that the dynamics of honor culture might differentially affect mental health outcomes in these groups.”

The researchers also found that depression appeared to help explain the link between honor and suicidal ideation. In other words, living in a culture that places strong demands on reputation may increase the likelihood of experiencing depression, which in turn may lead to more suicidal thoughts.

To test whether these findings held true at the individual level, the researchers conducted a second study involving over 4,200 adults from California and Louisiana—two states that differ in their levels of honor culture. Participants completed an online survey in which they rated how much they agreed with traditional masculine and feminine honor values. They also reported on their recent experiences with depression and anxiety symptoms, and whether they had seriously considered suicide in the past year.

Even after controlling for a wide range of demographic and personal factors—including income, education, political beliefs, and access to health insurance—individuals who endorsed honor values more strongly were more likely to report symptoms of depression and to say they had thought about suicide. But honor values were not significantly related to anxiety symptoms.

“The finding that most surprised me was that honor endorsement was not associated with anxiety,” Bock said. “Other work in the honor culture literature has found honor endorsement to be associated with outcomes and constructs related to anxiety, such as hypervigilance and intolerance of uncertainty, so we somewhat expected a small association between honor and anxiety. However, the association was non-existent.”

As in the first study, depression appeared to explain the link between honor and suicidal ideation. Those who strongly endorsed honor ideals were more likely to report depressive symptoms, and those symptoms were in turn linked to greater risk of suicidal thinking.

These findings suggest that honor-based norms may play a role in shaping people’s mental health. The researchers propose that in honor cultures, where social value depends on how others perceive you, failing to meet cultural expectations—such as being strong, self-reliant, or loyal—can be a source of distress. At the same time, honor cultures often discourage help-seeking behaviors and may stigmatize mental health struggles, making it harder for individuals to find support when they are suffering.

Earlier studies had already shown that people in honor states are less likely to seek mental health treatment, and that these states often have fewer mental health resources. The current research adds that even when individuals do experience depression, cultural pressures related to honor may make it more difficult for them to acknowledge their distress or get the help they need.

“Collectively, this work shows that honor culture at both the state and individual levels is associated with higher levels of depression and suicidal ideation, two factors strongly related to suicide attempts and suicide deaths,” Bock said. “This work adds to a growing body of research highlighting how the norms and values of honor cultures increase the risk of self-harm.”

While the findings are compelling, the authors acknowledge some limitations. Much of the data is correlational, meaning it cannot prove that honor causes depression or suicidal thoughts.

“Arguably the biggest limitation of the present work is the inability to definitively assign direction of causality in the honor-depression-suicidal ideation associations,” Bock noted. “Across two studies at two levels of analysis, we tested theoretically informed models, but these data are still correlational, so it is important to not draw causal conclusions.

“Another important caveat is that our observed effect sizes were modest, especially among individuals in Study 2. Thus, our finding that honor endorsement predicted higher levels of depression which, in turn, predicted a greater likelihood of suicidal ideation does not mean that all individuals that who endorse honor norms will be depressed and/or ideate, nor does it mean that honor plays a major role in facilitating thoughts of suicide.”

“Our collective results simply provide evidence for a plausible mechanism by which honor culture leads to depression and suicidal ideation, but longitudinal data are needed to clarify and substantiate this mechanism.”

In particular, future studies could track individuals over time to see whether shifts in cultural values or personal identity correspond to changes in mental health. The researchers also recommend incorporating measures of honor fulfillment—whether people feel they are living up to the expectations of honor culture—as this may be especially relevant to understanding who is at risk. Previous work has shown that men who endorse honor norms but feel they have failed to meet them are particularly vulnerable to suicidal thinking.

“My long-term goal with this line of work is to better understand the factors that lead individuals in honor-oriented states and those that endorse honor-related norms to die by suicide,” Bock explained. “It is important to first have a solid understanding of these factors before developing and implementing mental health interventions.”

The study, “Is Honor Culture Linked With Depression?: Examining the Replicability and Robustness of a Disputed Association at the State and Individual Levels,” was authored by Jarrod E. Bock, Ryan P. Brown, Nicole E. Johns, Kalysha Closson, Michael Cunningham, Stephen Foster, and Anita Raj.