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

  • Roberto Lewis-Fernández (a1), Neil Krishan Aggarwal (a2), Peter C. Lam (a3), Hanga Galfalvy (a4), Mitchell G. Weiss (a5), Laurence J. Kirmayer (a6), Vasudeo Paralikar (a7), Smita N. Deshpande (a8), Esperanza Díaz (a9), Andel V. Nicasio (a3), Marit Boiler (a3), Renato D. Alarcón (a10), Hans Rohlof (a11), Simon Groen (a12), Rob C. J. van Dijk (a13), Sushrut Jadhav (a14), Sanjeev Sarmukaddam (a15), David Ndetei (a16), Monica Z. Scalco (a17), Kavoos Bassiri (a18), Sergio Aguilar-Gaxiola (a19), Hendry Ton (a20), Joseph Westermeyer (a21) and Johann M. Vega-Dienstmaier (a22)...
Abstract
Background

There is a need for clinical tools to identify cultural issues in diagnostic assessment.

Aims

To assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice.

Method

Mixed-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.

Results

Mixed-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.

Conclusions

The CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.

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Copyright
Corresponding author
Roberto Lewis-Fernández, MD, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY 10032, USA. Email: rlewis@nyspi.columbia.edu
Footnotes
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Declaration of interest

R.L.-F., N.K.A. and L.J.K. receive royalties from an edited book on the Cultural Formulation Interview, published by American Psychiatric Publishing, Inc.

