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

Abstract

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.