A Theoretical Framework for the Role of Spiritual Distress in the Etiology and Course of Mood Disorders in Nigeria

Spiritual distress, conceptualized as a disruption of a person's relationship with transcendent meaning, purpose, and religious identity, is increasingly recognized as a dimension of mental health yet remains theoretically underdeveloped in sub-Saharan African psychiatry. This study develops an original theoretical framework for understanding the role of spiritual distress in the etiology and course of mood disorders in Nigeria. A three-phase mixed-methods design will be used. Phase one involves a scoping review of peer-reviewed and grey literature on spirituality and mood disorders in Nigeria and sub-Saharan Africa from 2015 to 2025. Phase two employs a qualitative Delphi technique with 30 experts including psychiatrists, clinical psychologists, religious scholars, and patients with lived experience to generate consensus on conceptual domains. Phase three uses structural equation modeling with data from 300 outpatients with mood disorders at six tertiary hospitals to empirically test theoretical relationships between spiritual distress, depression severity, and recovery. The resultant framework will integrate spiritual distress as a legitimate clinical domain within Nigerian mood disorder assessment and treatment planning. This constitutes an original theoretical contribution of direct relevance to culturally responsive psychiatry in Nigeria and broader West African settings. Keywords: spiritual distress, mood disorders, theoretical framework, Nigeria, culturally responsive psychiatry