Vernacular Naming of Psychological Disorders in Fulfulde and Diagnostic Distance from Clinical Care: A Convergent Mixed-Methods Study in Cameroon

This study investigates whether the semantic structure of vernacular disorder denominations in Fulfulde — a Sahelian language spoken by over 24 million people in West Africa — constitutes a measurable psycholinguistic predictor of psychological distance from clinical diagnosis. Anchored in cognitive psycholinguistic theory of folk illness categorisation [16,17], the aetiological primacy hypothesis [18], Kleinman’s explanatory model framework [1], and a multi-component model of psychological distance integrating the Health Belief Model [21], the Theory of Planned Behaviour [22], and social stigma theory [23], the study tests four hypotheses: that Fulfulde vernacular denominations organise into semantically distinct aetiological clusters (H1); that supernatural aetiological vocabulary predicts higher diagnostic distance than social/moral or biomedical vocabulary (H2); that this relationship is further modulated by education, residence, sex, and ethnicity as structural determinants of lexical register access (H3); and that aetiological cluster membership fully mediates the effect of formal education on diagnostic distance, operationalising the causal pathway through which structural determinants shape clinical attitudes via lexical restructuring (H4). Using a convergent mixed-methods design with 400 Fulfulde-speaking adults across ten sites in the Far North Region of Cameroon — spanning five rural, three peri-urban, and two urban ecologies — lexical clustering, one-way ANOVAs, hierarchical regression, and bootstrap mediation analysis (Hayes PROCESS, Model 4, 10,000 iterations) were applied. Three aetiological clusters emerged: supernatural (CL1, 37.5%), social/moral (CL2, 35.3%), and mixed/biomedical (CL3, 27.3%). Semantic cluster membership alone explained 72% of variance in Psychological Distance from Diagnosis Scale (PDDS) scores; the full model reached adjusted R² = .82. Mediation analysis revealed that aetiological cluster membership fully mediated the effect of education on diagnostic distance: the indirect effect was large and significant (ab = −7.84, 95% Boot CI [−9.12, −6.61]), while the direct effect was non-significant after cluster entry (c’ = −0.43, p = .38), with 96% of the total effect transmitted via lexical restructuring. CL1 participants showed near-ceiling diagnostic distance (M = 83.1/90) and 0% referral to psychologists across all eight clinical vignettes including suicidal ideation. These findings establish vernacular aetiological naming as the proximal psycholinguistic mechanism linking education to care-seeking propensity, with direct implications for community mental health triage and suicide prevention in Sahelian African contexts.

Vernacular naming, psychological distance, Fulfulde, cultural idioms of distress

1. Kleinman, A. (1980). Patients and healers in the context of culture. University of California Press. [Google Scholar] [Crossref]

2. Kirmayer, L. J., Gomez-Carrillo, A., & Veissière, S. (2017). Culture and depression in global mental health. Social Science & Medicine, 183, 163–168. https://doi.org/10.1016/j.socscimed.2017.04.034 [Google Scholar] [Crossref]

3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 [Google Scholar] [Crossref]

4. World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/ [Google Scholar] [Crossref]

5. Kohrt, B. A., & Hruschka, D. J. (2010). Nepali concepts of psychological trauma. Culture, Medicine and Psychiatry, 34(2), 322–352. https://doi.org/10.1007/s11013-010-9170-2 [Google Scholar] [Crossref]

6. Patel, V., et al. (2018). The Lancet Commission on global mental health. The Lancet, 392(10157), 1553–1598. https://doi.org/10.1016/S0140-6736(18)31612-X [Google Scholar] [Crossref]

7. Jacob, K. S., et al. (2007). Mental health systems in countries: Where are we now? The Lancet, 370(9592), 1061–1077. https://doi.org/10.1016/S0140-6736(07)61241-0 [Google Scholar] [Crossref]

8. Shibre, T., et al. (2010). Perception of stigma among family members of individuals with schizophrenia in rural Ethiopia. Social Psychiatry and Psychiatric Epidemiology, 36(6), 299–303. https://doi.org/10.1007/s001270170065 [Google Scholar] [Crossref]

9. Ae-Ngibise, K., et al. (2010). Traditional and faith healers in Ghana. International Review of Psychiatry, 22(6), 558–567. https://doi.org/10.3109/09540261.2010.536149 [Google Scholar] [Crossref]

10. Kabir, M., Iliyasu, Z., Abubakar, I. S., & Aliyu, M. H. (2004). Perception and beliefs about mental illness in northern Nigeria. BMC International Health and Human Rights, 4, Article 3. https://doi.org/10.1186/1472-698X-4-3 [Google Scholar] [Crossref]

