Using the Cultural Formulation Interview in Denmark: Acceptability and clinical utility for medical doctors and migrant patients

Previous studies have shown the importance of focusing on the cultural background of migrant patients in the psychiatric assessment. The Cultural Formulation Interview (CFI) offers a patient-focused approach to foreground the cultural context of the patient in the clinical encounter. Our objective was to explore the acceptability and clinical utility of the CFI for physicians and its acceptability for migrant patients seen at a transcultural mental health clinic in Denmark. In this study, the CFI was used in a second session following the standard clinical assessment to explore what additional information was gained from the CFI. Data on the use of the CFI data were collected immediately after the interview with questionnaires for medical doctors (MDs) ( N = 12) and patients ( N = 71). The findings showed that the CFI, in addition to standard assessment, was useful to the MDs for planning the treatment (60.0%) and for exploring the patients’ view on their cultural and social context (74.7%), but less so for the diagnostic process (9.9%). Patients reported high overall satisfaction with the CFI (93.0%) and viewed it as a welcome opportunity to tell their story. The findings add to existing knowledge on the CFI in terms of acceptability for patients of a primarily Middle Eastern origin and patients using an interpreter during the CFI session. Based on the findings of this study, the CFI is recommended to clinicians for treatment planning purposes and for exploring the cultural and social context of the patient.

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The Cultural Formulation Interview: Progress to date and future directions

Transcultural Psychiatry ◽

10.1177/1363461520938273 ◽

2020 ◽

Vol 57 (4) ◽

pp. 487-496

Author(s):

Roberto Lewis-Fernández ◽

Neil Krishan Aggarwal ◽

Laurence J. Kirmayer

Keyword(s):

Cultural Context ◽

Help Seeking ◽

Scale Up ◽

Implementation Strategies ◽

Transcultural Psychiatry ◽

Cultural Formulation ◽

Treatment Expectations ◽

Future Directions ◽

Dsm 5 ◽

Cultural Formulation Interview

The Cultural Formulation Interview (CFI) developed for DSM-5 provides a way to collect information on patients’ illness experience, social and cultural context, help-seeking, and treatment expectations relevant to psychiatric diagnosis and assessment. This thematic issue of Transcultural Psychiatry brings together articles examining the implementation and impact of the CFI in diverse settings. In this editorial introduction we discuss key areas raised by these and other studies, including: (1) the potential of the CFI for transforming current psychiatric assessment models; (2) training and implementation strategies for wider application and scale-up; and (3) refining the CFI by developing new modules and alternative protocols based on further research and clinical experience.

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Cultural Formulation Interview

Encyclopedia of Social Work ◽

10.1093/acrefore/9780199975839.013.1245 ◽

2020 ◽

Author(s):

Dorie Gilbert ◽

Katarzyna Olcoń

Keyword(s):

Mental Health ◽

Social Work ◽

Cultural Context ◽

Help Seeking ◽

Cultural Factors ◽

Cross Cultural ◽

Cultural Formulation ◽

Factors Affecting ◽

Cultural Assessment ◽

Cultural Formulation Interview

Research indicates that practitioners’ cultural biases are a barrier to effective cross-cultural assessment; thus, social work practitioners must demonstrate the ability to appraise a client’s cultural context in assessing and treating mental health concerns. The Cultural Formulation Interview (CFI) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides practitioners with a standardized cultural assessment method for use in mental health practice. This article provides a comprehensive overview of the CFI with a focus on its four domains: (a) cultural definition of the problem; (b) cultural perception of cause, context, and support; (c) cultural factors affecting self-coping and past help-seeking; and (d) cultural factors affecting current help-seeking. Conceptualizations of mental health and mental illness vary across cultural subgroups, and the nation’s changing demographics underscore the need to give particular attention to how the CFI can be useful for improving cross-cultural assessment with historically excluded or marginalized racial and ethnic groups. The CFI is an important step towards culturally grounded assessments; however, it has several conceptualization and implementation limitations, including its narrow focus on individual-level cultural explanations of distress while the effects of social inequities remain masked. The article concludes with additional considerations for cross-cultural assessment and implications for social work education and practice.

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Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.116.193862 ◽

2017 ◽

Vol 210 (4) ◽

pp. 290-297 ◽

Cited By ~ 39

Author(s):

Roberto Lewis-Fernández ◽

Neil Krishan Aggarwal ◽

Peter C. Lam ◽

Hanga Galfalvy ◽

Mitchell G. Weiss ◽

...

Keyword(s):

Mixed Methods ◽

Field Trial ◽

Clinical Utility ◽

Assessment Tool ◽

Qualitative Interviews ◽

Diagnostic Interview ◽

Cultural Issues ◽

Cultural Formulation ◽

Dsm 5 ◽

Cultural Formulation Interview

BackgroundThere is a need for clinical tools to identify cultural issues in diagnostic assessment.AimsTo assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice.MethodMixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored.ResultsMixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time.ConclusionsThe CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.

