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Like a number of other East Asian languages, Japanese uses a complex system of honorifics, i.e. a system where a number of different levels of politeness are expressed in language via words, word forms or grammatical constructs. These can range from addressing someone or referring to someone with contempt (very informal) to expressing the highest level of reference (as used in addressing or referring to God) or any number of levels in-between. One important aspect of addressing someone else in one’s or someone else’s family is by selecting the correct word when referring to them. One way to do this is through the usage of an appropriate title within a conversation as shown here in the widely-used Japanese Shinkaiyaku (新改訳) Bible of 2017.
Ruth refers to her mother-in-law as o-kā-sama (お母様) with a formal title -sama and the honorific prefix o- to express a higher level of respect. (Source: S. E. Doi, see also S. E. Doi in Journal of Translation, 18/2022, p. 37ff. )