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

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.

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

2020 ◽  
Vol 57 (4) ◽  
pp. 496-514 ◽  
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.

scholarly journals How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial

2015 ◽  
Vol 40 (4) ◽  
pp. 584-591 ◽  
Author(s):  
Neil Krishan Aggarwal ◽  
Peter Lam ◽  
Enrico G. Castillo ◽  
Mitchell G. Weiss ◽  
Esperanza Diaz ◽  
...  
Keyword(s):  
Cultural Competence ◽  
Field Trial ◽  
Cultural Formulation ◽  
Dsm 5 ◽  
Competence Training ◽  
Cultural Formulation Interview

scholarly journals The Cultural Formulation Interview: Progress to date and future directions

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.

DSM-5® Handbook on the Cultural Formulation Interview

2015 ◽  
Author(s):  
Roberto Lewis-Fernández ◽  
Neil Krishan Aggarwal ◽  
Ladson Hinton ◽  
Devon E. Hinton ◽  
Laurence J. Kirmayer
Keyword(s):  
Cultural Formulation ◽  
Dsm 5 ◽  
Cultural Formulation Interview

Training on the DSM-5 Cultural Formulation Interview improves cultural competence in general psychiatry residents: A pilot study

2017 ◽  
Vol 54 (2) ◽  
pp. 179-191 ◽  
Author(s):  
Stacia Mills ◽  
Anna Q. Xiao ◽  
Kate Wolitzky-Taylor ◽  
Russell Lim ◽  
Francis G. Lu
Keyword(s):  
Cultural Competence ◽  
Cultural Diversity ◽  
Assessment Tool ◽  
Cultural Knowledge ◽  
Psychiatry Residents ◽  
Cultural Formulation ◽  
Dsm 5 ◽  
General Psychiatry ◽  
The Mean ◽  
Cultural Formulation Interview

The objective of this study was to assess whether a 1-hour didactic session on the DSM-5 Cultural Formulation Interview (CFI) improves the cultural competence of general psychiatry residents. The main hypothesis was that teaching adult psychiatry residents a 1-hour session on the CFI would improve cultural competence. The exploratory hypothesis was that trainees with more experience in cultural diversity would have a greater increase in cultural competency scores. Psychiatry residents at a metropolitan, county hospital completed demographics and preintervention questionnaires, were exposed to a 1-hour session on the CFI, and were given a postintervention questionnaire. The questionnaire was an adapted version of the validated Cultural Competence Assessment Tool . Paired samples t tests compared pre- to posttest change. Hierarchical linear regression assessed whether pretraining characteristics predicted posttest scores. The mean change of total pre- and posttest scores was significant ( p = .002), as was the mean change in subscales Nonverbal Communications ( p < .001) and Cultural Knowledge ( p = .002). Demographic characteristics did not predict higher posttest scores (when covarying for pretest scores). Psychiatry residents’ cultural competence scores improved irrespective of previous experience in cultural diversity. More research is needed to further explore the implications of the improved scores in clinical practice.

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

2020 ◽  
Vol 57 (4) ◽  
pp. 556-566 ◽  
Author(s):  
Signe Skammeritz ◽  
Laura Glahder Lindberg ◽  
Erik Lykke Mortensen ◽  
Marie Norredam ◽  
Jessica Carlsson
Keyword(s):  
Social Context ◽  
Cultural Context ◽  
Clinical Utility ◽  
Middle Eastern ◽  
Clinical Encounter ◽  
Health Clinic ◽  
Diagnostic Process ◽  
Medical Doctors ◽  
Cultural Formulation ◽  
Cultural Formulation Interview

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.

scholarly journals The Content Validity of the Cultural Formulation Interview (CFI)

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Behnam Shariati ◽  
Amir-Abbas Keshavarz-Akhlaghi ◽  
Arash Mohammadzadeh ◽  
Ruohollah Seddigh
Keyword(s):  
Content Validity ◽  
Help Seeking ◽  
The United States ◽  
Cultural Factors ◽  
Cultural Formulation ◽  
Factors Affecting ◽  
Cultural Perception ◽  
Dsm 5 ◽  
Back Translation ◽  
Cultural Formulation Interview

Aims. The present study investigates content validity of the open-ended items in Cultural Formulation Interview in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Methods. After translating into Persian and assessing the content validity of the items and their modification by psychiatrists, the questionnaire was translated back into English by two translators and then retranslated into Persian. The final Persian version and its back-translation were submitted for approval to the DSM-5 design workshop in the United States. After obtaining the group’s approval on the back-translation and permission to use the questionnaire, samples were distributed among panel members and the content validity of the questionnaire was thus examined. Results. The content validity index (CVI) of cultural formulation interview was 0.51 and all the items were acceptable although some, especially those on the cultural perception of the context and the cultural factors affecting current help-seeking, had lower content validity ratios (CVR). Conclusion. The cultural formulation interview seems to have an overall acceptable content validity although it is weak and thus needs further studies in relation to the two domains of the cultural perception of the context and the cultural factors affecting help-seeking in the Iranian population.

Examining the effectiveness of the Cultural Formulation Interview with young children: A clinical illustration

2018 ◽  
Vol 57 (4) ◽  
pp. 515-524 ◽  
Author(s):  
Martin J. La Roche ◽  
Jill Betz Bloom
Keyword(s):  
Young Children ◽  
Structured Interview ◽  
Assessment Process ◽  
Cultural Formulation ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Interview Format ◽  
Cultural Formulation Interview ◽  
Clinical Illustration

After years of extensive research, the Cultural Formulation Interview (CFI) was released in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Similar to its predecessor, the Outline of the Cultural Formulation (OCF), the CFI aims to refine the psychiatric assessment process by systematically examining cultural factors. However, in contrast to the OCF which employs open-ended questions, the CFI uses a semi-structured interview format. Unfortunately, children and adolescents have only been included in a handful of OCF and CFI studies, which raises questions about their applicability with youth, particularly young children (11 years or younger). In this article, we start examining the usefulness of the CFI with young children and propose recommendations to enhance its benefits by suggesting the development of a supplementary module specifically designed for young children. These ideas are illustrated with the assessment of a 6-year-old boy of Somali descent.

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