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Impact on routine psychiatric diagnostic practice from implementing the DSM-5 Cultural Formulation Interview: A pragmatic RCT in Sweden

10.21203/rs.3.rs-631151/v1 ◽

2021 ◽

Author(s):

Malin Idar Wallin ◽

Maria Rosaria Galanti ◽

Lauri Nevonen ◽

Roberto Lewis-Fernández ◽

Sofie Bäärnhielm

Keyword(s):

Diagnostic Procedure ◽

Delayed Diagnosis ◽

Prevalence Ratio ◽

Diagnostic Procedures ◽

Significant Degree ◽

Diagnostic Process ◽

Cultural Formulation ◽

Dsm 5 ◽

Diagnostic Practice ◽

Cultural Formulation Interview

Abstract BackgroundCulture and social context affect the expression and interpretation of symptoms of distress, raising challenges for transcultural psychiatric diagnostics. This increases the risk that mental disorders among migrants and ethnic minorities are undetected, diagnosed late or misdiagnosed. We investigated whether adding a culturally sensitive tool, the DSM-5 core Cultural Formulation Interview (CFI), to routine diagnostic procedures impacts the psychiatric diagnostic process. MethodWe compared the outcome of a diagnostic procedure that included the CFI with routine diagnostic procedures used at Swedish psychiatric clinics. New patients (n=256) admitted to a psychiatric outpatient clinic were randomized to a control (n=122) or CFI-enhanced diagnostic procedure (n=134) group. An intention-to-treat analysis was conducted and the prevalence ratio and corresponding 95% confidence intervals (CI) were calculated across arms for depressive and anxiety disorder diagnoses, multiple diagnoses, and delayed diagnosis. ResultsThe prevalence ratio (PR) of a depressive disorder diagnosis across arms was 1.21 (95% CI=0.83-1.75), 33.6% of intervention-arm participants vs. 27.9% of controls. The prevalence ratio was higher among patients whose native language was not Swedish (PR =1.61, 95% CI=0.91-2.86). The prevalence ratio of receiving multiple diagnoses was higher for the CFI group among non-native speaking patients, and lower to a statistically significant degree among native Swedish speakers (PR=.39, 95% CI=0.18-0.82). ConclusionsThe results suggest that the implementation of the DSM-5 CFI in routine psychiatric diagnostic practice may facilitate identification of symptoms of certain psychiatric disorders among non-native speaking patients in a migration context. Trial registrationISRCTN36661, 29/07/2019. The trial was retrospectively registered.

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Culture in the DSM-5

Sociocultural Issues in Psychiatry ◽

10.1093/med/9780190849986.003.0003 ◽

2019 ◽

pp. 37-50

Author(s):

Nhi-Ha T. Trinh ◽

Maya Son ◽

Justin A. Chen

Keyword(s):

Best Practices ◽

Clinical Significance ◽

Cultural Context ◽

Cultural Formulation ◽

Dsm 5 ◽

Cultural Concepts ◽

Dsm Iv ◽

Cultural Concepts Of Distress ◽

Cultural Formulation Interview

This chapter focuses on the revision of the DSM-IV to DSM-5, including an increased emphasis on the role of culture in psychopathology. The DSM-5, published in 2013, includes a revision of DSM-IV’s Outline for Cultural Formulation and includes the newly added standardized and manualized Cultural Formulation Interview (CFI), the 12 supplementary modules to the CFI, and a Glossary of Cultural Concepts of Distress. With these changes, DSM-5 strives to provide clinicians with a practical interpretive framework to explore patients’ varied experiences and expression of mental distress, increasing the clinical significance of each patient’s ethnic and cultural context. This chapter explores these additions to and revision of the DSM-5, reviews some of its criticism, and offers best practices for using these tools in the evaluation and management of diverse patients.

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Building a bridge: A case report on communicating mental-health diagnoses to patients of a culturally and linguistically diverse background

Australasian Psychiatry ◽

10.1177/1039856217726685 ◽

2017 ◽

Vol 25 (5) ◽

pp. 478-480 ◽

Cited By ~ 3

Author(s):

Rony Kayrouz ◽

Christine Irene Senediak ◽

Roy Laube

Keyword(s):

