Honor Culture and Deaths of Despair: State- and Individual-Level Associations in the U.S. Among non-Hispanic White and non-White Males and Females

Deaths of despair (DoD; i.e., suicide, drug overdoses, and alcohol-related deaths) have drastically increased among non-Hispanic Whites since 1999. Beyond the established honor–suicide association, there are several reasons to suspect that U.S. honor cultures also exhibit higher DoD rates given similarities in the socioecological factors underlying both outcomes and that substance use increases risk for suicide. We examined this possibility at both the state and individual levels. Using two indices of honor culture, Study 1 examined statewide differences in DoD rates among non-Hispanic Whites and non-Whites between 1999-2019 by age group and sex. Among non-Hispanic Whites, we found honor- (v. dignity-) oriented states exhibited significantly higher overall DoD rates, suicide rates, drug overdose rates (only among females), and alcohol-related death rates, and that rates typically peaked in middle-age. The collective pattern of evidence indicated that honor culture is not related to DoD among non-Whites. Using a large sample of non-Hispanic Whites (paralleling the target population from Study 1), Study 2 ( N = 1,686) examined associations between individual-level endorsement of gendered honor norms and thoughts and behaviors that might precipitate despair-related deaths. Results indicated that honor endorsement significantly predicted suicidal ideation, but not binge drinking or illicit drug use. However, the effect of honor endorsement on these latter two outcomes was significant among men but not women. Collectively, this work extends prior research on the honor–suicide association by showing that the cultural ideology of honor affects a wider range of death outcomes. We discuss theoretical, health, and policy implications.