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

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.

Declaración sobre la Crisis Migratoria Mundial / Position Statement on the Migrant Crisis around the World

En este artículo se presenta una versión resumida de la Declaración sobre la Crisis Migratoria Mundial (1), suscrita por la Asociación Mundial de Psiquiatría Cultural en el marco del Congreso Desafíos globales y psiquiatría cultural: Desastres naturales, conflictos, inseguridad, migración y espiritualidad -sostenido en Puerto Vallarta, Jalisco, México, del 29 de octubre al 2 de noviembre de 2015-. El tema principal abordado por la declaración es la actual crisis migratoria mundial, causada, entre otras, por el aumento del conflicto armado y de hechos violentos en Medio Oriente y África como generador de desplazamientos forzados masivos hacia Europa, sumado a la dramática realidad migratoria de largo plazo de la región de Latinoamérica a la de Norteamérica. En esta versión corta de la declaración se discutirán varios factores de la situación migratoria actual en Europa, América, Asia y África con el fin de identificar factores comunes y distintivos y empezar a realizar acciones de frente a esta situación.

This article presents a short version of the Position Statement on the Migrant Crisis around the World (1), signed by the World Association of Cultural Psychiatry under the Congress: Global. Challenges & Cultural Psychiatry: "Natural Disasters, Conflict, Insecurity, Migration and Spirituality", held in Puerto Vallarta, Jalisco, Mexico, from 29 October to 2 November 2015. The main issue addressed by the statement is the current World Migration Crisis caused by several reasons, including an increase in the armed conflict and violence acts present in the Middle East and in Africa as the source of massive forced displacements to Europe which adds to the dramatic reality of long-term migration of Latin America to North America. In this short version of the statement several factors of the current migration situation in Europe, the Americas, Asia and Africa will be discussed in order to identify common and distinctive factors and begin to take actions to address this situation.

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

OBJECTIVE: This study's objective is to analyze training methods clinicians reported as most and least helpful during the DSM-5 Cultural Formulation Interview field trial, reasons why, and associations between demographic characteristics and method preferences. METHOD: The authors used mixed methods to analyze interviews from 75 clinicians in five continents on their training preferences after a standardized training session and clinicians' first administration of the Cultural Formulation Interview. Content analysis identified most and least helpful educational methods by reason. Bivariate and logistic regression analysis compared clinician characteristics to method preferences. RESULTS: Most frequently, clinicians named case-based behavioral simulations as "most helpful" and video as "least helpful" training methods. Bivariate and logistic regression models, first unadjusted and then clustered by country, found that each additional year of a clinician's age was associated with a preference for behavioral simulations: OR = 1.05 (95 % CI: 1.01-1.10; p = 0.025). CONCLUSIONS: Most clinicians preferred active behavioral simulations in cultural competence training, and this effect was most pronounced among older clinicians. Effective training may be best accomplished through a combination of reviewing written guidelines, video demonstration, and behavioral simulations. Future work can examine the impact of clinician training satisfaction on patient symptoms and quality of life.

Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5.

The Outline for Cultural Formulation (OCF) introduced with DSM-IV provided a framework for clinicians to organize cultural information relevant to diagnostic assessment and treatment planning. However, use of the OCF has been inconsistent, raising questions about the need for guidance on implementation, training, and application in diverse settings. To address this need, DSM-5 introduced a cultural formulation interview (CFI) that operationalizes the process of data collection for the OCF. The CFI includes patient and informant versions and 12 supplementary modules addressing specific domains of the OCF. This article summarizes the literature reviews and analyses of experience with the OCF conducted by the DSM-5 Cross-Cultural Issues Subgroup (DCCIS) that informed the development of the CFI. We review the history and contents of the DSM-IV OCF, its use in training programs, and previous attempts to render it operational through questionnaires, protocols, and semi-structured interview formats. Results of research based on the OCF are discussed. For each domain of the OCF, we summarize findings from the DCCIS that led to content revision and operationalization in the CFI. The conclusion discusses training and implementation issues essential to service delivery.

Somatization in refugees: a review.

PURPOSE: To present a review of the literature concerning medically unexplained physical symptoms in refugees. METHODS: We outline a variety of definitions and explanations of somatization, as well as the role of culture in the concept of disease. In addition, we present a review of the epidemiological literature about somatization in refugees. RESULTS: Refugees from non-Western countries exhibit more unexplained somatic symptoms than the general Western population. Although different studies have employed different methodologies and are therefore difficult to compare, it can be concluded that refugees form a particular population in which somatization is prominent. CONCLUSIONS: Potential, not mutually exclusive, explanations of the high number of somatic symptoms in the refugee population include general psychopathology, specifically traumatisation, results of torture, and stigmatisation of psychiatric care. There are implications for assessment, clinical treatment and further research concerning somatization in refugees.

Cultural psychiatry in Tel Aviv: how relevant!

The First Mediterranean Conference on Cultural Psychiatry took place in Tel Aviv, Israel. This conference was a great success. With about 200 participants, mostly from Israel but with also 46 participants coming from 13 other countries: Mediterranean countries, Europe, North America and Australia. It contained three intensive days of plenary lectures and symposia, and a very impressive film, "Waltz with Bashir". The proceedings included 88 lectures, and there were 8 posters, which meant that nearly half of the attending persons were giving a lecture, as is always the case in real scientific conferences. Four parallel programs were running at the same time, which made it very difficult to choose which to attend. Inevitably, this report reflects only a part of the conference.

Use of the cultural formulation with refugees.

This article discusses the experiences of mental health professionals who applied the Cultural Formulation (CF) of the DSM-IV for assessment of psychopathology and treatment needs of refugees in the Netherlands. The CF approach proved to be a useful tool in the assessment and diagnostic phase of clinical treatment. However, patients reported problems with defining their own culture and providing explanations of illness and therapists had difficulty identifying culturally-based difficulties in the clinical relationship. Additional information was needed about working with interpreters, therapists' attitudes towards the culture of the patient and towards their own culture, patients' previous experiences with discrimination and inaccessibility of care, gender issues, and specific cultures and subcultures. A more structured approach to conducting the CF is recommended. We developed the "Cultural Formulation Interview" for this purpose. The adaptations are aimed at improving the CF for use with refugee populations, as well as for more general use in transcultural psychiatry.