Footnotes
References
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1 Adeponle, AB, Thombs, BD, Groleau, D, Jarvis, E, Kirmayer, LJ. Using the cultural formulation to resolve uncertainty in diagnoses of psychosis among ethnoculturally diverse patients. Psychiatric Serv 2012; 63: 147–53.
2 Bhui, K, Bhugra, D. Explanatory models for mental distress: implications for clinical practice and research. Br J Psychiatry 2002; 181: 67.
3 Ayonrinde, O. Importance of cultural sensitivity in therapeutic transactions: considerations for healthcare providers. Dis Manage Health Outcomes 2003; 11: 233–48.
4 Schouten, B, Meeuwesen, L. Cultural differences in medical communication: a review of the literature. Patient Educ Couns 2006; 64: 2134.
5 Lewis-Fernández, R. Cultural formulation of psychiatric diagnosis. Cult Med Psychiatry 1996; 20: 133–44.
6 Mezzich, J. Cultural formulation and comprehensive diagnosis: clinical and research perspectives. Psychiatr Clin North Am 1995; 18: 649–87.
7 Aggarwal, NK, Rohrbaugh, RM. Teaching cultural competency through an experiential seminar on anthropology and psychiatry. Acad Psychiatry 2011; 35: 331–2.
8 Scarpinati Rosso, M, Bäärnhielm, S. The cultural formulation: a model to combine nosology and patients' life context in psychiatric diagnostic practice. Transcult Psychiatry 2009; 46: 406–28.
9 Hansen, H, Dugan, TM, Becker, AE, Lewis-Fernández, R, Lu, FG, Oquendo, MA, et al. Educating psychiatry residents about cultural aspects of care: a qualitative study of approaches used by US expert faculty. Acad Psychiatry 2013; 37: 412–6.
10 Rohlof, H, Knipscheer, J, Kleber, R. Use of the cultural formulation with refugees. Transcult Psychiatry 2009; 46: 487505.
11 Groen, S, Richters, A, Laban, K, Deville, W. Implementation of the Cultural Formulation through a newly developed Brief Cultural Interview: pilot data from the Netherlands. Transcult Psychiatry (in press).
12 Lewis-Fernández, R. The cultural formulation. Transcult Psychiatry 2009; 46: 379–82.
13 Caballero-Martínez, L. DSM-IV-TR Cultural formulation of psychiatric cases: two proposals for clinicians. Transcult Psychiatry 2009; 46: 506–23.
14 Aggarwal, NK. Adapting the cultural formulation for clinical assessments in forensic psychiatry. J Am Acad Psychiatry Law 2012; 40: 113–8.
15 Alarcón, RD. Culture, cultural factors and psychiatric diagnosis: review and projections. World Psychiatry 2009; 8: 131–9.
16 Weiss, M. Cultural epidemiology: an introduction and overview. Anthropol Med 2001; 8: 529.
17 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edn. American Psychiatric Association, 1994.
18 Lewis-Fernández, R, Aggarwal, N, Baarnhielm, S, Rohlof, H, Kirmayer, LJ, Weiss, MG, et al. Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5. Psychiatry 2014; 77: 130–54.
19 Aggarwal, NK, Nicasio, AV, DeSilva, R, Boiler, M, Lewis-Fernández, R. Barriers to implementing the DSM-5 cultural formulation interview: a qualitative study. Cult Med Psychiatry 2013; 37: 505–33.
20 Proctor, E, Silmere, H, Raghavan, R, Hovmand, P, Aarons, G, Bunger, A, et al. Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health 2011; 38: 6576.
21 Lewis-Fernández, R, Aggarwal, N, Hinton, L, Hinton, D, Kirmayer, . The DSM-5 Handbook on the Cultural Formulation Interview. American Psychiatric Publishing, 2016.
22 Clarke, DE, Narrow, WE, Regier, DA, Kuramoto, SJ, Kupfer, DJ, Kuhl, EA, et al. DSM-5 field trials in the United States and Canada, Part I: Study design, sampling strategy, implementation, and analytic approaches. Am J Psychiatry 2013; 170: 4358.
23 Regier, D, Narrow, W, Clarke, D, Kraemer, HC, Kuramoto, SJ, Kuhl, EA, et al. DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of the selected categorical diagnoses. Am J Psychiatry 2013; 170: 5970.
24 Hinton, L, Aggarwal, N, Losif, A-M, Weiss, M, Paralikar, V, Deshpande, S, et al. Perspectives of family members participating in cultural assessment of psychiatric disorders: findings from the DSM-5 international field trial. Int Rev Psychiatry 2015; 27: 310.
25 Aggarwal, NK, Lam, P, Castillo, EG, Weiss, MG, Díaz, E, Alarcón, RD, et al. How do clinicians prefer cultural competence training? Findings from the DSM-5 Cultural Formulation Interview field trial. Acad Psychiatry 2016; 40: 584–91.
26 Bravo, M, Canino, GJ, Rubio-Stipec, M, Woodbury-Farina, M. A cross-cultural adaptation of a psychiatric epidemiologic instrument: the diagnostic interview schedule's adaptation in Puerto Rico. Cult Med Psychiatry 1991; 15: 118.
27 Paralikar, V, Sarmukaddam, S, Patil, K, Nulkar, A, Weiss, M. Clinical value of the cultural formulation interview in Pune, India. Indian J Psychiatry 2015; 57: 5967.
28 Kramer, CY. Extension of multiple range tests to group means with unequal numbers of replications. Biometrics 1956; 12: 307–10.
29 Krippendorff, K. Content Analysis: An Introduction to its Methodology. Sage Publications, 2013.
30 Elo, S, Kyngas, H. The qualitative content analysis process. J Adv Nurs 2008; 62: 107–15.
31 Barbour, RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ 2001; 322: 1115–7.
32 Wu, C. An examination of the wording effect in the Rosenberg Self-Esteem Scale among culturally Chinese people. J Soc Psych 2008; 148: 535.
33 Proctor, E, Landsverk, J, Aarons, G, Chambers, D, Glisson, C, Mittman, B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training callenges. Adm Policy Ment Health 2009; 36: 2434.
34 Aggarwal, N. Clinical implementation of the Cultural Formulation Interview: planning and assessment. In The DSM-5 Handbook on the Cultural Formulation Interview (eds Lewis-Fernández, R, Aggarwal, NK, Hinton, L, Hinton, DE, Kirmayer, LJ): 191207. American Psychiatric Publishing, 2016.
35 Saxena, S, Thornicroft, G, Knapp, M, Whiteford, H. Resources for mental health, scarcity, inequity, and inefficiency. Lancet 2007; 370: 878–89.
36 Fischer, EP, Shumway, M, Owen, RR. Priorities of consumers, providers, and family members in the treatment of schizophrenia. Psychiatr Serv 2002; 53: 724–9.
37 Greenhalgh, T, Robert, G, MacFarlane, F, Bate, P, Kyriakidou, O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004; 82: 581629.
38 Mechanic, D, McAlpine, D, Rosenthal, M. Are patients' office visits with physicians getting shorter? N Engl J Med 2001; 344: 198204.
39 Olfson, M, Cherry, D, Lewis-Fernández, R. Racial differences in visit duration of outpatient psychiatric visits. Arch Gen Psychiatry 2009; 66: 214–21.
40 Olfson, M, Marcus, S, Pincus, H. Trends in office-based psychiatric practice. Am J Psychiatry 1999; 156: 451–7.
41 Bird, VJ, Le Boutillier, C, Leamy, M, Williams, J, Bradstreet, S, Slade, M. Evaluating the feasibility of complex interventions in mental health services: standardised measure and reporting guidelines. Br J Psychiatry 2014; 204: 316–21.
42 Napier, A, Ancarno, C, Butler, B, Calabrese, J, Chater, A, Chatterjee, H, et al. Culture and health. Lancet 2014; 384: 1607–39.
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Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial

  • Roberto Lewis-Fernández (a1), Neil Krishan Aggarwal (a2), Peter C. Lam (a3), Hanga Galfalvy (a4), Mitchell G. Weiss (a5), Laurence J. Kirmayer (a6), Vasudeo Paralikar (a7), Smita N. Deshpande (a8), Esperanza Díaz (a9), Andel V. Nicasio (a3), Marit Boiler (a3), Renato D. Alarcón (a10), Hans Rohlof (a11), Simon Groen (a12), Rob C. J. van Dijk (a13), Sushrut Jadhav (a14), Sanjeev Sarmukaddam (a15), David Ndetei (a16), Monica Z. Scalco (a17), Kavoos Bassiri (a18), Sergio Aguilar-Gaxiola (a19), Hendry Ton (a20), Joseph Westermeyer (a21) and Johann M. Vega-Dienstmaier (a22)...
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