Mental Health ◽

Case Report ◽

Middle Eastern ◽

Linguistically Diverse ◽

Culturally And Linguistically Diverse ◽

Cultural Formulation ◽

Mental Health Diagnosis ◽

Diagnosis Of Cancer ◽

Cultural Formulation Interview ◽

Health Diagnosis

Objective: This paper is based on a case report, describing a protocol to help practitioners communicate mental-health diagnosis to patients from culturally and linguistically diverse (CALD) backgrounds. The protocol was presented by integrating the DSM-5 Cultural Formulation Interview (CFI) and the SPIKES protocol for communicating the diagnosis of cancer, yielding a modified CFI-SPIKES protocol (i.e. S, Support; P, Perception using CFI; I, Invitation; K, Knowledge; E, Emotions). The protocol was demonstrated using a case report with a patient of a Middle-Eastern background experiencing generalised anxiety disorder. Conclusions: The CFI-SPIKES protocol for communicating mental-health diagnosis allows for a collaborative process, whereby the CALD patient and practitioner can address the stigma associated with communicating a mental-health diagnosis, ensuring patient engagement and informed shared decision making.

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The Cultural Formulation Interview since DSM-5: Prospects for training, research, and clinical practice

Transcultural Psychiatry ◽

10.1177/1363461520940481 ◽

2020 ◽

Vol 57 (4) ◽

pp. 496-514 ◽

Cited By ~ 1

Author(s):

Neil Krishan Aggarwal ◽

G. Eric Jarvis ◽

Ana Gómez-Carrillo ◽

Laurence J. Kirmayer ◽

Roberto Lewis-Fernández

Keyword(s):

Clinical Practice ◽

Social Science Research ◽

Science Research ◽

Cultural Dimensions ◽

Cultural Formulation ◽

Simplified Approach ◽

Clinician Training ◽

Dsm 5 ◽

Training Research ◽

Cultural Formulation Interview

While social science research has demonstrated the importance of culture in shaping psychiatric illness, clinical methods for assessing the cultural dimensions of illness have not been adopted as part of routine care. Reasons for limited integration include the impression that attention to culture requires specialized skills, is only relevant to a subset of patients from unfamiliar backgrounds, and takes too much time to be useful. The DSM-5 Cultural Formulation Interview (CFI), published in 2013, was developed to provide a simplified approach to collecting information needed for cultural assessment. It offers a 16-question interview protocol that has been field tested at sites around the world. However, little is known about how CFI implementation has affected training, health services, and clinical outcomes. This article offers a comprehensive narrative review that synthesizes peer-reviewed, published studies on CFI use. A total of 25 studies were identified, with sample sizes ranging from 1 to 460 participants. In all pilot CFI studies 960 unique subjects were enrolled, and in final CFI studies 739 were enrolled. Studies focused on how the CFI affects clinical practice; explored the CFI through research paradigms in medical communication, implementation science, and family psychiatry; and examined clinician training. In most studies, patients and clinicians reported that using the CFI improved clinical rapport. This evidence base offers an opportunity to consider implications for training, research, and clinical practice and to identify crucial areas for further research.

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‘Thrown in at the Deep End’: The Experience of Graduates of Transnational Western Medical Education Transitioning into Middle Eastern Clinical Practice

International Journal of Higher Education ◽

10.5430/ijhe.v8n6p36 ◽

2019 ◽

Vol 8 (6) ◽

pp. 36

Author(s):

Fiza Rashid-Doubell ◽

Timothy P Doubell

Keyword(s):

Medical Education ◽

Clinical Practice ◽

Cultural Context ◽

Middle Eastern ◽

Phenomenological Approach ◽

Full Time ◽

Host Countries ◽

Medical Teams ◽

The One ◽

And Coping

Background: Newly qualified doctors educated in their home country usually go on to work in their first hospital job in same country. These graduates are familiar with the socio-cultural context of clinical setting they work in. But, with many Western universities providing cross-border education to host countries in the Middle East and South East Asia in subjects such as medicine. The experiences of those graduating from transnational medical education and working in local hospitals are absent.The aim of the study was to explore the early transitional experiences of newly qualified doctors moving from a European branch campus to practice at hospitals affiliated to the medical school situated in a Middle-Eastern country.Methods: A qualitative study using an interpretive phenomenological approach through interviews to explore experiences of graduates of transnational medical education working in Middle Eastern hospitals. Results: The main findings can be summarised under the three themes generated: the essentials of practice, routine of practice and realities of practice. The results evidenced the transition as a challenging period for new doctors finding dissonance between the skills taught while in transnational education and the workplace. There were three particular areas of discord for the graduates in clinical practice: working in medical teams with a different arrangement to the one prepared for; adapting to a more patient-centred language and coping with differences in ethical norms, values and practices in the hospital.Conclusions: The graduates found transitioning from university to full-time clinical practice difficult and were disappointed by their experience not matching their expectations of work. These findings are valuable for transnational medical educators seeking to improve the experience of graduates who are moving from the clear ideals, norms and values of transnational medical education into the complexity of full-time clinical practice.

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