Religious leaders as mental health gatekeepers in Nigeria: Belief–attitude typologies and implications for faith–health system integration: Findings from the CLERIC study

Abstract In Nigeria, religious leaders are de facto mental health gatekeepers, yet their explanatory models and attitudes remain poorly characterised at the population level. This cross-sectional study maps causal beliefs and attitudes among 207 Christian and Muslim religious leaders in Lagos using validated, culturally adapted instruments, forming the attitudinal and typological component of the CLERIC research programme. An integrated conceptual model posits that explanatory models structure causal attributions, which constitute the cognitive foundation of stigma-related attitudes clustering into typologies with direct implementation implications. Spiritual causation was most strongly endorsed ( M = 11.9, SD = 2.3) but coexisted with psychosocial and biological attributions in pluralistic frameworks. Stronger spiritual beliefs linked to more restrictive attitudes ( r = .41); biological beliefs predicted more supportive orientations ( r = .35). Latent class analysis identified three optimal typologies (AIC = 2,847.3, BIC = 2,912.8, entropy = 0.82): spiritually oriented–high restrictiveness (38.2%), pluralistic–high benevolence (35.7%) and biologically oriented–low restrictiveness (26.1%). Education and prior mental health training were the strongest independent modifiable predictors of supportive orientation. These typologies challenge monolithic views of religious leaders and provide a stratified, evidence-based framework for designing tailored faith–health integration strategies beyond universalist engagement models in Nigeria and comparable low- and middle-income countries contexts.