Academic journal article Indian Journal of Psychiatry

Clinical Value of the Cultural Formulation Interview in Pune, India

Academic journal article Indian Journal of Psychiatry

Clinical Value of the Cultural Formulation Interview in Pune, India

Article excerpt

Byline: Vasudeo. Paralikar, Sanjeev. Sarmukaddam, Kanak. Patil, Amit. Nulkar, Mitchell. Weiss

Context: Development of the cultural formulation interview (CFI) in DSM-5 required validation for cross-cultural and global use. Aims: To assess the overall value (OV) of CFI in the domains of feasibility, acceptability, and utility from the vantage points of clinician-interviewers, patients and accompanying relatives. Settings and Design: We conducted cross-sectional semi-structured debriefing interviews in a psychiatric outpatient clinic of a general hospital. Materials and Methods: We debriefed 36 patients, 12 relatives and eight interviewing clinicians following the audio-recorded CFI. We transformed their Likert scale responses into ordinal values - positive for agreement and negative for disagreement (range +2 to −2). Statistical Analysis: We compared mean ratings of patients, relatives and clinician-interviewers using nonparametric tests. Clinician-wise grouping of patients enabled assessment of clinician effects, inasmuch as patients were randomly interviewed by eight clinicians. We assessed the influence of the presence of relatives, clinical diagnosis and interview characteristics by comparing means. Patient and clinician background characteristics were also compared. Results: Patients, relatives and clinicians rated the CFI positively with few differences among them. Patients with serious mental disorders gave lower ratings. Rating of OV was lower for patients and clinicians when relatives were present. Clinician effects were minimal. Clinicians experienced with culturally diverse patients rated the CFI more positively. Narratives clarified the rationale for ratings. Conclusions: Though developed for the American DSM-5, the CFI was valued by clinicians, patients and relatives in out-patient psychiatric assessment in urban Pune, India. Though relatives may add information and other value, their presence in the interview may impose additional demands on clinicians. Our findings contribute to cross-cultural evaluation of the CFI.

Introduction

Urbanization and globalization have contributed to the importance and appreciation of the interests of cultural psychiatry. Culture is relevant for a wide range of conditions, not just mainstream psychiatric disorders, but also medically unexplained symptoms [sup][1] and various chronic diseases. [sup][2] After developing the outline for cultural formulation in DSM-IV, the current DSM-5 now includes an operational approach to assessment that addresses cultural issues as a feature of clinical evaluation. [sup][3] The role of culture in making a diagnosis, value of the approach of the cultural formulation, its possible applications and potential barriers in the use of DSM-5 have been widely discussed. [sup][4],[5],[6],[7] Although research tools had previously been available for cultural assessment (e.g. explanatory model interview catalogue ( EMIC) interviews for cultural epidemiology [sup][8],[9] and the short explanatory model interview [SEMI]) [sup][10] an interview guide for cultural assessment in clinical practice had been lacking. The cultural formulation interview (CFI) for DSM-5 aimed to fill this gap. It was a product of the cultural issues subgroup of the culture and gender group for DSM-5.

Having developed the tool, it required validation, and the cultural interest group was sensitive to the need for validating such a tool. The importance of that has been articulated in the section of DSM-5 explaining the use of the manual. Considering further needs and anticipated future development of diagnostic assessments, the CFI was included among several instruments for which further study and scientific assessment are needed. A series of field studies were, therefore, undertaken to examine the feasibility, acceptability and clinical utility of the CFI. Cognizant of DSM aspirations for global validity, an aspect of the field, which is particularly relevant to the interests of cultural psychiatry, field trials were also included in settings beyond the U. …

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