Untreated Depression Predicts Higher Suicide Rates in U.S. Honor Cultures

Abstract

Osterman and Brown demonstrated that U.S. honor states had higher rates of suicide than non-honor states and related this phenomenon to the higher incidence of depression and a reduced readiness to seek antidepression treatment in honor states. The present study critiques their research and re-examines the origin of the association between honor culture and suicide using a more expansive multi-year data set and controlling for culturally relevant factors (i.e., climate, gun ownership, population density, collectivism, access to health care, economic deprivation). Replicating some of their findings, higher rates of depression were related to higher levels of suicide in honor states but not non-honor states. In addition, we found state levels of antidepressant drug prescriptions to be related to lower levels of suicide in honor states but not non-honor states. A mediation analysis further revealed that levels of antidepressant drug prescriptions, but not levels of depression, mediated the relationship between honor culture and suicide, consistent with higher suicide rates in honor states being the result of a lack of treatment. The discussion focuses on clinical and cultural implications for suicide prevention in honor states.

Is Individualism Suicidogenic? Findings From a Multinational Study of Young Adults From 12 Countries

“…Also, research indicates that people with a suicidal past (85) and people from regions with a high suicide rate (86) have less positive attitudes and lower intentions to help-seeking behaviors. In similar vein, Crowder and Kemmelmeier (87) showed that in regions with high suicide rates people are less likely to seek out psychiatric services for depression. Against this background, in our fifth hypothesis we tested whether national suicide rates are associated with attitudes towards suicide and suicidal persons in the countries investigated.…”

Cultural Differences in Shame and Guilt as Understandable Reasons for Suicide

“…Indeed, in our own Study 1, perceived shame and guilt were highly correlated ( r = .60). Further, since a state’s honor-dignity status and state-level collectivism are positively correlated ( r = .34) but are differentially associated with suicide (Crowder & Kemmelmeier, 2014), state collectivism was included as a covariate. Statistical significance of parameter estimates was determined using robust standard errors ( RSE ).…”

“…Personal well-being is often contingent on meeting cultural expectations (e.g., Diener & Suh, 2000; Tov & Diener, 2007), and suicide can serve as an ultimate “way out” when people cannot meet important cultural mandates (cf. Crowder & Kemmelmeier, 2017; Tov & Diener, 2007). As such, differences in cultural expectations for behavior can give rise to differences in cultural constructions of suicide.…”

“…Having to maintain one’s public image seems to make members of honor cultures more susceptible to suicide (Crowder & Kemmelmeier, 2014; Osterman & Brown, 2011). Suicide rates are elevated among older men in honor cultures, presumably because some members of this group have a harder time living up to the high expectations of masculinity that honor cultures place on them (Crowder & Kemmelmeier, 2017). Additionally, with members of honor states being sensitive to honor threats, mental illness is considered particularly stigmatizing.…”

“…This deters individuals from honor states from seeking help when psychologically distressed (Brown, Imura, & Mayeux, 2014). A recent investigation demonstrated that a failure to seek treatment for depression could account, in part, for the higher suicide rates in U.S. honor cultures (Crowder & Kemmelmeier, 2017).…”