Understanding Distress in Its Own Language: A Case Study of Culturally Adapting Depression Assessment in Nigerian Pidgin English Contexts

Abstract Depression is a leading contributor to the global burden of disease, yet its recognition and diagnosis remain significantly constrained in low- and middle-income countries (LMICs) due to structural, cultural, and linguistic barriers. This case study examines a lived-experience-informed initiative conducted in Nigeria, exploring how depression is experienced, expressed, and interpreted through Nigerian Pidgin English and how these expressions inform culturally responsive mental health assessment and communication strategies. The initiative engaged six adults with lived experience of depression in repeated, longitudinal group discussions over a 3-month period across South-West and North-Central Nigeria. Through iterative dialogue and participatory reflection, participants generated, refined, and collectively validated culturally grounded expressions of depressive experience, mapping these onto established diagnostic constructs, particularly those represented in the Patient Health Questionnaire-9 (PHQ-9). Findings demonstrate that depression is primarily conceptualised and communicated through idioms of distress such as “life just dey dry” and “you no get ginger,” which reflect disruptions in emotional vitality, motivation, cognition, and socially embedded self-perception. The case highlights how linguistic misalignment between clinical frameworks and everyday communication constitutes a structural barrier to recognition and help-seeking. It further illustrates how participatory language adaptation offers a pathway for enhancing the cultural validity, accessibility, and effectiveness of mental health interventions. The lessons derived provide actionable insights for policymakers, practitioners, and researchers seeking to design scalable, culturally grounded mental health strategies in resource-constrained settings. Information © The Authors 2026