11. Khoury, N. M., Kaiser, B. N., Keys, H. M., Brewster, A. R. T., & Kohrt, B. A. (2012). Explanatory models and mental health treatment in rural Haiti. Culture, Medicine and Psychiatry, 36(3), 514–534. https://doi.org/10.1007/s11013-012-9270-2 [Google Scholar] [Crossref]

12. Sorsdahl, K., Stein, D. J., Grimsrud, A., Seedat, S., Flisher, A. J., Williams, D. R., & Myer, L. (2009). Traditional healers in the treatment of common mental disorders in South Africa. Journal of Nervous and Mental Disease, 197(6), 434–441. https://doi.org/10.1097/NMD.0b013e3181a61dbc [Google Scholar] [Crossref]

13. Tourneux, H., & Iyébi-Mandjek, O. (1994). L’école dans une petite ville africaine (Maroua, Cameroun). Karthala. [Google Scholar] [Crossref]

14. Institut National de la Statistique. (2014). Annuaire statistique du Cameroun. INS. [Google Scholar] [Crossref]

15. Ministère de la Santé Publique du Cameroun. (2022). Rapport annuel sur la santé mentale au Cameroun. MINSANTE. [Google Scholar] [Crossref]

16. Rosch, E. (1978). Principles of categorization. In E. Rosch & B. B. Lloyd (Eds.), Cognition and categorization (pp. 27–48). Lawrence Erlbaum Associates. [Google Scholar] [Crossref]

17. Waxman, S. R., & Medin, D. L. (2007). Experience and cultural models matter. Human Development, 50(1), 23–30. https://doi.org/10.1159/000097681 [Google Scholar] [Crossref]

18. Bhikha, A. G., Farooq, S., Chaudhry, N., & Husain, N. (2012). A systematic review of explanatory models of illness for psychosis in developing countries. International Review of Psychiatry, 24(5), 450–462. https://doi.org/10.3109/09540261.2012.711746 [Google Scholar] [Crossref]

19. Nichter, M. (2010). Idioms of distress revisited. Culture, Medicine and Psychiatry, 34(2), 401–416. https://doi.org/10.1007/s11013-010-9179-6 [Google Scholar] [Crossref]

20. Kohrt, B. A., et al. (2014). Cultural concepts of distress and psychiatric disorders. International Journal of Epidemiology, 43(2), 365–406. https://doi.org/10.1093/ije/dyt227 [Google Scholar] [Crossref]

21. Rosenstock, I. M. (1966). Why people use health services. The Milbank Memorial Fund Quarterly, 44(3), 94–127. https://doi.org/10.2307/3348967 [Google Scholar] [Crossref]

22. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T [Google Scholar] [Crossref]

23. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385. https://doi.org/10.1146/annurev.soc.27.1.363 [Google Scholar] [Crossref]

24. Link, B. G., Cullen, F. T., Frank, J., & Wozniak, J. F. (1987). The social rejection of former mental patients. American Journal of Sociology, 92(6), 1461–1500. https://doi.org/10.1086/228672 [Google Scholar] [Crossref]

25. Sow, I., & Bhugra, D. (2018). Mental illness in sub-Saharan Africa. In D. Bhugra & K. Bhui (Eds.), Textbook of cultural psychiatry (2nd ed., pp. 312–326). Cambridge University Press. [Google Scholar] [Crossref]

26. Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). GPower 3: A flexible statistical power analysis program. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/BF03193146 [Google Scholar] [Crossref]

27. Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). SAGE Publications. [Google Scholar] [Crossref]

28. Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving integration in mixed methods designs. Health Services Research, 48(6), 2134–2156. https://doi.org/10.1111/1475-6773.12117 [Google Scholar] [Crossref]

29. Braun, V., & Clarke, V. (2021). Thematic analysis: A practical guide. SAGE Publications. [Google Scholar] [Crossref]

30. Rousseeuw, P. J. (1987). Silhouettes: A graphical aid to the interpretation and validation of cluster analysis. Journal of Computational and Applied Mathematics, 20, 53–65. https://doi.org/10.1016/0377-0427(87)90125-7 [Google Scholar] [Crossref]

31. Steiger, J. H. (2004). Beyond the F test: Effect size confidence intervals and tests of close fit. Psychological Methods, 9(2), 164–182. https://doi.org/10.1037/1082-989X.9.2.164 [Google Scholar] [Crossref]

32. R Core Team. (2023). R: A language and environment for statistical computing (v. 4.3.1). R Foundation for Statistical Computing. https://www.R-project.org/ [Google Scholar] [Crossref]

33. Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis (3rd ed.). Guilford Press. [Google Scholar] [Crossref]

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