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

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.